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Petrosal approach

Thomas Coquet, Michel Lefranc, Louis Chenin, Pascal Foulon, Éric Havet, Johann Peltier
In this anatomy report, we describe the first case of abducens nerve duplication limited to the sphenopetroclival venous gulf and the cavernous sinus. The objective point of division of the two duplicated roots was localized at the gulfar face of the dural porus, just distal to the unique cisternal trunk of the abducens nerve, as it pierced the petroclival dural mater. In the gulfar segment, both roots traveled through a variant of Dorello's canal called the "petrosphenoidal canal" and remained separated through the posterior half of the cavernous sinus...
March 15, 2018: Surgical and Radiologic Anatomy: SRA
Charles G Kulwin, Troy D Payner, Rick F Nelson, Laurie L Ackerman, Daniel H Fulkerson
BACKGROUND: Brainstem cavernous malformations (cavernomas) in children have a high risk of hemorrhage and neurological deterioration. This risk is magnified if the child has a genetic predisposition for cavernoma formation. The surgical management is challenging and carries a significant risk of morbidity. OBJECTIVE: To describe the feasibility of a posterior petrosal approach to brainstem cavernomas in a pediatric population. METHODS: A single institution operative experience with this technique was reviewed; 2 cases were identified and are technically described here with supportive figures and illustrations, as well as a focused literature review...
March 3, 2018: Operative Neurosurgery (Hagerstown, Md.)
Min Wu, Xianming Fu, Ying Ji, Wanhai Ding, Dali Deng, Yehan Wang, Xiaofeng Jiang, Chaoshi Niu
BACKGROUND: Microvascular decompression (MVD) of the trigeminal nerve is the most effective treatment for trigeminal neuralgia (TN). However, when encountering with classical trigeminal neuralgia caused by venous compression, the procedure becomes much more difficult, and failure or recurrence due to incomplete decompression may become frequent. This study aimed to investigate the anatomical variation of the culprit veins, and discuss the surgical strategy for different types respectively...
March 3, 2018: World Neurosurgery
Sachin Ranganatha Goudihalli, Hiroki Morisako, Wimba Prastarana, Takeo Goto, Hiroki Ohata, Kenji Ohata
Retrochiasmatic craniopharyngiomas (RC) are a challenge for the neurosurgeon to treat surgically, restrained by their location in the interpeduncular fossa, surrounded by vital neurovascular structures, narrow corridor and poor visibility. Many approaches are possible and elucidated in the literature, which the surgeon chooses, based on multiple factors, such as the size of tumor, calcification, laterality, preoperative neurological deficits and the endocrine function status, recurrence, postradiotherapy status, or significant superior and/or posterior extension...
February 2018: Journal of Neurological Surgery. Part B, Skull Base
Moujahed Labidi, Kentaro Watanabe, Marie-Pier Loit, Shunya Hanakita, Sébastien Froelich
Objectives  To discuss the use of the posterior petrosal approach for the resection of a retrochiasmatic craniopharyngioma. Design  Operative video. Results  In this case video, the authors discuss the surgical management of a large craniopharyngioma, presenting with mass effect on the third ventricle and optic apparatus. A first surgical stage, through an endoscopic endonasal transtubercular approach, allowed satisfactory decompression of the optic chiasma and nerves in preparation for adjuvant therapy...
February 2018: Journal of Neurological Surgery. Part B, Skull Base
Robert C Rennert, Reid Hoshide, Mark Calayag, Joanna Kemp, David D Gonda, Hal S Meltzer, Takanori Fukushima, John D Day, Michael L Levy
OBJECTIVE Treatment of hemorrhagic cavernous malformations within the lateral pontine region demands meticulous surgical planning and execution to maximize resection while minimizing morbidity. The authors report a single institution's experience using the extended middle fossa rhomboid approach for the safe resection of hemorrhagic cavernomas involving the lateral pons. METHODS A retrospective chart review was performed to identify and review the surgical outcomes of patients who underwent an extended middle fossa rhomboid approach for the resection of hemorrhagic cavernomas involving the lateral pons during a 10-year period at Rady Children's Hospital of San Diego...
February 2, 2018: Journal of Neurosurgery. Pediatrics
Noritaka Komune, Satoshi Matsuo, Koichi Miki, Yojiro Akagi, Ryota Kurogi, Koji Iihara, Takashi Nakagawa
OBJECTIVE: The endoscopic endonasal approach to the anatomically complex lateral skull base presents technical challenges. The use of the eustachian tube as a landmark to identify the petrous internal carotid artery has recently been reported, and this study aims to define the anatomic relationship between the eustachian tube and its surrounding structures using cadaveric dissection and radiologic analysis. METHODS: To clarify the relationship of the eustachian tube with its surrounding structures, we performed endoscopic and microscopic dissection of 4 adult cadaveric heads and analyzed computed topography scans from 20 patients...
January 8, 2018: World Neurosurgery
Osama Al-Mefty
No abstract text is available yet for this article.
January 2018: Neurosurgical Focus
Ming Feng, Ziyuan Liu, Xiaohai Liu, Xiaobo Zhang, Xinjie Bao, Yong Yao, Kan Deng, Bing Xing, Wei Lian, Huijuan Zhu, Lin Lu, Renzhi Wang
BACKGROUND: Bilateral inferior petrosal sinus sampling (IPSS) with corticotropin-releasing hormone (CRH) is currently the gold standard in the diagnosis of Cushing's disease (CD) and has also been used in tumour lateralization. Our objective was to determine the diagnostic value and lateralization accuracy of IPSS with desmopressin. METHODS: We retrospectively analysed 91 patients with Cushing's syndrome who had either negative findings on pituitary dynamic enhanced magnetic resonance imaging (MRI) or nonsuppressed high-dose dexamethasone suppression tests (HDDST)...
February 2018: Clinical Endocrinology
Hao Wang, Xiang Ying, Wen H Yu, Qiang Zhu, Xiao Q Dong, Yong F Sheng, Ding Wang
OBJECTIVE Surgical exposure and decompression of the entire trigeminal nerve in a conventional lateral supracerebellar approach can be challenging because of blockages from the superior petrosal vein complex, cerebellum, and vestibulocochlear nerve. The authors demonstrate a novel suprafloccular approach via the petrosal fissure and venous corridors that can be used as a substitute for the conventional route used to treat trigeminal neuralgia and present a consecutive series of patients and their clinical outcomes...
October 20, 2017: Journal of Neurosurgery
Omar Arnaout, Ossama Al-Mefty
The authors present the case of a 56-year-old patient who presented with a large petroclival meningioma and clinical symptoms of brainstem compression and hydrocephalus. The authors describe a two-stage combined petrosal approach for complete resection of the tumor. The nuances of the approach and microsurgical technique are discussed, as well as the radiographic and clinical outcomes. The video can be found here: .
October 2017: Neurosurgical Focus
Shunsuke Shibao, Hamid Borghei-Razavi, Kazunari Yoshida
BACKGROUND: Although the greater superficial petrosal nerve (GSPN) is an important landmark of the anterior transpetrosal approach (ATPA), bleeding from the interdural space around the foramen spinosum (FS), the GSPN, and the foramen ovale impedes the identification of the GSPN, during epidural dissection in the ATPA. OBJECTIVE: To describe the technique of intraspinosum middle meningeal artery (MMA) ligation, which enables us to control bleeding from the interdural space...
April 1, 2017: Operative Neurosurgery (Hagerstown, Md.)
Florian Bernard, Ilyess Zemmoura, Jean Philippe Cottier, Henri-Dominique Fournier, Louis-Marie Terrier, Stéphane Velut
OBJECTIVE The dura mater is made of 2 layers: the endosteal layer (outer layer), which is firmly attached to the bone, and the meningeal layer (inner layer), which directly covers the brain and spinal cord. These 2 dural layers join together in most parts of the skull base and cranial convexity, and separate into the orbital and perisellar compartments or into the spinal epidural space to form the extradural neural axis compartment (EDNAC). The EDNAC contains fat and/or venous blood. The aim of this dissection study was to anatomically verify the concept of the EDNAC by focusing on the dural layers surrounding the jugular foramen area...
September 8, 2017: Journal of Neurosurgery
Tomoaki Murakami, Hajime Nakamura, Takeo Nishida, Tomohiko Ozaki, Katsunori Asai, Tomoki Kidani, Yoshinori Kadono, Toshiki Yoshimine
Dural arteriovenous fistula (DAVF) in a sinus of the lesser sphenoid wing (SLSW) is rarely reported. Here, we report a case of an isolated SLSW DAVF treated by coils placed into the sinus through the feeding artery. A 68-year-old man was admitted to our hospital with headache. Magnetic resonance images and an angiogram showed a varix in the right middle cranial fossa. A DAVF, consisting of three main feeders and the isolated SLSW, was diagnosed based on the angiogram findings. Retrograde leptomeningeal venous drainage to the deep middle cerebral vein was observed...
April 2017: NMC Case Report Journal
Qiong Fang, Anhong Jiang, Wei Tao, Lin Xin
OBJECTIVE: The drainage portion of the vein of Labbé varies, and it is difficult to predict whether the operation is likely to damage this vein. The aim of this study was to correlate the microanatomy of the vein of Labbé with digital subtraction angiography (DSA) and computed tomographic venography (CTV), in order to provide a basis for the preservation of the vein of Labbé during a supratentorial surgical approach. METHODS: A total of 30 human cadavers (60 sides) and 61 living patients (110 sides) were examined in this study...
June 26, 2017: Biomedical Engineering Online
Susmeeta T Sharma
Cushing syndrome (CS) is caused by chronic exposure to excess glucocorticoids. Early recognition and treatment of hypercortisolemia can lead to decreased morbidity and mortality. The diagnosis of CS and thereafter, establishing the cause can often be difficult, especially in patients with mild and cyclic hypercortisolism. Surgical excision of the cause of excess glucocorticoids is the optimal treatment for CS. Medical therapy (steroidogenesis inhibitors, medications that decrease adrenocorticotropic hormone [ACTH] levels or glucocorticoid antagonists) and pituitary radiotherapy may be needed as adjunctive treatment modalities in patients with residual, recurrent or metastatic disease, in preparation for surgery, or when surgery is contraindicated...
June 2017: Endocrine Practice
Atsushi Matsumoto, Masanobu Okauchi, Atsushi Shindo, Masahiko Kawanishi, Takashi Tamiya
Introduction In case of cavernous sinus dural arteriovenous fistula (CSDAVF), transvenous embolization (TVE) of the cavernous sinus (CS) via the inferior petrosal sinus (IPS) is generally performed. However, various approach routes have been reported when the accessibility of the IPS is challenging. We herein report a case of CSDAVF treated by TVE with direct puncture of the facial vein. Case report A 70-year-old woman who suffered from tinnitus, chemosis, diplopia and bruit was referred to our hospital. Digital subtraction angiography (DSA) demonstrated CSDAVF...
June 2017: Interventional Neuroradiology
Fernando Alonso, Simone E Dekker, James Wright, Christina Wright, Andrea Alonso, Margaret Carmody, R Shane Tubbs, Nicholas C Bambakidis
OBJECTIVE: The anatomic area exposed through exposure of Trautmann triangle may not be sufficient. We studied the additional exposure provided by skeletonizing the sigmoid sinus (SS). METHODS: In 5 human cadaveric heads, thin-cut computed tomography images of 2 sides of the temporal bone were obtained for a total of 10 sides. The estimated surgical working angle was calculated based on the relationship of the SS to the posterior semicircular canal (PSC), superior petrosal sinus, and jugular bulb on imaging...
August 2017: World Neurosurgery
M Burhan Janjua, James P Caruso, Jeffrey P Greenfield, Mark M Souweidane, Theodore H Schwartz
The combined petrosal approach is an essential technique for the skull base neurosurgeon. In this manuscript, the authors provide a brief history of the development of this approach, technical instruction with consideration of important landmarks, and a literature review of the broad range of clinical applications for this approach. The combined petrosal approach was performed bilaterally in 6 cadaveric injected specimens. The relationship of middle and posterior fossa dura, venous sinuses, cranial nerves (CNs), and the vascular anatomy were studied...
July 2017: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
Carlos Castaño, Sebastián Remollo, Rosa García-Sort, Carlos Domínguez, Mikel Terceño
Background Carotid cavernous fistulas (CCFs) Barrow type 'B' are dural shunts between the meningeal branches of the internal carotid artery and the cavernous sinus. The symptoms include vision deterioration, ophthalmoplegia with diplopia, exophthalmos, conjunctival injection, chemosis, ocular bruit, seizures, or neurological deficit. Endovascular treatment remains the gold standard for treatment through the transvenous or transarterial routes. The transvenous approaches have been proved to be the first option...
December 2017: Neuroradiology Journal
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