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Petrosal approach

Martin M Mortazavi, Marcus A Cox, Erfanul Saker, Sanjay Krishnamurthy, Ketan Verma, Christoph J Griessenauer, Marios Loukas, Rod J Oskouian, R Shane Tubbs
The superior petrosal sinus is located between the middle and posterior cranial fossae and is important during many neurosurgical approaches to the skull base. Using standard search engines, the anatomical and clinical importance of the superior petrosal sinus was investigated. The superior petrosal sinus is important in many neurosurgical approaches and pathological entities. Therefore, it is important for those who operate at the skull base or interpret imaging here to have a good working knowledge of its anatomy, development, and pathological involvement...
September 19, 2016: Neurosurgical Review
Nakao Ota, Felix Goehre, Takanori Miyazaki, Yu Kinoshita, Hidetoshi Matsukawa, Takeshi Yanagisawa, Humihiro Sakakibara, Norihiro Saito, Shiro Miyata, Kosumo Noda, Toshiyuki Tsuboi, Hiroyasu Kamiyama, Sadahisa Tokuda, Kyousuke Kamada, Rokuya Tanikawa
BACKGROUND: The application of bypass procedures to the posterior cerebral artery (PCA) in combination with proximal clipping or trapping is a useful option for the treatment of complex posterior circulation aneurysms, especially those of the PCA. Due to its course around the midbrain through various cisterns, different approaches are required to access the PCA. OBJECTIVE: The presented study analyzes a retrospective case series of bypass procedures to the PCA to investigate the relevant treatment strategies and their outcomes...
September 16, 2016: World Neurosurgery
Francesco Acerbi, Giuseppe FARAGò, Morgan Broggi, Claudio Cavallo, Michela Ranieri, Valentina Caldiera, Elisa Ciceri, Paolo Ferroli
Backgorund Direct exposure and cannulation of superior ophthalmic vein (SOV) provides an alternative access to reach the cavernous sinus for carotid-cavernous fistula (CCF) embolization, when classic transvenous routes through inferior petrosal sinus (IPS) or facial vein are not feasible. We have used indocyanine green (ICG) videoangiography to study intraoperatively the flow inside the SOV in two cases of indirect CCF. In this paper we report the operative technique and the result of ICG videoangiographic-guided cannulation of the SOV for endovascular treatment of CCF...
July 15, 2016: Turkish Neurosurgery
Kevin Phan, Joshua Xu, Vannessa Leung, Ian Teng, Sharaf Sheik-Ali, Monish Maharaj, Ralph Mobbs, Prashanth J Rao
Carotid cavernous fistulas (CCFs) are abnormal connections between the carotid arteries and the cavernous sinus. CCFs often present with double vision, reduced visual acuity and conjunctivitis. Deteriorating ocular symptoms due to abnormal fistula drainage can potentially cause permanent blindness, and so urgent interventional treatment is necessary. Transvenous embolization of the fistula is the primary treatment option for the majority of patients with symptomatic CCFs. Orbital approaches are considered to be risky compared to the traditional approach via the inferior petrosal sinus, and is thus used as a secondary option...
August 29, 2016: World Neurosurgery
Daniele Marchioni, Davide Soloperto, Alessia Rubini, João Flávio Nogueira, Mohamed Badr-El-Dine, Livio Presutti
Tympanic facial nerve segment surgery has been traditionally performed using microscopic approaches, but currently, exclusive endoscopic approaches have been performed for traumatic, neoplastic, or inflammatory diseases, specially located at the geniculate ganglion, greater petrosal nerve, and second tract of the facial nerve, until the second genu. The tympanic segment of the facial nerve can be reached and visualized using an exclusive transcanal endoscopic approach, even in poorly accessible regions such as the second genu and geniculate ganglion, avoiding mastoidectomy, bony demolition, and meningeal or cerebral lobe tractions, with low complication rates using a minimally invasive surgical route...
October 2016: Otolaryngologic Clinics of North America
Prakriti Gaba, Christopher V DeSimone, Benhur D Henz, Paul A Friedman, Charles J Bruce, David R Holmes, Malini Madhavan, Krithika Vasudevan, Douglas Wahnschaffe, Steven Berhow, Andrew J Danielsen, Dorothy J Ladewig, Susan B Mikell, Susan B Johnson, Scott H Suddendorf, Tomas Kara, Gregory A Worrell, Samuel J Asirvatham
OBJECTIVE: Pharmacotherapy for epilepsy is limited with 30% of patients refractory to this approach of suppressing seizures. Current surgical options are invasive and carry significant morbidities including infection, bleeding, and the potential for deleterious neurocognitive effects. As a result, there is a burgeoning need for innovation to develop safer and efficacious interventions. METHODS: Four distinct catheters (2 existing: Cardima catheter, Standard EPT Blazer catheter; 2 new prototypes: balloon catheter, basket catheters) were tested in 12 baboons (21-30 kg, 100% male)...
June 2016: Journal of Neurology & Neurophysiology
Mark Calayag, Reid Hoshide, David D Gonda, Hal S Meltzer, Takanori Fukushima, Michael L Levy
INTRODUCTION: Hemorrhagic cavernous malformations involving the lateral pontine region require complex surgical considerations to maximize complete resection of the cavernoma and associated hemorrhage while minimizing morbidity. We describe our experience through the middle fossa rhomboid approach in 8 children with cavernomas involving the pons, with lateralized hemorrhages extending through the pontine parenchyma. METHODS: Eight children underwent this approach over a 10-year period at Rady Children's Hospital of San Diego...
August 2016: Neurosurgery
Katsuhiro Mizutani, Masahiro Toda, Kazunari Yoshida
BACKGROUND: The anterior transpetrosal approach (ATPA) has been used in the resection of petroclival meningioma (PCM) for more than 20 years. Although PCM sometimes involves the petrosal vein and its preservation has been an important issue, the precise risk of petrosal vein sacrifice and subsequent venous complications associated with the use of the ATPA in patients with PCM has not yet been elucidated. METHODS: We used computed tomographic (CT) digital subtraction venography (DSV) in the retrospective analysis of the petrosal vein and its tributaries in patients with PCM before and after surgery...
September 2016: World Neurosurgery
Hua Cui, Cai-Fang Zhou, Ying-Hui Bao, Ming-Sheng Wang, Yong Wang
OBJECTIVE: The aim of this study was to evaluate the clinical features, treatment strategies, and outcomes of patients presented with petrous apex meningiomas. METHODS: In this retrospective clinical study, 17 patients with petrous apex meningiomas were treated microsurgically via an extended suboccipital retrosigmoid approach. Data regarding the general characteristics of the patients, surgical management, and surgery-related outcomes were obtained by reviewing patients' medical records...
July 2016: Journal of Craniofacial Surgery
Young Dae Cho, Jong Kook Rhim, Dong Hyun Yoo, Hyun-Seung Kang, Jeong Eun Kim, Won-Sang Cho, Moon Hee Han
BACKGROUND AND PURPOSE: Transarterial access to dural arteriovenous fistulas (dAVFs) has been popularized by device improvements and novel embolic materials. However, this approach is limited in the cavernous sinus (CS) because of related complications and low cure rates. Although a transvenous approach, via ipsilateral inferior petrosal sinus (IPS), may be more suitable for CS-dAVFs, microcatheter delivery is occasionally impeded by ipsilateral IPS occlusion. Described herein is a microguidewire looping method to breach such occlusions, thus enabling access to CS lesions...
October 2016: Interventional Neuroradiology
Kazuhide Adachi, Motoharu Hayakawa, Kohei Ishihara, Tukasa Ganaha, Shinya Nagahisa, Mituhiro Hasegawa, Yuichi Hirose
OBJECTIVE: To elucidate venous drainage patterns to avoid damage to the venous drainage route in the middle cranial fossa and superior petrosal sinus when employing the transpetrosal approach. METHODS: Venous drainage patterns were assessed using three-dimensional computed tomography venography in 22 hemispheres of petroclival meningioma (PCM) cases from patients who underwent primary surgery and 40 hemispheres of control cases. Intracranial venous drainage patterns were compared between control cases and PCM cases...
August 2016: World Neurosurgery
Eric Mason, Jason Van Rompaey, C Arturo Solares, Ramon Figueroa, Daniel Prevedello
Background The petroclival region seats many neoplasms. Traditional surgical corridors to the region can result in unacceptable patient morbidity. The combined subtemporal retrolabyrinthine transpetrosal (posterior petrosal) approach provides adequate exposure with hearing preservation; however, the facial nerve and labyrinth are put at risk. Approaching the petroclival region with an endoscopic endonasal approach (EEA) could minimize morbidity. Objective To provide an anatomical and computed tomography (CT) comparison between the posterior petrosal approach and EEA to the petroclival region...
June 2016: Journal of Neurological Surgery. Part B, Skull Base
Zhou Xu, Xingruo Zeng, Daofeng Tian, Qianxue Chen
AIM: To study and summarize our experience with the subtemporal transtentorial approach for resection of petroclival tumors. MATERIAL AND METHODS: Twenty-eight patients who suffered from petroclival tumors and underwent tumor resection via a subtemporal transtentorial approach between October 2010 and July 2013 were retrospectively reviewed. RESULTS: Total resection was performed in 22 cases, at a rate of 78.57%, subtotal resection in 5 cases, and large portion resection in 1 case...
2016: Turkish Neurosurgery
Jung-Shun Lee, Alba Scerrati, Jun Zhang, Mario Ammirati
Surgical approaches to the pons lump together different areas of the pons, such as the anterosuperior and the anteroinferior pons. These areas are topographically different, and different approaches may be best suited for one or the other area. We evaluated the exposure of the anterosuperior pons using different surgical approaches. We quantify the surgical exposure and surgical freedom to the anterosuperior pons afforded by the pterional transtentorial (PT), the orbitozygomatic with anterior clinoidectomy (OZ), and the anterior petrosal (AP) approaches...
October 2016: Neurosurgical Review
Marcos Alexandre da Franca Pereira, Aline Gomes Bittencourt, Emerson Magno de Andrade, Ricardo Ferreira Bento, Rubens de Brito
BACKGROUND: Peripheral facial palsy is characterized by the permanent or temporary interruption of facial muscle function. The middle cranial fossa (MCF) approach has been used to decompress the facial nerve (FN) when hearing needs to be preserved. In this work, we describe a technique for decompressing the FN through the MCF approach, which allows the direct exposure of the labyrinthine and entire tympanic segment of the FN, with preservation of inner ear function. METHODS: Twenty cadavers heads were used in this study...
June 2016: Acta Neurochirurgica
Masahiro Shin, Kenji Kondo, Shunya Hanakita, Hirotaka Hasegawa, Masanori Yoshino, Yu Teranishi, Taichi Kin, Nobuhito Saito
OBJECTIVE Reports about endoscopic endonasal surgery for skull base tumors involving the lateral part of petrous apex remain scarce. The authors present their experience with the endoscopic transsphenoidal anterior petrosal (ETAP) approach through the retrocarotid space for tumors involving the internal auditory canal, jugular fossa, and cavernous sinus. METHODS The authors performed the ETAP approach in 10 patients with 11 tumors (bilateral in 1 patient) that extensively occupied the lateral part of petrous apex, e...
April 1, 2016: Journal of Neurosurgery
Xingdong Wang, Enxi Xu, Hengzhu Zhang, Lei She, Xiaodong Wang, Zhengcun Yan
OBJECTIVE: To study the endoscope anatomy of the petroclival and ventrolateral brainstem regions via the intradural subtemporal keyhole Kawase approach and discuss the feasibility and indications of this approach to the regions. MATERIALS AND METHODS: Craniotomy procedures performed via the intradural subtemporal keyhole Kawase approach were simulated on 16 sides of 8 adult cadaveric heads fixed by formalin, and the related anatomical structures were observed through the 0-degree endoscope or alternatively 30-degree one...
May 2016: Journal of Craniofacial Surgery
M R Bogomil'sky, M M Polunin, E I Zelikovich, Yu L Soldatsky, O V Burova
This publication was designed to describe a rare case of development of apicalpetrositis in a child presenting with acute otitis mediafollowing chicken pox experienced in the preceding period. We carried out the study with the use of computed tomography (CT) that demonstrated destruction of the temporal bone, bones of the base of the skull and of the first cervical vertebra. The treatment strategy chosen for the management of this condition that included antibiotic therapy and expectant observation proved justified and can be recommended as an algorithm of choice taking into consideration the difficulty of surgical approach to the apex of the petrous pyramid...
2016: Vestnik Otorinolaringologii
Mikail Inal, Nuray Bayar Muluk, Veysel Burulday, Mehmet Hüseyin Akgül, Mehmet Faik Ozveren, Umut Orkun Çelebi, Gökçe Şimşek, Birsen Ünal Daphan
OBJECTIVES: The aim of this paper was a retrospective investigation of calcification at the petroclival region using Multi-slice Computed Tomography (MSCT). METHODS: One hundred thirty skull bases were reviewed. The images were acquired with a 64 slice CT (MSCT). At first images were taken at the axial plane; and then coronal and sagittal reconstructions of raw data were performed. Later investigations were carried out on these 3-dimensional images (3-D imaging)...
April 2016: Journal of Cranio-maxillo-facial Surgery
Peng Liu, Ya Xu, Xianli Lv, Huijian Ge, Ming Lv, Youxiang Li
The pathogenic association between cavernous dural arteriovenous fistula (CDAVF) and moyamoya disease remains unclear. This unusual case is the first report of a progression of unilateral moyamoya disease resulting in the spontaneous occlusion of ipsilateral CDAVF. A 52-year-old woman presented with two-week spontaneous exophthalmos, chemosis and tinnitus, and cerebral angiography showed a right CDAVF coexisting with ipsilateral moyamoya disease. Transvenous approaches through the inferior petrosal sinus and facial vein were attempted but failed...
June 2016: Interventional Neuroradiology
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