Peritrigeminal Safe Entry Zone Access to Anterolateral Pons Using the Presigmoid Retrolabyrinthine Suprameatal Approach: A Cadaveric Morphometric Study.

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  • Additional Information
    • Source:
      Publisher: Lippincott Williams & Wilkins, Inc Country of Publication: United States NLM ID: 101635417 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 2332-4260 (Electronic) Linking ISSN: 23324252 NLM ISO Abbreviation: Oper Neurosurg (Hagerstown) Subsets: MEDLINE
    • Publication Information:
      Publication: 2022- : [Philadelphia] : Lippincott Williams & Wilkins, Inc.
      Original Publication: Hagerstown, MD: Lippincott, Williams & Wilkins, 2014-
    • Subject Terms:
      Neurosurgical Procedures*/methods ; Pons*/diagnostic imaging ; Pons*/surgery; Humans ; Trigeminal Nerve/surgery ; Microsurgery/methods ; Cadaver
    • Abstract:
      Background and Objectives: Access to the anterolateral pontine lesions can be achieved through the peritrigeminal and supratrigeminal safe entry zones using Kawase, retrosigmoid, or translabyrinthine approaches. However, these approaches entail shallow extensive dissection, tangential access, and compromise vestibulocochlear function. We aimed to investigate infratentorial presigmoid retrolabyrinthine approach to access pontine lesions through the peritrigeminal zone.
      Methods: We performed 10 presigmoid retrolabyrinthine suprameatal approach dissections in 5 cadaveric heads. Anatomic-radiological characteristics and variations were evaluated. Six morphometric parameters were measured and analyzed to predict surgical accessibility.
      Results: The pontine infratrigeminal area was accessible in all patients. The mean exposed area of the anterolateral pontine surface was 98.95 cm 2 (±38.11 cm 2 ). The mean length of the exposed trigeminal nerve was 7.9 cm (±2.9 cm). Preoperative anatomic-radiological parameters may allow to select patients with favorable anatomy that offers appropriate surgical accessibility to the anterior pontine cavernoma through a presigmoid retrolabyrinthine corridor.
      Conclusion: Anterolateral pontine lesions can be accessed through a minimally invasive infratentorial presigmoid retrolabyrinthine approach by targeting the infratrigeminal safe entry zone. Further clinical studies should be conducted to evaluate the viability of this technique for treating these complex pathologies in real clinical settings.
      (Copyright © Congress of Neurological Surgeons 2023. All rights reserved.)
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    • Publication Date:
      Date Created: 20230814 Date Completed: 20240214 Latest Revision: 20240214
    • Publication Date:
      20240214
    • Accession Number:
      10.1227/ons.0000000000000866
    • Accession Number:
      37578224