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The modified lateral supraorbital approach for tumors of the petroclival junction extending into the anterior cerebellopontine area.

Lim J, Cho K - J. Neurooncol. (2016)

Bottom Line: In this study, we compared the surgical outcomes of the combined petrosal approach and a modified lateral supraorbital (MLSO) approach and evaluated the reliability and safety of the MLSO approach.There was no significant difference in the gross total resection rate between the two approaches (p = 0.67).The new modified approach of MLSO yielded good surgical results for these tumors compared to the combined petrosal approach.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Bundang CHA Medical Center, CHA University College of Medicine, Yatap-dong 59, Seongnam, 463-712, Korea.

ABSTRACT
Various surgical approaches for the removal of meningioma and trigeminal schwannoma in the petroclival junction (PCJ) and anterior cerebellopontine area (CPA) have been described previously. In this study, we compared the surgical outcomes of the combined petrosal approach and a modified lateral supraorbital (MLSO) approach and evaluated the reliability and safety of the MLSO approach. Fifty patients underwent surgical treatment using the combined petrosal or MLSO approach between 1996 and 2011. We retrospectively analyzed the clinical data and compared the two approaches. Among 50 patients, 27 patients underwent operation through the combined petrosal approach and 23 underwent operation through the MLSO approach. The operation time of the MLSO approach was significantly shorter than that of the combined petrosal approach (p = 0.03). There was no significant difference in the gross total resection rate between the two approaches (p = 0.67). After the operation, the improvement in Karnofsky performance score and Mean Glasgow outcomes scales were better in the MLSO approach, but without statistical significance (p = 0.723, p = 0.20 respectively). Complications occurred more often with the combined petrosal approach than with MLSO. Facial nerve palsy was the most common complication, followed by hearing difficulty. The frequency of these two complications was higher in the combined petrosal approach. Various tumors occurring in the PCJ and anterior CPA remain a challenging problem for neurosurgeons. The new modified approach of MLSO yielded good surgical results for these tumors compared to the combined petrosal approach. Therefore, the MLSO approach might be a good option for removal of tumors in the PCJ including anterior CPA.

No MeSH data available.


Related in: MedlinePlus

Surgical images. a Trans-eyebrow skin incision. b The bone flap. c The operation field. d Exposure of the petrous bone. e Postoperative bone-surface CT image. f, g Front and lateral view of the skin wound 3 months after surgery
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Fig2: Surgical images. a Trans-eyebrow skin incision. b The bone flap. c The operation field. d Exposure of the petrous bone. e Postoperative bone-surface CT image. f, g Front and lateral view of the skin wound 3 months after surgery

Mentions: The patient is positioned in a supine position with a Mizuho head holder and the head is elevated above the heart and turned to the contralateral side by 10–30°. The skin incision is located at the inferior edge of the eyebrow, starting from 0.5 cm medial to the mid-pupillary line and extending laterally to just behind the frontal process of the zygomatic bone and approximately 1 cm inferior laterally. A burr hole is drilled on the frontosphenoid suture and a craniotome is used to make a bone flap that includes the supraorbital bone, frontozygomatic process and frontal bone. The roof and lateral wall of the orbit are cut using an osteotome and the temporal bone is removed using a rongeur and punch. After exposure of the superior orbital fissure, the meningo-orbital band is transected to facilitate extradural access to the anterior clinoid process. The orbital roof is carefully removed and the optic canal is unroofed before performing anterior clinoidectomy. The outer layer of the cavernous sinus is peeled extradurally from anterior to posterior, exposing the inner membranous layer. The greater superficial petrosal nerve is the lateral landmark, the anteromedial margin of the eminencia arcuata is the posterior landmark, and the lateral margin of the porus trigeminus is the posterior landmark on the middle cranial fossa. After we confirm the anatomical landmarks of the Kawase triangle, the apex of the petrous bone is drilled out and then the petroclival junction and anterior CPA are opened. After removing the tumor, a cranial plate is used to fix the bone flap and a bone chip is used to fill the temporal craniectomy site (Figs. 1, 2).Fig. 1


The modified lateral supraorbital approach for tumors of the petroclival junction extending into the anterior cerebellopontine area.

Lim J, Cho K - J. Neurooncol. (2016)

Surgical images. a Trans-eyebrow skin incision. b The bone flap. c The operation field. d Exposure of the petrous bone. e Postoperative bone-surface CT image. f, g Front and lateral view of the skin wound 3 months after surgery
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4835518&req=5

Fig2: Surgical images. a Trans-eyebrow skin incision. b The bone flap. c The operation field. d Exposure of the petrous bone. e Postoperative bone-surface CT image. f, g Front and lateral view of the skin wound 3 months after surgery
Mentions: The patient is positioned in a supine position with a Mizuho head holder and the head is elevated above the heart and turned to the contralateral side by 10–30°. The skin incision is located at the inferior edge of the eyebrow, starting from 0.5 cm medial to the mid-pupillary line and extending laterally to just behind the frontal process of the zygomatic bone and approximately 1 cm inferior laterally. A burr hole is drilled on the frontosphenoid suture and a craniotome is used to make a bone flap that includes the supraorbital bone, frontozygomatic process and frontal bone. The roof and lateral wall of the orbit are cut using an osteotome and the temporal bone is removed using a rongeur and punch. After exposure of the superior orbital fissure, the meningo-orbital band is transected to facilitate extradural access to the anterior clinoid process. The orbital roof is carefully removed and the optic canal is unroofed before performing anterior clinoidectomy. The outer layer of the cavernous sinus is peeled extradurally from anterior to posterior, exposing the inner membranous layer. The greater superficial petrosal nerve is the lateral landmark, the anteromedial margin of the eminencia arcuata is the posterior landmark, and the lateral margin of the porus trigeminus is the posterior landmark on the middle cranial fossa. After we confirm the anatomical landmarks of the Kawase triangle, the apex of the petrous bone is drilled out and then the petroclival junction and anterior CPA are opened. After removing the tumor, a cranial plate is used to fix the bone flap and a bone chip is used to fill the temporal craniectomy site (Figs. 1, 2).Fig. 1

Bottom Line: In this study, we compared the surgical outcomes of the combined petrosal approach and a modified lateral supraorbital (MLSO) approach and evaluated the reliability and safety of the MLSO approach.There was no significant difference in the gross total resection rate between the two approaches (p = 0.67).The new modified approach of MLSO yielded good surgical results for these tumors compared to the combined petrosal approach.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Bundang CHA Medical Center, CHA University College of Medicine, Yatap-dong 59, Seongnam, 463-712, Korea.

ABSTRACT
Various surgical approaches for the removal of meningioma and trigeminal schwannoma in the petroclival junction (PCJ) and anterior cerebellopontine area (CPA) have been described previously. In this study, we compared the surgical outcomes of the combined petrosal approach and a modified lateral supraorbital (MLSO) approach and evaluated the reliability and safety of the MLSO approach. Fifty patients underwent surgical treatment using the combined petrosal or MLSO approach between 1996 and 2011. We retrospectively analyzed the clinical data and compared the two approaches. Among 50 patients, 27 patients underwent operation through the combined petrosal approach and 23 underwent operation through the MLSO approach. The operation time of the MLSO approach was significantly shorter than that of the combined petrosal approach (p = 0.03). There was no significant difference in the gross total resection rate between the two approaches (p = 0.67). After the operation, the improvement in Karnofsky performance score and Mean Glasgow outcomes scales were better in the MLSO approach, but without statistical significance (p = 0.723, p = 0.20 respectively). Complications occurred more often with the combined petrosal approach than with MLSO. Facial nerve palsy was the most common complication, followed by hearing difficulty. The frequency of these two complications was higher in the combined petrosal approach. Various tumors occurring in the PCJ and anterior CPA remain a challenging problem for neurosurgeons. The new modified approach of MLSO yielded good surgical results for these tumors compared to the combined petrosal approach. Therefore, the MLSO approach might be a good option for removal of tumors in the PCJ including anterior CPA.

No MeSH data available.


Related in: MedlinePlus