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Microsurgical transcranial approaches to the posterior surface of petrosal portion of the temporal bone: quantitative analysis of surgical volumes and exposed areas

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Abstract 

Different microsurgical transcranial approaches (MTAs) have been described to expose the posterior surface of the petrous bone (PPB). A quantitative, anatomical comparison of the most used MTAs, for specific areas of the PPB, is not available. Anatomical dissections were performed on five formalin-fixed, latex-injected cadaver heads (10 sides). Six MTAs were analyzed: Kawase approach (KWA), retrosigmoid approach (RSA), retrosigmoid approach with suprameatal extension (RSAS), retrolabyrinthine approach (RLA), translabyrinthine approach (TLA), and transcochlear approach (TCA). Surgical volumes and exposed areas of each approach were quantified with a dedicated neuronavigation system (ApproachViewer, part of GTx-Eyes II, University Health Network, Toronto, Canada) and adjuvant software (ITK-SNAP and Autodesk Meshmixer 3.5). Areas and volumes were compared using linear mixed models. TCA provided the best exposure of Trautmann’s triangle and the retromeatal, suprameatal, meatal, and premeatal regions. RSAs provided the best exposure of the inframeatal region, with RSAS gaining significant exposure of the suprameatal region. KWA had the highest surgical volume, and RLA the lowest. Transpetrosal approaches offer the widest exposure of PPB proportionally to their invasiveness. Retrosigmoid approaches, which get to the studied region through a postero-lateral path, are paramount for the exposure of the inframeatal and suprameatal region and, given the adequate exposure of the remaining PPB, represent an effective approach for the cerebellopontine angle (CPA). These anatomical findings must be considered with approach-related morbidity and the pathological features in order to choose the most appropriate approach in clinical practice.

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Authors and Affiliations

  1. Division of Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Piazza Spedali Civili 1, Spedali Civili of Brescia, 25123, Brescia, Italy

    Simona Serioli, Edoardo Agosti & Marco Maria Fontanella

  2. Unit of Neurosurgery, GVM Care&Research, Maria Cecilia Hospital, Cotignola, Ravenna, Italy

    Simona Serioli, Riccardo Draghi, Ignazio Borghesi & Fabio Calbucci

  3. Section of Anatomy and Physiopathology, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy

    Barbara Buffoli & Rita Rezzani

  4. Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden

    Elena Raffetti

  5. Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA

    A. Yohan Alexander & Maria Peris-Celda

  6. Department of Neurosurgery, Mount Sinai Hospital, New York City, NY, USA

    Laura Salgado-López

  7. Division of Anatomy, Center for Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria

    Lena Hirtler

  8. Division of Radiology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy

    Roberto Maroldi

  9. Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy

    Francesco Doglietto

  10. Catholic University School of Medicine, Rome, Italy

    Francesco Doglietto

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  1. Simona Serioli
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  2. Edoardo Agosti
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  3. Barbara Buffoli
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  4. Elena Raffetti
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Edoardo Agosti, Simona Serioli, and Elena Raffetti. The manuscript was written by Edoardo Agosti, Simona Serioli, Riccardo Draghi, Francesco Doglietto, and reviewed by all authors. All authors reviewed and approved the final manuscript.

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Correspondence to Edoardo Agosti.

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The anatomical study was performed in line principles of the Declaration of Helsinki and its later amendments or comparable ethical standards.

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The authors declare no competing interests.

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Simona Serioli, Edoardo Agosti are Co-first authors.

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Serioli, S., Agosti, E., Buffoli, B. et al. Microsurgical transcranial approaches to the posterior surface of petrosal portion of the temporal bone: quantitative analysis of surgical volumes and exposed areas. Neurosurg Rev 46, 48 (2023). https://doi.org/10.1007/s10143-023-01956-y

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