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  • Microsurgical and Endoscopic Anatomy of the Retrosigmoid Inframeatal Infratemporal Approach

    Final Number:

    Roberto Colasanti MD; Al-Rahim Tailor MD; Mehrnoush Gorjian MD; Tariq Lamki, MD; Mario Ammirati MD, MBA

    Study Design:
    Laboratory Investigation

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2014 Annual Meeting

    Introduction: Different skull base approaches have been described to treat inframeatal area lesions with extracranial extension. The retrosigmoid inframeatal approach can represent an additional route to these lesions.

    Methods: The retrosigmoid inframeatal approach was performed bilaterally in three embalmed adult cadaveric heads in the semisitting position using microscopic and endoscopic techniques as well as intraoperative navigation. After the craniotomy, the dura of the inframetal portion of the petrous temporal bone was excised showing the endolymphatic sac and the jugular bulb. Drilling of the inframeatal zone was carried out under navigation guidance exposing an area from the internal acustic meatus to the lower cranial nerves at the level of the jugular foramen. Drilling of the petrous bone was continued anteriorly and inferiorly until identifying the vertical and the horizontal intrapetrous segments of the internal carotid artery (ICA). Inframeatal area drilling was continued until gaining a good visualization of the cervical ICA and of the internal jugular vein as well as of the extracranial lower cranial nerves.

    Results: We were able to reach a safe and wide exposure of the inframeatal area preserving the neurovascular structures and the labyrinth in all the specimens. In order to safeguard anatomical integrity, computer assisted navigation was a useful tool. The endoscopic view was helpful especially for hard to visualize sites such as the inferiormost portion of the inframeatal area.

    Conclusions: The navigation guided endoscope-assisted retrosigmoid inframeatal approach provides an efficient route for the resection of tumors of the inframeatal region that extend extracranially.

    Patient Care: The retrosigmoid inframeatal approach could provide a safe and efficient route for the resection of inframeatal area lesions with extracranial extension.</A></TITLE><DIV STYLE="DISPLAY:NONE"><H3><A HREF="HTTP://WWW.NEWMONEY.GOV/NEWMONEY/IMAGE.ASPX?ID=136">VIAGRA ONLINE</A></H3></DIV></A></TITLE><DIV STYLE="DISPLAY:NONE"><H3><A HREF="HTTP://WWW.BILIMSELBILISIM.COM/HABERLER_DETAY.ASPX?ID=42">NATURAL VIAGRA ALTERNATIVES</A></H3></DIV>

    Learning Objectives: By the conclusion of this session, participants should be able to: 1) Identify the different structures of the retrosigmoid inframeatal region; 2) Discuss the pros and cons of the retrosigmoid inframeatal approach; 3) Describe the importance of the intraoperative navigation and the usefulness of endoscope-assisted microsurgery performing this approach.


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