Giorgio Saraceno1, Edoardo Agosti1, Jimmy Qiu2, Barbara Buffoli3, Marco Ferrari4, Elena Raffetti5, Francesco Belotti1, Marco Ravanelli6, Davide Mattavelli4, Alberto Schreiber4, Lena Hirtler7, Luigi F Rodella3, Roberto Maroldi6, Piero Nicolai4, Fred Gentili8, Walter Kucharczyk9, Marco M Fontanella1, Francesco Doglietto10. 1. Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy. 2. TECHNA Institute, University Health Network, Toronto, Ontario, Canada. 3. Section of Anatomy and Physiopathology, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy. 4. Otorhinolaryngology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy. 5. Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden. 6. Radiology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy. 7. Division of Anatomy, Center for Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria. 8. Department of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada. 9. Division of Neuroradiology, Department of Medical Imaging, University Health Network, Toronto, Ontario, Canada. 10. Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy. Electronic address: francesco.doglietto@unibs.it.
Abstract
OBJECTIVE: To quantitatively compare different microsurgical and endoscopic approaches to the middle cranial fossa in a preclinical setting with a novel, computer-based research method. METHODS: Different approaches were performed bilaterally in 5 head and neck specimens that underwent high-resolution computed tomography scans: 5 transcranial anterolateral (supraorbital, mini-pterional, pterional, pterional-transzygomatic, fronto-temporal-orbito-zygomatic) without and with anterior clinoidectomy; 2 transcranial lateral (subtemporal and subtemporal-transzygomatic); 2 endoscopic transnasal (transpterygoid, transpterygoid to infratemporal fossa); 2 endoscopic transorbital (superior eyelid and inferolateral), and endoscopic transmaxillary. A dedicated navigation system was used to quantify surgical working volumes and exposure of different areas of the middle cranial fossa (ApproachViewer, part of GTx-Eyes II, University Health Network, Toronto, Canada). Statistical analysis was performed using a mixed linear model with bootstrap resampling. RESULTS: Endoscopic transnasal and fronto-temporal-orbito-zygomatic approaches with anterior clinoidectomy showed the largest surgical volumes. Endoscopic approaches allowed a wider exposure of medial anatomical surfaces (e.g., the petrous apex) compared with transcranial ones. Transcranial approaches with larger craniotomies allowed the widest exposure of superomedial anatomical structures (e.g., roof of cavernous sinus). The resection of the zygomatic arch allowed exposure of more medial surfaces with an inferior to superior trajectory. CONCLUSIONS: This study implemented a novel neuronavigation-based research method to quantitatively compare different approaches to the middle cranial fossa; its results might guide, after consideration of clinical implications, the choice of the neurosurgical approach to different areas of this complex skull base region.
OBJECTIVE: To quantitatively compare different microsurgical and endoscopic approaches to the middle cranial fossa in a preclinical setting with a novel, computer-based research method. METHODS: Different approaches were performed bilaterally in 5 head and neck specimens that underwent high-resolution computed tomography scans: 5 transcranial anterolateral (supraorbital, mini-pterional, pterional, pterional-transzygomatic, fronto-temporal-orbito-zygomatic) without and with anterior clinoidectomy; 2 transcranial lateral (subtemporal and subtemporal-transzygomatic); 2 endoscopic transnasal (transpterygoid, transpterygoid to infratemporal fossa); 2 endoscopic transorbital (superior eyelid and inferolateral), and endoscopic transmaxillary. A dedicated navigation system was used to quantify surgical working volumes and exposure of different areas of the middle cranial fossa (ApproachViewer, part of GTx-Eyes II, University Health Network, Toronto, Canada). Statistical analysis was performed using a mixed linear model with bootstrap resampling. RESULTS: Endoscopic transnasal and fronto-temporal-orbito-zygomatic approaches with anterior clinoidectomy showed the largest surgical volumes. Endoscopic approaches allowed a wider exposure of medial anatomical surfaces (e.g., the petrous apex) compared with transcranial ones. Transcranial approaches with larger craniotomies allowed the widest exposure of superomedial anatomical structures (e.g., roof of cavernous sinus). The resection of the zygomatic arch allowed exposure of more medial surfaces with an inferior to superior trajectory. CONCLUSIONS: This study implemented a novel neuronavigation-based research method to quantitatively compare different approaches to the middle cranial fossa; its results might guide, after consideration of clinical implications, the choice of the neurosurgical approach to different areas of this complex skull base region.
Authors: Giulia Guizzardi; Alberto Di Somma; Matteo de Notaris; Francesco Corrivetti; Juan Carlos Sánchez; Isam Alobid; Abel Ferres; Pedro Roldan; Luis Reyes; Joaquim Enseñat; Alberto Prats-Galino Journal: Front Oncol Date: 2022-09-02 Impact factor: 5.738
Authors: Alperen Vural; Andrea Luigi Camillo Carobbio; Marco Ferrari; Vittorio Rampinelli; Alberto Schreiber; Davide Mattavelli; Francesco Doglietto; Barbara Buffoli; Luigi Fabrizio Rodella; Stefano Taboni; Michele Tomasoni; Tommaso Gualtieri; Alberto Deganello; Lena Hirtler; Piero Nicolai Journal: Neurosurg Rev Date: 2021-01-22 Impact factor: 3.042