Anterior inferior petrosectomy

Defining the role of endonasal endoscopic techniques for petrous apex approaches: Laboratory investigation

Jamie Van Gompel, Puya Alikhani, Mark H. Tabor, Harry R. Van Loveren, Sivero Agazzi, Sebastien Froelich, A. Samy Youssef

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Object. Historically, surgery to the petrous apex has been addressed via craniotomy and open microscopic anterior petrosectomy (OAP). However, with the popularization of endoscopic approaches, the petrous apex can further be approached endonasally by way of an endoscopic endonasal anterior petrosectomy (EAP). Endonasal anterior petrosectomy is a relatively new procedure and has not been compared anatomically with OAP. The authors hypothesized that the EAP and OAP techniques approach different portions of the petrous apex and therefore may have different applications. Methods. Four cadaveric heads were used. An OAP was performed on one side and an EAP was performed on the contralateral side; the limits of bony resection were defined. The extent of bony resection was then evaluated using predissection and postdissection thin-slice CT scans. The comparative resection was then reconstructed using 3D modeling on Brainlab workstations. Results. The average resection volumes for EAP and OAP were 0.297 cm3 and 0.649 cm3, respectively, representing a comparative percentage of 46% (EAP/OAP). An EAP and OAP achieved resection of 29% and 64% of the total petrous apex volume, respectively. Indeed, EAP addressed the inferior portion of the petrous apex located adjacent to the petroclival suture more completely than OAP, where 45% of the bone overlying the petroclival suture (petroclival angle to the jugular foramen) was resected with the EAP, while 0% was resected with the OAP. Conclusions. In anatomically normal cadavers, OAP achieved nearly a 50% larger volumetric resection than EAP. Furthermore, while OAP appears to completely address the superior portion of the petrous apex, EAP appears to have a niche in approaches to lesions in the inferior petrous apex. Given these results, the authors propose that OAP be redefined as the "superior anterior petrosectomy," while EAP be referred to as the "inferior anterior petrosectomy," which more clearly defines the role of each approach in anterior petrosectomy.

Original languageEnglish (US)
Pages (from-to)1321-1325
Number of pages5
JournalJournal of Neurosurgery
Volume120
Issue number6
DOIs
StatePublished - 2014

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Sutures
Craniotomy
Cadaver
Neck
Head
Bone and Bones

Keywords

  • Anterior petrosectomy
  • Endoscopic
  • Microsurgery
  • Skull base

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Anterior inferior petrosectomy : Defining the role of endonasal endoscopic techniques for petrous apex approaches: Laboratory investigation. / Van Gompel, Jamie; Alikhani, Puya; Tabor, Mark H.; Van Loveren, Harry R.; Agazzi, Sivero; Froelich, Sebastien; Youssef, A. Samy.

In: Journal of Neurosurgery, Vol. 120, No. 6, 2014, p. 1321-1325.

Research output: Contribution to journalArticle

Van Gompel, Jamie ; Alikhani, Puya ; Tabor, Mark H. ; Van Loveren, Harry R. ; Agazzi, Sivero ; Froelich, Sebastien ; Youssef, A. Samy. / Anterior inferior petrosectomy : Defining the role of endonasal endoscopic techniques for petrous apex approaches: Laboratory investigation. In: Journal of Neurosurgery. 2014 ; Vol. 120, No. 6. pp. 1321-1325.
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abstract = "Object. Historically, surgery to the petrous apex has been addressed via craniotomy and open microscopic anterior petrosectomy (OAP). However, with the popularization of endoscopic approaches, the petrous apex can further be approached endonasally by way of an endoscopic endonasal anterior petrosectomy (EAP). Endonasal anterior petrosectomy is a relatively new procedure and has not been compared anatomically with OAP. The authors hypothesized that the EAP and OAP techniques approach different portions of the petrous apex and therefore may have different applications. Methods. Four cadaveric heads were used. An OAP was performed on one side and an EAP was performed on the contralateral side; the limits of bony resection were defined. The extent of bony resection was then evaluated using predissection and postdissection thin-slice CT scans. The comparative resection was then reconstructed using 3D modeling on Brainlab workstations. Results. The average resection volumes for EAP and OAP were 0.297 cm3 and 0.649 cm3, respectively, representing a comparative percentage of 46{\%} (EAP/OAP). An EAP and OAP achieved resection of 29{\%} and 64{\%} of the total petrous apex volume, respectively. Indeed, EAP addressed the inferior portion of the petrous apex located adjacent to the petroclival suture more completely than OAP, where 45{\%} of the bone overlying the petroclival suture (petroclival angle to the jugular foramen) was resected with the EAP, while 0{\%} was resected with the OAP. Conclusions. In anatomically normal cadavers, OAP achieved nearly a 50{\%} larger volumetric resection than EAP. Furthermore, while OAP appears to completely address the superior portion of the petrous apex, EAP appears to have a niche in approaches to lesions in the inferior petrous apex. Given these results, the authors propose that OAP be redefined as the {"}superior anterior petrosectomy,{"} while EAP be referred to as the {"}inferior anterior petrosectomy,{"} which more clearly defines the role of each approach in anterior petrosectomy.",
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T1 - Anterior inferior petrosectomy

T2 - Defining the role of endonasal endoscopic techniques for petrous apex approaches: Laboratory investigation

AU - Van Gompel, Jamie

AU - Alikhani, Puya

AU - Tabor, Mark H.

AU - Van Loveren, Harry R.

AU - Agazzi, Sivero

AU - Froelich, Sebastien

AU - Youssef, A. Samy

PY - 2014

Y1 - 2014

N2 - Object. Historically, surgery to the petrous apex has been addressed via craniotomy and open microscopic anterior petrosectomy (OAP). However, with the popularization of endoscopic approaches, the petrous apex can further be approached endonasally by way of an endoscopic endonasal anterior petrosectomy (EAP). Endonasal anterior petrosectomy is a relatively new procedure and has not been compared anatomically with OAP. The authors hypothesized that the EAP and OAP techniques approach different portions of the petrous apex and therefore may have different applications. Methods. Four cadaveric heads were used. An OAP was performed on one side and an EAP was performed on the contralateral side; the limits of bony resection were defined. The extent of bony resection was then evaluated using predissection and postdissection thin-slice CT scans. The comparative resection was then reconstructed using 3D modeling on Brainlab workstations. Results. The average resection volumes for EAP and OAP were 0.297 cm3 and 0.649 cm3, respectively, representing a comparative percentage of 46% (EAP/OAP). An EAP and OAP achieved resection of 29% and 64% of the total petrous apex volume, respectively. Indeed, EAP addressed the inferior portion of the petrous apex located adjacent to the petroclival suture more completely than OAP, where 45% of the bone overlying the petroclival suture (petroclival angle to the jugular foramen) was resected with the EAP, while 0% was resected with the OAP. Conclusions. In anatomically normal cadavers, OAP achieved nearly a 50% larger volumetric resection than EAP. Furthermore, while OAP appears to completely address the superior portion of the petrous apex, EAP appears to have a niche in approaches to lesions in the inferior petrous apex. Given these results, the authors propose that OAP be redefined as the "superior anterior petrosectomy," while EAP be referred to as the "inferior anterior petrosectomy," which more clearly defines the role of each approach in anterior petrosectomy.

AB - Object. Historically, surgery to the petrous apex has been addressed via craniotomy and open microscopic anterior petrosectomy (OAP). However, with the popularization of endoscopic approaches, the petrous apex can further be approached endonasally by way of an endoscopic endonasal anterior petrosectomy (EAP). Endonasal anterior petrosectomy is a relatively new procedure and has not been compared anatomically with OAP. The authors hypothesized that the EAP and OAP techniques approach different portions of the petrous apex and therefore may have different applications. Methods. Four cadaveric heads were used. An OAP was performed on one side and an EAP was performed on the contralateral side; the limits of bony resection were defined. The extent of bony resection was then evaluated using predissection and postdissection thin-slice CT scans. The comparative resection was then reconstructed using 3D modeling on Brainlab workstations. Results. The average resection volumes for EAP and OAP were 0.297 cm3 and 0.649 cm3, respectively, representing a comparative percentage of 46% (EAP/OAP). An EAP and OAP achieved resection of 29% and 64% of the total petrous apex volume, respectively. Indeed, EAP addressed the inferior portion of the petrous apex located adjacent to the petroclival suture more completely than OAP, where 45% of the bone overlying the petroclival suture (petroclival angle to the jugular foramen) was resected with the EAP, while 0% was resected with the OAP. Conclusions. In anatomically normal cadavers, OAP achieved nearly a 50% larger volumetric resection than EAP. Furthermore, while OAP appears to completely address the superior portion of the petrous apex, EAP appears to have a niche in approaches to lesions in the inferior petrous apex. Given these results, the authors propose that OAP be redefined as the "superior anterior petrosectomy," while EAP be referred to as the "inferior anterior petrosectomy," which more clearly defines the role of each approach in anterior petrosectomy.

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KW - Endoscopic

KW - Microsurgery

KW - Skull base

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