Skip to main content

Advertisement

SpringerLink
Log in

Endoscopic transorbital route to the petrous apex: a feasibility anatomic study

  • Original Article - Neurosurgical Anatomy
  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

Abstract

Background

While the subtemporal approach represents the surgical module milestone designed to reach the petrous apex, a novel ventral route, which is the superior eyelid endoscopic transorbital approach, has been proposed to access the skull base. Accordingly, we aimed to evaluate the feasibility of this route to the petrous apex, providing a qualitative and quantitative analysis of this relatively novel pathway.

Methods

Five human cadaveric heads were dissected at the Laboratory of Surgical NeuroAnatomy of the University of Barcelona. After proper dissection planning, anterior petrosectomy via the endoscopic transorbital route was performed. Specific quantitative analysis, as well as dedicated three-dimensional reconstruction, was done.

Results

Using the endoscopic transorbital approach, it was possible to reach the petrous apex with an average volume bone removal of 1.33 ± 0.21 cm3. Three main intradural spaces were exposed: cerebellopontine angle, middle tentorial incisura, and ventral brainstem. The first one was bounded by the origin of the trigeminal nerve medially and the facial and vestibulocochlear nerves laterally, the second extended from the origin of the oculomotor nerve to the entrance of the trochlear nerve into the tentorium free edge while the ventral brainstem area was hardly accessible through the straight, ventral endoscopic transorbital trajectory.

Conclusion

This is the first qualitative and quantitative anatomic study concerning details of the lateral aspect of the incisura and ventrolateral posterior fossa reached via the transorbital window. This manuscript is intended as a feasibility anatomic study, and further clinical contributions are mandatory to confirm the effectiveness of this approach, defining its possible role in the neurosurgical armamentarium.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11
Fig. 12

Similar content being viewed by others

References

  1. Abdel Aziz KM, Bhatia S, Tantawy MH, Sekula R, Keller JT, Froelich S, Happ E (2011) Minimally invasive transpalpebral “eyelid” approach to the anterior cranial base. Neurosurgery 69:ons195–ons206; discussion 206-197. https://doi.org/10.1227/NEU.0b013e31821c3ea3

    PubMed  Google Scholar 

  2. Abdel Aziz KM, Sanan A, van Loveren HR, Tew JM, Keller JT, Pensak ML (2000) Petroclival meningiomas: predictive parameters for transpetrosal approaches. Neurosurgery 47:139–150 discussion 150-132

    CAS  PubMed  Google Scholar 

  3. Ahmed O, Walther J, Theriot K, Manuel M, Guthikonda B (2016) Morphometric analysis of bone resection in anterior petrosectomies. J Neurol Surg B Skull Base 77:238–242. https://doi.org/10.1055/s-0035-1566301

    PubMed  Google Scholar 

  4. Almefty R, Dunn IF, Pravdenkova S, Abolfotoh M, Al-Mefty O (2014) True petroclival meningiomas: results of surgical management. J Neurosurg 120:40–51. https://doi.org/10.3171/2013.8.JNS13535

    Article  PubMed  Google Scholar 

  5. Almeida JP, Ruiz-Treviño AS, Shetty SR, Omay SB, Anand VK, Schwartz TH (2017) Transorbital endoscopic approach for exposure of the sylvian fissure, middle cerebral artery and crural cistern: an anatomical study. Acta Neurochir. https://doi.org/10.1007/s00701-017-3296-8

  6. Andaluz N, Romano A, Reddy LV, Zuccarello M (2008) Eyelid approach to the anterior cranial base. J Neurosurg 109:341–346. https://doi.org/10.3171/JNS/2008/109/8/0341

    Article  PubMed  Google Scholar 

  7. Andaluz N, Van Loveren HR, Keller JT, Zuccarello M (2003) Anatomic and clinical study of the orbitopterional approach to anterior communicating artery aneurysms. Neurosurgery 52:1140–1148 discussion 1148-1149

    PubMed  Google Scholar 

  8. Asaoka K, Terasaka S (2014) Combined petrosal approach for resection of petroclival meningioma. Neurosurg Focus 36:1. https://doi.org/10.3171/2014.V1.FOCUS13446

    Article  PubMed  Google Scholar 

  9. Ayberk G, Ozveren MF, Uzum N, Tosun O, Akcay EK (2008) Cellular schwannoma of the greater superficial petrosal nerve presenting with abducens nerve palsy and xerophthalmia: case report. Neurosurgery 63:E813–E814; discussion E814. https://doi.org/10.1227/01.NEU.0000325501.75772.FD

    Article  PubMed  Google Scholar 

  10. Borghei-Razavi H, Tomio R, Fereshtehnejad SM, Shibao S, Schick U, Toda M, Kawase T, Yoshida K (2015) Anterior petrosal approach: the safety of Kawase triangle as an anatomical landmark for anterior petrosectomy in petroclival meningiomas. Clin Neurol Neurosurg 139:282–287. https://doi.org/10.1016/j.clineuro.2015.10.032

    Article  PubMed  Google Scholar 

  11. Borghei-Razavi H, Tomio R, Fereshtehnejad SM, Shibao S, Schick U, Toda M, Yoshida K, Kawase T (2016) Pathological location of cranial nerves in petroclival lesions: how to avoid their injury during anterior petrosal approach. J Neurol Surg B Skull Base 77:6–13. https://doi.org/10.1055/s-0035-1555137

    PubMed  Google Scholar 

  12. Chang SW, Wu A, Gore P, Beres E, Porter RW, Preul MC, Spetzler RF, Bambakidis NC (2009) Quantitative comparison of Kawase’s approach versus the retrosigmoid approach: implications for tumors involving both middle and posterior fossae. Neurosurgery 64:ons44–ons51; discussion ons51-42. https://doi.org/10.1227/01.NEU.0000334410.24984.DD

    Article  PubMed  Google Scholar 

  13. Charachon R, Gratacap B, Lavieille JP (1992) Chondrosarcomas of the petrous apex. Skull Base Surg 2:171–175

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Colasanti R, Tailor AR, Lamki T, Zhang J, Ammirati M (2015) Maximizing the petroclival region exposure via a suboccipital retrosigmoid approach: where is the intrapetrous internal carotid artery? Neurosurgery 11(Suppl 2):329–336; discussion 336-327. https://doi.org/10.1227/NEU.0000000000000749

    Article  PubMed  Google Scholar 

  15. Cui H, Zhou CF, Bao YH, Wang MS, Wang Y (2016) Extended suboccipital retrosigmoid surgical approach is effective for resection of petrous apex meningioma. J Craniofac Surg 27:e429–e433. https://doi.org/10.1097/SCS.0000000000002705

    Article  PubMed  Google Scholar 

  16. Dallan I, Castelnuovo P, Locatelli D, Turri-Zanoni M, AlQahtani A, Battaglia P, Hirt B, Sellari-Franceschini S (2015) Multiportal combined transorbital transnasal endoscopic approach for the management of selected skull base lesions: preliminary experience. World Neurosurg 84:97–107. https://doi.org/10.1016/j.wneu.2015.02.034

    Article  PubMed  Google Scholar 

  17. Dallan I, Castelnuovo P, Turri-Zanoni M, Fiacchini G, Locatelli D, Battaglia P, Sellari-Franceschini S (2016) Transorbital endoscopic assisted management of intraorbital lesions: lessons learned from our first 9 cases. Rhinology 54:247–253. https://doi.org/10.4193/Rhin15.237

    CAS  PubMed  Google Scholar 

  18. Dallan I, Di Somma A, Prats-Galino A, Solari D, Alobid I, Turri-Zanoni M, Fiacchini G, Castelnuovo P, Catapano G, de Notaris M (2016) Endoscopic transorbital route to the cavernous sinus through the meningo-orbital band: a descriptive anatomical study. J Neurosurg 127:1–8. https://doi.org/10.3171/2016.8.JNS16465

    Google Scholar 

  19. Dallan I, Sellari-Franceschini S, Turri-Zanoni M, de Notaris M, Fiacchini G, Romana Fiorini F, Battaglia P, Locatelli D, Castelnuovo P (2017) Endoscopic transorbital superior eyelid approach for the management of selected spheno-orbital meningiomas: preliminary experience. Oper Neurosurg opx100. https://doi.org/10.1093/ons/opx100

  20. De la Cruz A, Teufert KB (2009) Transcochlear approach to cerebellopontine angle and clivus lesions: indications, results, and complications. Otol Neurotol 30:373–380. https://doi.org/10.1097/MAO.0b013e31819a892b

    Article  PubMed  Google Scholar 

  21. de Souza DG, Ditzel Filho LF, Makonnen G, Zoli M, Naudy C, Muto J, Prevedello DM (2014) Retrosigmoid approach for resection of petrous apex meningioma. Neurosurg Focus 36:1. https://doi.org/10.3171/2014.V1.FOCUS13456

    Article  PubMed  Google Scholar 

  22. Diaz Day J (2012) The middle fossa approach and extended middle fossa approach: technique and operative nuances. Neurosurgery 70:192–201. https://doi.org/10.1227/NEU.0b013e31823583a1

    CAS  PubMed  Google Scholar 

  23. Essayed WI, Singh H, Lapadula G, Almodovar-Mercado GJ, Anand VK, Schwartz TH (2017) Endoscopic endonasal approach to the ventral brainstem: anatomical feasibility and surgical limitations. J Neurosurg 127:1–8. https://doi.org/10.3171/2016.9.JNS161503

    Article  Google Scholar 

  24. Eytan DF, Kshettry VR, Sindwani R, Woodard TD, Recinos PF (2014) Surgical outcomes after endoscopic management of cholesterol granulomas of the petrous apex: a systematic review. Neurosurg Focus 37:E14. https://doi.org/10.3171/2014.7.FOCUS14344

    Article  PubMed  Google Scholar 

  25. Ferrari M, Schreiber A, Mattavelli D, Belotti F, Rampinelli V, Lancini D, Doglietto F, Fontanella MM, Tschabitscher M, Rodella LF, Nicolai P (2016) The inferolateral Transorbital endoscopic approach: a preclinical anatomic study. World Neurosurg 90:403–413. https://doi.org/10.1016/j.wneu.2016.03.017

    Article  PubMed  Google Scholar 

  26. Freeman JL, Sampath R, Quattlebaum SC, Casey MA, Folzenlogen ZA, Ramakrishnan VR, Youssef AS (2017) Expanding the endoscopic transpterygoid corridor to the petroclival region: anatomical study and volumetric comparative analysis. J Neurosurg 1–10. https://doi.org/10.3171/2017.1.JNS161788

  27. Grossi PM, Nonaka Y, Watanabe K, Fukushima T (2012) The history of the combined supra- and infratentorial approach to the petroclival region. Neurosurg Focus 33:E8. https://doi.org/10.3171/2012.6.FOCUS12141

    Article  PubMed  Google Scholar 

  28. Gupta SK, Salunke P (2012) Intradural anterior petrosectomy for petroclival meningiomas: a new surgical technique and results in 5 patients: technical note. J Neurosurg 117:1007–1012. https://doi.org/10.3171/2012.9.JNS12429

    Article  PubMed  Google Scholar 

  29. Harrison Priddy B, Nunes C, Beer-Furlan A, Carrau R, Dallan I, Prevedello D (2017) A side door to Meckel’s cave: anatomic feasibility study for the lateral transorbital approach. Oper Neurosurg 13:1–8. https://doi.org/10.1093/ons/opx042

    Article  Google Scholar 

  30. Hegazy A, Alfiki A, Adel MF, Alsawy MF, Al-Dash MF, Zein M, Amin SM, Al-Shami H, Biswas A (2016) Role of surgery for small petrous apex meningiomas causing refractory trigeminal neuropathy in the minimally invasive era. Neurol India 64:973–979. https://doi.org/10.4103/0028-3886.190230

    Article  PubMed  Google Scholar 

  31. Hunter JB, Weaver KD, Thompson RC, Wanna GB (2015) Petroclival meningiomas. Otolaryngol Clin N Am 48:477–490. https://doi.org/10.1016/j.otc.2015.02.007

    Article  Google Scholar 

  32. Ichimura S, Hori S, Hecht N, Czabanka M, Vajkoczy P (2016) Intradural anterior transpetrosal approach. Neurosurg Rev 39:625–631. https://doi.org/10.1007/s10143-016-0711-1

    Article  PubMed  Google Scholar 

  33. Ichimura S, Yoshida K, Sutiono AB, Horiguchi T, Sasaki H, Kawase T (2010) Greater petrosal nerve schwannomas-analysis of four cases and review of the literature. Neurosurg Rev 33:477–482. https://doi.org/10.1007/s10143-010-0277-2

    Article  PubMed  Google Scholar 

  34. Jacquesson T, Berhouma M, Tringali S, Simon E, Jouanneau E (2015) Which routes for Petroclival tumors? A comparison between the anterior expanded endoscopic endonasal approach and lateral or posterior routes. World Neurosurg 83:929–936. https://doi.org/10.1016/j.wneu.2015.02.003

    Article  PubMed  Google Scholar 

  35. Janjua MB, Caruso JP, Greenfield JP, Souweidane MM, Schwartz TH (2017) The combined transpetrosal approach: anatomic study and literature review. J Clin Neurosci. https://doi.org/10.1016/j.jocn.2017.03.015

  36. Kasemsiri P, Carrau RL, Ditzel Filho LF, Prevedello DM, Otto BA, Old M, de Lara D, Kassam AB (2014) Advantages and limitations of endoscopic endonasal approaches to the skull base. World Neurosurg 82:S12–S21. https://doi.org/10.1016/j.wneu.2014.07.022

    Article  PubMed  Google Scholar 

  37. Kawase T, Shiobara R, Toya S (1991) Anterior transpetrosal-transtentorial approach for sphenopetroclival meningiomas: surgical method and results in 10 patients. Neurosurgery 28:869–875 discussion 875-866

    Article  CAS  PubMed  Google Scholar 

  38. Kawase T, Shiobara R, Toya S (1994) Middle fossa transpetrosal-transtentorial approaches for petroclival meningiomas. Selective pyramid resection and radicality. Acta Neurochir 129:113–120

    Article  CAS  PubMed  Google Scholar 

  39. King TT, Benjamin JC, Morrison AW (1989) Epidermoid and cholesterol cysts in the apex of the petrous bone. Br J Neurosurg 3:451–461

    Article  CAS  PubMed  Google Scholar 

  40. Komatsu F, Komatsu M, Di Ieva A, Tschabitscher M (2013) Endoscopic extradural subtemporal approach to lateral and central skull base: a cadaveric study. World Neurosurg 80:591–597. https://doi.org/10.1016/j.wneu.2012.12.018

    Article  PubMed  Google Scholar 

  41. Kusumi M, Fukushima T, Mehta AI, Aliabadi H, Nonaka Y, Friedman AH, Fujii K (2012) Tentorial detachment technique in the combined petrosal approach for petroclival meningiomas. J Neurosurg 116:566–573. https://doi.org/10.3171/2011.11.JNS11985

    Article  PubMed  Google Scholar 

  42. Kusumi M, Fukushima T, Mehta AI, Cunningham CD, Friedman AH, Fujii K (2013) Middle fossa approach for total resection of petrous apex cholesterol granulomas: use of vascularized galeofascial flap preventing recurrence. Neurosurgery 72:77–86; discussion 86. https://doi.org/10.1227/NEU.0b013e3182724354

    Article  PubMed  Google Scholar 

  43. Lau DP, Wharton SB, Antoun NM, Bottrill ID, Moffat DA (1997) Chondrosarcoma of the petrous apex. Dilemmas in diagnosis and treatment. J Laryngol Otol 111:368–371

    Article  CAS  PubMed  Google Scholar 

  44. Lim J, Cho K (2016) The modified lateral supraorbital approach for tumors of the petroclival junction extending into the anterior cerebellopontine area. J Neuro-Oncol 127:541–550. https://doi.org/10.1007/s11060-016-2061-9

    Article  Google Scholar 

  45. Locatelli D, Pozzi F, Turri-Zanoni M, Battaglia P, Santi L, Dallan I, Castelnuovo P (2016) Transorbital endoscopic approaches to the skull base: current concepts and future perspectives. J Neurosurg Sci 60:514–525

    PubMed  Google Scholar 

  46. Mandel M, Tutihashi R, Abramovicz Mandel S, Jacobsen Teixeira M, Gadelha Figueiredo E (2017) Minimally invasive transpalpebral “eyelid” approach to unruptured middle cerebral artery aneurysms. Oper Neurosurg 13:1–12. https://doi.org/10.1093/ons/opx021

    Article  Google Scholar 

  47. Mandelli C, Porras L, López-Sánchez C, Sicuri GM, Lomonaco I, García-Martínez V (2008) The partial labyrinthectomy petrous apicectomy approach to petroclival meningiomas. A quantitative anatomic comparison with other approaches to the same region. Neurocirugia (Astur) 19:133–142

    Article  CAS  Google Scholar 

  48. Maurer AJ, Bonney PA, Iser CR, Ali R, Sanclement JA, Sughrue ME (2015) Endoscopic endonasal infrapetrous transpterygoid approach to the Petroclival junction for petrous apex chondrosarcoma: technical report. J Neurol Surg Rep 76:e113–e116. https://doi.org/10.1055/s-0035-1549222

    Article  PubMed  PubMed Central  Google Scholar 

  49. Miller ME, Mastrodimos B, Cueva RA (2012) Hearing preservation in management of epidermoids of the cerebellopontine angle: CPA epidermoids and hearing preservation. Otol Neurotol 33:1599–1603. https://doi.org/10.1097/MAO.0b013e31826bed8d

    Article  PubMed  Google Scholar 

  50. Moe KS, Bergeron CM, Ellenbogen RG (2010) Transorbital neuroendoscopic surgery. Neurosurgery 67:ons16–ons28. https://doi.org/10.1227/01.NEU.0000373431.08464.43

    PubMed  Google Scholar 

  51. Muto J, Prevedello DM, Ditzel Filho LF, Tang IP, Oyama K, Kerr EE, Otto BA, Kawase T, Yoshida K, Carrau RL (2016) Comparative analysis of the anterior transpetrosal approach with the endoscopic endonasal approach to the petroclival region. J Neurosurg 125:1171–1186. https://doi.org/10.3171/2015.8.JNS15302

    Article  PubMed  Google Scholar 

  52. Peyre M, Bozorg-Grayeli A, Rey A, Sterkers O, Kalamarides M (2012) Posterior petrous bone meningiomas: surgical experience in 53 patients and literature review. Neurosurg Rev 35:53–66; discussion 66. https://doi.org/10.1007/s10143-011-0333-6

    Article  PubMed  Google Scholar 

  53. Presutti L, Alicandri-Ciufelli M, Rubini A, Gioacchini FM, Marchioni D (2014) Combined lateral microscopic/endoscopic approaches to petrous apex lesions: pilot clinical experiences. Ann Otol Rhinol Laryngol 123:550–559. https://doi.org/10.1177/0003489414525342

    Article  PubMed  Google Scholar 

  54. Ramakrishna R, Kim LJ, Bly RA, Moe K, Ferreira M (2016) Transorbital neuroendoscopic surgery for the treatment of skull base lesions. J Clin Neurosci 24:99–104. https://doi.org/10.1016/j.jocn.2015.07.021

    Article  PubMed  Google Scholar 

  55. Rigante L, Herlan S, Tatagiba MS, Stanojevic M, Hirt B, Ebner FH (2016) Petrosectomy and topographical anatomy in traditional Kawase and posterior Intradural petrous apicectomy (PIPA) approach: an anatomical study. World Neurosurg 86:93–102. https://doi.org/10.1016/j.wneu.2015.08.083

    Article  PubMed  Google Scholar 

  56. Russo FY, De Seta D, Mosnier I, Sterkers O, Bernardeschi D (2016) Surgical management of petrous apex cholesterol granulomas by an infralabyrinthine approach: our experience with fourteen cases. Clin Otolaryngol. https://doi.org/10.1111/coa.12721

  57. Sabin HI, Bordi LT, Symon L (1987) Epidermoid cysts and cholesterol granulomas centered on the posterior fossa: twenty years of diagnosis and management. Neurosurgery 21:798–805

    Article  CAS  PubMed  Google Scholar 

  58. Samii A, Gerganov V, Herold C, Gharabaghi A, Hayashi N, Samii M (2009) Surgical treatment of skull base chondrosarcomas. Neurosurg Rev 32:67–75; discussion 75. https://doi.org/10.1007/s10143-008-0170-4

    Article  PubMed  Google Scholar 

  59. Sbaihat A, Bacciu A, Pasanisi E, Sanna M (2013) Skull base chondrosarcomas: surgical treatment and results. Ann Otol Rhinol Laryngol 122:763–770. https://doi.org/10.1177/000348941312201206

    Article  PubMed  Google Scholar 

  60. Sharma M, Ambekar S, Guthikonda B, Nanda A (2014) A comparison between the Kawase and extended retrosigmoid approaches (retrosigmoid transtentorial and retrosigmoid intradural suprameatal approaches) for accessing the petroclival tumors. A cadaveric study. J Neurol Surg B Skull Base 75:171–176. https://doi.org/10.1055/s-0033-1359305

    Article  PubMed  PubMed Central  Google Scholar 

  61. Shimony N, Gonen L, Shofty B, Abergel A, Fliss DM, Margalit N (2016) Surgical resection of skull-base chordomas: experience in case selection for surgical approach according to anatomical compartments and review of the literature. Acta Neurochir. https://doi.org/10.1007/s00701-016-3032-9

  62. Shin M, Kondo K, Hanakita S, Hasegawa H, Yoshino M, Teranishi Y, Kin T, Saito N (2017) Endoscopic transsphenoidal anterior petrosal approach for locally aggressive tumors involving the internal auditory canal, jugular fossa, and cavernous sinus. J Neurosurg 126:212–221. https://doi.org/10.3171/2016.1.JNS151979

    Article  PubMed  Google Scholar 

  63. Simal-Julián JA, Miranda-Lloret P, Botella-Asunción C, Kassam A (2014) Full endoscopic endonasal expanded approach to the petroclival region: optimizing the carotid-clival window. Acta Neurochir 156:1627–1629. https://doi.org/10.1007/s00701-014-2125-6

    Article  PubMed  Google Scholar 

  64. Taniguchi M, Akutsu N, Mizukawa K, Kohta M, Kimura H, Kohmura E (2016) Endoscopic endonasal translacerum approach to the inferior petrous apex. J Neurosurg 124:1032–1038. https://doi.org/10.3171/2015.1.JNS142526

    Article  PubMed  Google Scholar 

  65. Tatagiba M, Acioly MA, Roser F (2013) Petroclival tumors. J Neurosurg 119:526–528. https://doi.org/10.3171/2013.2.JNS13319

    Article  PubMed  Google Scholar 

  66. Tripathi M, Deo RC, Suri A, Srivastav V, Baby B, Kumar S, Kalra P, Banerjee S, Prasad S, Paul K, Roy TS, Lalwani S (2015) Quantitative analysis of the Kawase versus the modified Dolenc-Kawase approach for middle cranial fossa lesions with variable anteroposterior extension. J Neurosurg 123:14–22. https://doi.org/10.3171/2015.2.JNS132876

    Article  PubMed  Google Scholar 

  67. Troude L, Carissimi M, Lavieille JP, Roche PH (2016) How I do it: the combined petrosectomy. Acta Neurochir 158:711–715. https://doi.org/10.1007/s00701-016-2740-5

    Article  PubMed  Google Scholar 

  68. Van Gompel JJ, Alikhani P, Youssef AS, Loveren HR, Boyev KP, Agazzi S (2015) Anterior petrosectomy: consecutive series of 46 patients with attention to approach-related complications. J Neurol Surg B Skull Base 76:379–384. https://doi.org/10.1055/s-0034-1543971

    Article  PubMed  PubMed Central  Google Scholar 

  69. Wayhs SY, Lepski GA, Frighetto L, Isolan GR (2017) Petroclival meningiomas: remaining controversies in light of minimally invasive approaches. Clin Neurol Neurosurg 152:68–75. https://doi.org/10.1016/j.clineuro.2016.11.021

    Article  PubMed  Google Scholar 

  70. Wright E, Spetzler RF (2015) The expanded endoscopic endonasal approach to Petroclival lesions: a useful adjunct to traditional skull base approaches. World Neurosurg 84:224–225. https://doi.org/10.1016/j.wneu.2015.04.010

    Article  PubMed  Google Scholar 

  71. Xu F, Karampelas I, Megerian CA, Selman WR, Bambakidis NC (2013) Petroclival meningiomas: an update on surgical approaches, decision making, and treatment results. Neurosurg Focus 35:E11. https://doi.org/10.3171/2013.9.FOCUS13319

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors thank Antonia Conti, Medical Illustrator, for the precious artistic drawing dedicated to this paper.

This work has been partly supported by the grant “Marató TV3 Project” [411/U/2011—title: Quantitative analysis and computer-aided simulation of minimally invasive approaches for intracranial vascular lesions].

Author information

Authors and Affiliations

  1. Division of Neurosurgery, School of Medicine and Surgery, Università degli Studi di Napoli “Federico II”, 80131, Naples, Italy

    Alberto Di Somma, Luigi Maria Cavallo, Federico Frio, Rosa Maria Gerardi, Domenico Solari & Paolo Cappabianca

  2. Department of Neurosurgery, University of Cincinnati (UC) College of Medicine, Comprehensive Stroke Center at UC Neuroscience Institute, Mayfield Clinic, Cincinnati, OH, USA

    Norberto Andaluz

  3. Department of Neurosurgery, Hospital Clinic, Faculty of Medicine, Universitat de Barcelona, Barcelona, Spain

    Thomaz E. Topczewski & Joaquim Enseñat

  4. Laboratory of Surgical Neuroanatomy (LSNA), Faculty of Medicine, Universitat de Barcelona, Barcelona, Spain

    Jose Pineda & Alberto Prats-Galino

Authors
  1. Alberto Di Somma
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Norberto Andaluz
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Luigi Maria Cavallo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Thomaz E. Topczewski
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Federico Frio
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Rosa Maria Gerardi
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jose Pineda
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Domenico Solari
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Joaquim Enseñat
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Alberto Prats-Galino
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Paolo Cappabianca
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Alberto Di Somma.

Ethics declarations

Conflicts of interest

None.

Human and animal rights and informed consent

This article does not contain any studies with human participants performed by any of the authors.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Di Somma, A., Andaluz, N., Cavallo, L.M. et al. Endoscopic transorbital route to the petrous apex: a feasibility anatomic study. Acta Neurochir 160, 707–720 (2018). https://doi.org/10.1007/s00701-017-3448-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00701-017-3448-x

Keywords

Search

Navigation