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Endoscopic approach-routes in the posterior fossa cisterns through the retrosigmoid keyhole craniotomy: an anatomical study

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Abstract

Endoscopy in cerebellopontine angle surgery is an increasingly used technique. Despite of its advantages, the shortcomings arising from the complex anatomy of the posterior fossa are still preventing its widespread use. To overcome these drawbacks, the goal of this study was to define the anatomy of different endoscopic approaches through the retrosigmoid craniotomy and their limitations by surgical windows. Anatomical dissections were performed on 25 fresh human cadavers to describe the main approach-routes. Surgical windows are spaces surrounded by neurovascular structures acting as a natural frame and providing access to deeper structures. The approach-routes are trajectories starting at the craniotomy and pointing to the lesion, passing through certain windows. Twelve different windows could be identified along four endoscopic approach-routes. The superior route provides access to the structures of the upper pons, lower mesencephalon, and the upper neurovascular complex through the suprameatal, superior cerebellar, and infratrigeminal windows. The supratentorial route leads to the basilar tip and some of the suprasellar structures via the ipsi- and contralateral oculomotor and dorsum sellae windows. The central endoscopic route provides access to the middle pons and the middle neurovascular complex through the inframeatal, AICA, and basilar windows. The inferior endoscopic route is the pathway to the medulla oblongata and the lower neurovascular complex through the accessory, hypoglossal, and foramen magnum windows. The anatomy and limitations of each surgical windows were described in detail. These informations are essential for safe application of endoscopy in posterior fossa surgery through the retrosigmoid approach.

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Acknowledgment

The present work was performed in fulfillment of the requirements for obtaining the degree “Dr. med.” at the Faculty of Medicine, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Germany

We would like to thank the kindly support for the team of the Endomin College, namely for Prof. Nikolai J. Hopf and Prof. Robert Reisch. Working together on numerous courses on endoscopic and minimally invasive neurosurgery helped for the authors (PK, GB) to gain many ideas and experiences for the present study during teaching of colleagues from all over the world for handling of endoscopes and the related anatomy of the skull base.

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Authors and Affiliations

  1. Department of Neurosurgery, Katharinenhospital, Klinikum Stuttgart, Kriegsbergstrasse 60, 70174, Stuttgart, Germany

    Peter Kurucz, Firas Thaher & Oliver Ganslandt

  2. Laboratory for Applied and Clinical Anatomy, Department of Anatomy, Histology and Embryology, Semmelweis University, Budapest, Hungary

    Peter Kurucz, Gabor Baksa & Lajos Patonay

  3. Department of Neurosurgery, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany

    Michael Buchfelder

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  1. Peter Kurucz
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  2. Gabor Baksa
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Correspondence to Peter Kurucz.

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The authors declare that they have no conflict of interest.

Ethical approval

The complete study was performed on the cadaveric specimens of the Department of Anatomy, Histology and Embryology, Semmelweis University, Budapest, Hungary. According to the Institutional Rules, the use of these cadaveric specimens for anatomical dissections does not require specific approval from ethics committee.

This article does not contain any studies with human participants or animals performed by any of the authors. For this type of study, formal consent is not required.

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Kurucz, P., Baksa, G., Patonay, L. et al. Endoscopic approach-routes in the posterior fossa cisterns through the retrosigmoid keyhole craniotomy: an anatomical study. Neurosurg Rev 40, 427–448 (2017). https://doi.org/10.1007/s10143-016-0800-1

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