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Simplified anterior transpetrosal approach without superior petrosal sinus and tentorial incision for lesions centered in Meckel’s cave

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Abstract

Objective

The anterior transpetrosal approach (ATPA) is an effective method to reach lesions in the petroclival region. This approach involves many steps, including superior petrosal sinus (SPS) ligation and tentorial cutting. It is sometimes unnecessary to perform all procedures in the ATPA for certain lesions, especially those centered in the Meckel’s cave. Here, we present a simplified anterior transpetrosal approach (SATPA) without superior petrosal sinus and tentorial incision for lesions centered in the Meckel’s cave as a modified ATPA.

Methods

This study included 13 patients treated with SATPA. The initial steps of SATPA are similar to ATPA, excluding a middle cranial fossa dural incision, SPS dissection, or tentorial incision. Histological examination was performed to understand the membrane structure of the trigeminal nerve, which runs through the Meckel’s cave.

Results

Pathology revealed trigeminal schwannoma (n=11), extraventricular central neurocytoma (n=1), and a metastatic tumor (n=1). The average tumor size was 2.4 cm. The total removal rate was 76.9% (10/13). Permanent complications included trigeminal neuropathy in four cases and cerebrospinal fluid leakage in one case. Histological examination revealed the trigeminal nerve traverses the subarachnoid space from the posterior fossa subdural space to the Meckel’s cave and is covered with the epineurium in the inner reticular layer.

Conclusions

We used SATPA for lesions located in the Meckel’s cave identified using histological examination. This approach may be considered for small- to medium-sized lesions centered in the Meckel space.

Clinical Trial Registration number

None.

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Acknowledgements

We would like to thank Ms. Sena Inoue for her excellent illustrations and Editage (www.editage.com) for English language editing.

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Ashikaga Red Cross Hospital, 284-1 Yobe-cho, Ashikaga, Tochigi, 326-0843, Japan

    Shunsuke Shibao

  2. Department of Neurosurgery, Keio University School of Medicine, 35 Shinano-machi, Shinjuku-ku, Tokyo, 160-8582, Japan

    Shunsuke Shibao & Kazunari Yoshida

Authors
  1. Shunsuke Shibao
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  2. Kazunari Yoshida
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Corresponding author

Correspondence to Shunsuke Shibao.

Ethics declarations

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee (the Keio University Center for Clinical Research) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.

Conflict of interest

The authors declare no competing interests.

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Comments

The authors reported an anterior transpetrosal approach simplified by minimizing the dural incision. In this procedure, a dura incision was made from the dura of the posterior cranial fossa to the Meckel's case after petrosectomy without cutting the middle cranial fossa dura, tentorium and superior petroleum sinus. The surgical procedure is clearly explained in the illustrations. Several modified techniques have been reported for anterior transpetrosal approach, including the extent of bone dissection, the use of intradural routes, etc.[1，2，3，4] Minimal dural incision, tailored to the lesion centered in the Meckel's cave in this manuscript, could be better used in endoscopic surgery.

(1) Ichimura S, Hori S, Hecht N, Czabanka M, Vajkoczy P (2016) Intradural anterior transpetrosal approach. Neurosurg Rev 39(4):625-31

(2) Morisako H, Ohata H, Shinde B, Nagahama A, Watanabe Y, Goto T (2021) Minimal anterior and posterior combined transpetrosal approach for large petroclival meningiomas. J Neurosurg DOI: 10.3171/2020.8.JNS202060.

(3) Tomio R, Horiguchi T, Borghei-Razavi H, Tamura R, Yoshida K, Kawase T (2021) Anterior transpetrosal approach: experiences in 274 cases over 33 years. Technical variations, operated patients, and approach-related complications. J Neurosurg 136(2): 413-421

(4) Xu Z, Wang W, Zhang J, Liu W, Feng Y, Li G (2014) Subtemporal-anterior transtentoral approach to middle cranial fossa microsurgical anatomy. J Craniofac Surg 25(6): 2220-2

Kenji Ohata

Osaka, Japan

Previous presentation: The manuscript was accepted as a podium presentation at the 29th annual meeting of the Japanese Society for Skull Base Surgery on June 15–16, 2017 in Matsumoto, Nagano, Japan.

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Shibao, S., Yoshida, K. Simplified anterior transpetrosal approach without superior petrosal sinus and tentorial incision for lesions centered in Meckel’s cave. Acta Neurochir 165, 1833–1839 (2023). https://doi.org/10.1007/s00701-023-05584-9

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  • DOI: https://doi.org/10.1007/s00701-023-05584-9

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