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Comparative anatomical study on the role of zygomatic osteotomy in the extradural subtemporal approach to the clival region, when less is more

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Abstract

Purpose

A great concern in performing the extradural subtemporal approach (ESTA) is the evaluation of the actual advantage provided by zygomatic osteotomy (ZO). Complications related to zygomatic dissection have been widely reported in the literature, making it of paramount importance to balance the actual need to perform it, against the risk of maneuver-related morbidity. Authors comparatively analyze the putative advantage provided by ZO in the ESTA in terms of anatomic exposure and surgical operability. Technical limits and potentials are critically revised and discussed.

Methods

A comparative microanatomical laboratory investigation was conducted. The operability score (OS) was applied for quantitative analysis of surgical operability.

Results

ZO was found to provide a weakly significant improvement in the surgical angle of attack (p value 0.01) (mean increase 3°). Maneuverability arch (MAC) increase related to ZO did not reach statistical significance (p value 0.09) (mean increase 2°). The variations provided by MAC increase on the conizing effect (CE) did not lead to an actual advantage in the real surgical scenario, modifying the vision area (VA) in terms of reduction of central vision area (CA) in favor of an increase of peripheral vision area (PA) only in the most caudal part of the surgical field. Ultimately, ZO did not influence the overall OS, scoring both ESTA-ZO+ and ESTA-ZO− 2 out of 3.

Conclusion

In the ESTA, ZO does not provide an actual significant advantage in terms of surgical operability on clival and paraclival areas.

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Funding

No funding was received for this research.

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Authors and Affiliations

  1. Department of Neurosurgery and Gamma Knife Radiosurgery, San Raffaele Scientific Institute, Vita-Salute University, Via Olgettina 60, 20132, Milan, Italy

    Filippo Gagliardi, Martina Piloni, Michele Bailo, Nicola Boari, Francesco Calvanese, Alfio Spina & Pietro Mortini

  2. Department of Neurological Surgery, The George Washington University, Washington, DC, USA

    Anthony J. Caputy

Authors
  1. Filippo Gagliardi
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  2. Martina Piloni
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  3. Michele Bailo
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  4. Nicola Boari
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  5. Francesco Calvanese
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  7. Anthony J. Caputy
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  8. Pietro Mortini
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Contributions

The corresponding author (FG) on behalf of all co-authors certify that all co-authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by FG, MP, MB, NB, FC and AS. The first draft of the manuscript was written by FG, PM and AJC and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Filippo Gagliardi.

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The corresponding author (F.G.) on behalf of all co-authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers' bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

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Being an anatomic cadaveric study, this article does not contain any studies with living human participants or animals performed by any of the authors.

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Gagliardi, F., Piloni, M., Bailo, M. et al. Comparative anatomical study on the role of zygomatic osteotomy in the extradural subtemporal approach to the clival region, when less is more. Surg Radiol Anat 42, 567–575 (2020). https://doi.org/10.1007/s00276-019-02407-4

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  • DOI: https://doi.org/10.1007/s00276-019-02407-4

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