Suboccipital Transhorizontal Fissure Approach for Posterior Cranial Fossa Lesions: A Cadaveric Study and First Clinical Experience

2021 ◽  
Author(s):  
Ryota Tamura ◽  
Makoto Katayama ◽  
Kohsei Yamamoto ◽  
Takashi Horiguchi
Keyword(s):  
Fourth Ventricle ◽  
Cerebellopontine Angle ◽  
Anatomical Study ◽  
Posterior Cranial Fossa ◽  
Cadaveric Study ◽  
Cerebellar Hemisphere ◽  
Anatomical Landmarks ◽  
Cerebellar Retraction ◽  
Cranial Fossa ◽  
Wide Access

Abstract BACKGROUND Surgical treatment of pathological lesions in the deep cerebellar hemisphere, cerebellopontine angle (CPA), and fourth ventricle of the posterior cranial fossa (PCF) is challenging. Conventional neurosurgical approaches to these lesions are associated with risk of various complications. Mastery of efficient fissure dissection is imperative when approaching deep-seated lesions. The horizontal fissure (HF) is the largest and deepest fissure of the cerebellum. OBJECTIVE To conduct an anatomical study and introduce a novel suboccipital trans-HF (SOTHF) approach to access lesions of the deep cerebellar hemispheres, CPA, and upper fourth ventricle of the PCF. METHODS We performed a cadaveric dissection study focusing on anatomical landmarks and surgical feasibility of the SOTHF approach then implemented it in 2 patients with a deep cerebellar hemispheric tumor. RESULTS Anatomical feasibility of the SOTHF approach was demonstrated and compared with conventional approaches in the cadaveric study. Opening the suboccipital surface of the HF to create medial, intermediate, and lateral surgical corridors provided optimal viewing angles and wide access to the deep cerebellar hemispheres, CPA, and upper fourth ventricle without heavy cerebellar retraction. Sacrificing cerebellar neural structures and complex skull base techniques were not required to obtain adequate exposure. The SOTHF approach was successfully applied without complication in 2 patients with a deep cerebellar hemispheric tumor. CONCLUSION The HF is an important cerebellar fissure that provides a gateway to deep areas of the PCF. Further studies are needed to define and expand applications of the SOTHF approach.

Posterior cranial fossa morphometry in symptomatic adult Chiari I malformation patients: Comparative clinical and anatomical study

2011 ◽  
Vol 113 (5) ◽  
pp. 399-403 ◽  
Author(s):  
Ahmet Dagtekin ◽  
Emel Avci ◽  
Engin Kara ◽  
Deniz Uzmansel ◽  
Oykut Dagtekin ◽  
...  
Keyword(s):  
Anatomical Study ◽  
Chiari I Malformation ◽  
Posterior Cranial Fossa ◽  
Chiari I ◽  
Cranial Fossa

Patterns for Differentiation of Posterior Fossa Neoplasms as Detected by Brain Scans

1970 ◽  
Vol 09 (04) ◽  
pp. 303-316
Author(s):  
Frank DeLand ◽  
A. EveretteJames ◽  
Henry Wagner
Keyword(s):  
Skull Base ◽  
Posterior Fossa ◽  
Cerebellopontine Angle ◽  
Lateral View ◽  
Posterior Cranial Fossa ◽  
Anatomical Location ◽  
Posterior View ◽  
Brain Scans ◽  
Histological Characteristics ◽  
Cranial Fossa

SummaryThe histological characteristics of neoplasms that occur in the posterior cranial fossa can often be predicted by a knowledge of the patient’s age and the specific anatomical location of the tumor. Dividing the posterior fossa into midline, cerebellar fossa and cerebellopontine angle provides a scheme to characterize abnormal accumulations of radioactivity according to their anatomical locations. Midline lesions arise from bases activity on the lateral view and are in the midline on the posterior view. Lesions of the cerebellar fossa may be adjacent to but do not appear to arise from the basal structures and are not in the midline. Cerebellopontine angle tumors are adjacent to and appear to arise from the normal radioactivity at the skull base but lie lateral to the midline. The expected distribution of histological types of neoplasms in each area according to age are discussed.

Endoscopic Transorbital Approaches to Anterior and Middle Cranial Fossa: A Laboratory Investigation on Surgical Anatomy and Potential Routes

2020 ◽  
Author(s):  
Beniamino A. Nannavecchia ◽  
Mario Ganau ◽  
Hélène Cebula ◽  
Antonino Scibilia ◽  
Maria T. Bozzi ◽  
...  
Keyword(s):  
Anatomical Study ◽  
Middle Cranial Fossa ◽  
Surgical Anatomy ◽  
Anatomical Landmarks ◽  
Orbital Cavity ◽  
New Horizons ◽  
Endoscopic Transorbital ◽  
Cranial Fossa ◽  
Alternative Routes ◽  
Anatomy Knowledge

Abstract Background Transorbital neuroendoscopic (TONES) approaches promise to open up new horizons for skull base surgery, offering alternative routes to reach the anterior and middle cranial fossa (ACF and MCF, respectively). Objective The aim of this anatomical study is to acquire new surgical anatomy knowledge and exploit it for the refinement of TONES approaches, as an alternative to open surgery, to reduce the distance to the target, and the risk of neurovascular lesions in pathological conditions extending beyond the orbital cavity. Materials and Methods Six head specimens (12 orbits) were studied/dissected. The orbit was approached and divided in a four clockwise quadrants manner to simulate three transconjunctival routes: the precaruncular (PC), preseptal (PS), and lateral retrocanthal (LRC), and one transpalpebral route—the superior eyelid crease (SLC). The boundaries and the most important anatomical landmarks were identified and are herein duly detailed with particular attention to the neurovascular structures encountered in each of those routes. Results The dissections showed that the PC approach facilitates the treatment of optic nerve and frontal sinus pathologies, whereas LRC appears safer to reach ACF and MCF allowing for a free multiplanar working channel (up to 180 degrees) to the floor, roof, and lateral-to-medial walls. Conclusion The plane of tendon lateral canthal's insertion and the sphenofrontal suture (SFS) were identified as the key anatomical landmarks for TONES approaches. Further studies are warranted to establish a practical clinical algorithm based on the anatomical four clockwise quadrants herein implemented/proposed, and the key surgical landmarks identified.

Chronic Lyme Disease with an Expansive Granulomatous Lesion in the Cerebellopontine Angle

Neurosurgery ◽  
1990 ◽  
Vol 27 (3) ◽  
pp. 446-451 ◽  
Author(s):  
Michael Mokry ◽  
Gerhard Flaschka ◽  
Gertrude Kleinert ◽  
Reinhold Kleinert ◽  
Franz Fazekas ◽  
...  
Keyword(s):  
Lyme Disease ◽  
Cerebellopontine Angle ◽  
Surgical Intervention ◽  
Chronic Phase ◽  
Posterior Cranial Fossa ◽  
Subtotal Resection ◽  
Cerebral Lesion ◽  
Chronic Lyme Disease ◽  
Granulomatous Lesions ◽  
Cranial Fossa

Abstract Expansive granulomatous lesions in the posterior cranial fossa are rare and have not been reported in conjunction with Lyme disease. We report a patient with verified Borrelia burgdorferi infection who developed a tumor in the cerebellopontine angle. Rapid growth of the tumor led to signs of cerebral compression and to hydrocephalus. Surgical intervention was required despite florid meningitis. The histological examination showed inflammatory, nonspecific granulation tissue. The origin of this tissue is almost certainly causally related to the B. burgdorferi infection. Signs of inflammation resolved rapidly after subtotal resection. The clinical, radiological, and biochemical course is documented. This is the first report of an expansive cerebral lesion in the chronic phase of Lyme disease.

Hydrocephalus associated with cystic dilation of the foramina of Magendie and Luschka

2010 ◽  
Vol 5 (4) ◽  
pp. 415-418 ◽  
Author(s):  
Hirokazu Takami ◽  
Masahiro Shin ◽  
Masafumi Kuroiwa ◽  
Ayako Isoo ◽  
Kan Takahashi ◽  
...  
Keyword(s):  
Fourth Ventricle ◽  
Imaging Study ◽  
Sudden Onset ◽  
Absorption Capacity ◽  
Posterior Cranial Fossa ◽  
Csf Flow ◽  
Suboccipital Craniotomy ◽  
Cine Mr ◽  
Cranial Fossa ◽  
Clonic Seizures

Cystic malformations in the posterior cranial fossa result from developmental failure in the paleocerebellum and meninges. The authors present the case of an infant with hydrocephalus associated with cystic dilation of the foramina of Magendie and Luschka. This 7-month-old female infant presented with sudden onset of tonic-clonic seizures. Computed tomography revealed tetraventricular hydrocephalus. Magnetic resonance imaging demonstrated a cyst communicating with the fourth ventricle and projecting to the cisterna magna and the cerebellopontine cisterns through the foramina of Magendie and Luschka. A suboccipital craniotomy was performed for removal of the cyst wall, and the transparent membrane covering the foramen of Magendie was removed under a microscope. After the surgery, the patient's hydrocephalus improved and a phase contrast cine MR imaging study showed evidence of normal CSF flow at the level of the third and fourth ventricles. Three weeks later, however, the hydrocephalus recurred. An endoscopic third ventriculocisternostomy was performed to address the possibility of stagnant CSF flow in the posterior cranial fossa, but the hydrocephalus continued. Finally the patient underwent placement of a ventriculoperitoneal shunt, resulting in improvement of her symptoms and resolution of the hydrocephalus. On the basis of this experience and previously published reports, the authors speculate that the cystic malformation in their patient could be classified in a continuum of persistent Blake pouch cysts. Hydrocephalus was caused by a combination of obstruction of CSF flow at the outlets of the fourth ventricle and disequilibrium between CSF production and absorption capacity.

scholarly journals REMOVING A RETROSELLAR PITUITARY ADENOMA VIA THE ENDOSCOPIC ENDONASAL TRANSSPHENOIDAL TRANSCAVERNOUS APPROACH

2019 ◽  
Vol 21 (2) ◽  
pp. 39-44
Author(s):  
О. I. Sharipov ◽  
M. A. Kutin ◽  
P. L. Kalinin
Keyword(s):  
Pituitary Adenoma ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Cavernous Sinus ◽  
Internal Carotid ◽  
Sella Turcica ◽  
Posterior Cranial Fossa ◽  
Anatomical Landmarks ◽  
Endoscopic Endonasal ◽  
Cranial Fossa

The study objective is to describe the removal of the pituitary adenoma from the posterior cranial fossa through endoscopic transsphenoidal trans-cavernous approach, when the main surgical corridor was the tumor-intact cavernous sinus. Materials and methods. A 55-year-old male patient with endosupraretrosellar endocrine-inactive pituitary adenoma was admitted to N.N. Burdenko Research Center of Neurosurgery. The patient had earlier undergone two surgeries for pituitary adenoma. Using the endoscopic endonasal transsphenoidal approach, we found that these surgeries resulted in the formation of scar-altered adipose tissue in the sphenoid sinus and partly in the sella turcica; anatomical landmarks indicating the midline and the location of the internal carotid arteries were absent. We formed an access to both retro- and suprasellar portions of the tumor between the sella turcica and cavernous segment of the internal carotid artery (through the cavernous sinus); then we dissected anterior and posterior walls of the sinus and revealed a soft capsule-free pituitary adenoma, which was completely removed by a vacuum aspirator. The skull base defect was repaired using the multilayer technique with autologous tissues. Results. After surgery, neurological status and visual functions did not change. In the postoperative period, we observed no oculomotor disorders, pituitary insufficiency, diabetes insipidus, or nasal liquorrhea. Follow-up computed tomography scans revealed no signs of intracranial complications or obvious residual tumor tissue. Magnetic resonance imaging 4 month postoperatively demonstrated small laterosellar fragments of the tumor in the sella turcica. The patient was further followed up. Conclusion. Cavernous sinus is a natural anatomical corridor providing access to the structures of the posterior cranial fossa and interpeduncular cistern. The main risk (damage to the cavernous segment of the internal carotid artery) can be minimized by using intraoperative dopplerography and visual control of all manipulations.

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