Surgical Approaches to Cerebellopontine Angle: A 17-Year Experience of Our Skull Base Team

It is with great pleasure and pride we submit this Neurosurgical Focus video supplement on surgical approaches to the CPA angle. We had the privilege of viewing a multitude of videos describing surgical pathology and technique for lesions within the cerebellar pontine angle. The quality of work was outstanding! Hours of review were required to narrow down the videos for this supplement. This issue consists of 23 videos that we feel offer unique surgical pearls to the viewer in clinical evaluation, surgical planning and surgery, and outcomes. The videos are of different clinical problems and offer education for both the novice and expert skull base surgeon. We enjoyed being a part of this project, and feel very proud of its content and authors. We are confident that you will enjoy this supplement.

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Use of Porcine Small Intestinal Submucosal Grafts in Skull Base Reconstruction after Resection of Cerebellopontine Angle Tumors

10.1055/s-0039-1679752 ◽

2019 ◽

Author(s):

Douglas Totten ◽

Robert Yawn ◽

Nauman Manzoor ◽

Matthew Dedmon ◽

Reid Thompson ◽

...

Keyword(s):

Skull Base ◽

Cerebellopontine Angle ◽

Skull Base Reconstruction ◽

Cerebellopontine Angle Tumors ◽

Small Intestinal

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SURGICAL APPROACHES TO THE ANTERIOR SKULL BASE

10.26226/morressier.578e3b51d462b80292382a24 ◽

2016 ◽

Author(s):

Dimitrios Avgoustidis

Keyword(s):

Skull Base ◽

Anterior Skull Base ◽

Surgical Approaches

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Revising the Indications of Transtemporal Surgical Approaches in the Modern Endoscopic Era of Skull Base Surgery: A Dying Art

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0040-1718767 ◽

2020 ◽

Author(s):

Ravi Sankar Manogaran ◽

Raj Kumar ◽

Arulalan Mathialagan ◽

Anant Mehrotra ◽

Amit Keshri ◽

...

Keyword(s):

Skull Base ◽

Surgical Approach ◽

Nerve Palsy ◽

Tertiary Care ◽

Surgical Approaches ◽

Microsurgical Anatomy ◽

Complete Excision ◽

Lateral Skull Base ◽

The Individual ◽

Selection Of

Abstract Objectives The aim of the study is to emphasize and explore the possible transtemporal approaches for spectrum of complicated lateral skull base pathologies. Design Retrospective analysis of complicated lateral skull base pathologies was managed in our institute between January 2017 and December 2019. Setting The study was conducted in a tertiary care referral center. Main Outcome Measures The study focused on the selection of approach based on site and extent of the pathology, the surgical nuances for each approach, and the associated complications. Results A total of 10 different pathologies of the lateral skull base were managed by different transtemporal approaches. The most common complication encountered was facial nerve palsy (43%, n = 6). Other complications included cerebrospinal fluid (CSF) collection (15%, n = 2), cosmetic deformity (24%, n = 4), petrous internal carotid artery injury (7%, n = 1), and hypoglossal nerve palsy (7%, n = 1). The cosmetic deformity included flap necrosis (n = 2) and postoperative bony defects leading to contour defects of the scalp (n = 2). Conclusion Surgical approach should be tailored based on the individual basis, to obtain adequate exposure and complete excision. Selection of appropriate surgical approach should also be based on the training and preference of the operating surgeon. Whenever necessary, combined surgical approaches facilitating full tumor exposure are recommended so that complete tumor excision is feasible. This requires a multidisciplinary team comprising neurosurgeons, neuro-otologist, neuroanesthetist, and plastic surgeons. The surgeon must know precise microsurgical anatomy to preserve the adjacent nerves and vessels, which is necessary for better surgical outcomes.

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Developmentally anomalous cerebellar encephalocele arising within the cerebellopontine angle and extending into the adjacent skull base in a pediatric patient

Child s Nervous System ◽

10.1007/s00381-020-05020-8 ◽

2021 ◽

Author(s):

Forrest A. Hamrick ◽

Michael Karsy ◽

Carol S. Bruggers ◽

Angelica R. Putnam ◽

Gary L. Hedlund ◽

...

Keyword(s):

Skull Base ◽

Pediatric Patient ◽

Cerebellopontine Angle ◽

Resonance Imaging ◽

Middle Cerebellar Peduncle ◽

Cerebellar Tissue ◽

Cerebellar Peduncle ◽

Histopathologic Analysis ◽

The Right ◽

Internal Acoustic Canal

AbstractLesions of the cerebellopontine angle (CPA) in young children are rare, with the most common being arachnoid cysts and epidermoid inclusion cysts. The authors report a case of an encephalocele containing heterotopic cerebellar tissue arising from the right middle cerebellar peduncle and filling the right internal acoustic canal in a 2-year-old female patient. Her initial presentation included a focal left 6th nerve palsy. Magnetic resonance imaging was suggestive of a high-grade tumor of the right CPA. The lesion was removed via a retrosigmoid approach, and histopathologic analysis revealed heterotopic atrophic cerebellar tissue. This report is the first description of a heterotopic cerebellar encephalocele within the CPA and temporal skull base of a pediatric patient.

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Keyhole Surgical Approaches for Skull Base and Other Intracranial Meningiomas: Technical Nuances and Clinical Outcomes in 177 Patients

10.1055/s-0041-1725314 ◽

2021 ◽

Author(s):

Jai Thakur ◽

Regin Mallari ◽

Alex Corlin ◽

Samantha Yawitz ◽

Amalia Eisenberg ◽

...

Keyword(s):

Skull Base ◽

Clinical Outcomes ◽

Surgical Approaches ◽

Intracranial Meningiomas

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Imaging of the Postoperative Skull Base and Cerebellopontine Angle

Neuroimaging Clinics of North America ◽

10.1016/j.nic.2021.08.005 ◽

2022 ◽

Vol 32 (1) ◽

pp. 159-174

Author(s):

Jeffrey Xi Yang ◽

Nafi Aygun ◽

Rohini Narahari Nadgir

Keyword(s):

Skull Base ◽

Cerebellopontine Angle

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Transorbital penetrating injury of the skull base and cavernous sinus - defining a minimal invasive treatment

Vojnosanitetski pregled ◽

10.2298/vsp200529106j ◽

2020 ◽

pp. 106-106

Author(s):

Bojan Jelaca ◽

Djula Djilvesi ◽

Papic Vladimir ◽

Filip Pajicic ◽

Milan Lepic ◽

...

Keyword(s):

Foreign Body ◽

Minimally Invasive ◽

Skull Base ◽

Cavernous Sinus ◽

Penetrating Trauma ◽

Minimal Invasive ◽

Surgical Approaches ◽

Invasive Treatment ◽

Minimal Invasive Treatment ◽

Therapeutic Problem

Introduction. A transorbital intracranial injury with a foreign body can be a very complex and controversial therapeutic problem. The orbit's content is susceptible to penetrating trauma, and neurovascular skull base structures are at high risk from injury. There are some traditional cranial surgical approaches, and more recently reported different endoscopic approaches for treating this kind of injury. Case report. We present a case of a 30-year-old male who had an accident at work when a piece of wood hit him in his head and entered through the medial aspect of his left orbit with skull base and cavernous sinus injury. Rapid and complete radiological and clinical assessments were performed, and the patient was treated in a minimally invasive manner. The foreign body was manually extracted with an endoscopic and endovascular team ready to treat adverse events. No postoperative complications were reported, and visual acuity increased at one month follow up. Conclusion. Penetrating wounds of the orbit represent a challenge that requires a multidisciplinary assessment and well-organized management. Combined endoscopic minimally invasive approaches should be considered during the treatment of this kind of injury.

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Skull Base Trauma: Clinical Considerations in Evaluation and Diagnosis and Review of Management Techniques and Surgical Approaches

Seminars in Plastic Surgery ◽

10.1055/s-0037-1607275 ◽

2017 ◽

Vol 31 (04) ◽

pp. 177-188 ◽

Cited By ~ 7

Author(s):

Soroush Farnoosh ◽

Robert Kellman ◽

Sherard Tatum ◽

Jacob Feldman

Keyword(s):

Skull Base ◽

Surgical Approaches ◽

Trauma Patients ◽

Traumatic Injuries ◽

Surgical Access ◽

Radiographic Testing ◽

Cranial Nerve Injury ◽

Cranial Fossa ◽

Skull Base Anatomy ◽

Neurovascular Structures

AbstractTraumatic injuries to the skull base can involve critical neurovascular structures and present with symptoms and signs that must be recognized by physicians tasked with management of trauma patients. This article provides a review of skull base anatomy and outlines demographic features in skull base trauma. The manifestations of various skull base injuries, including CSF leaks, facial paralysis, anosmia, and cranial nerve injury, are discussed, as are appropriate diagnostic and radiographic testing in patients with such injuries. While conservative management is sometimes appropriate in skull base trauma, surgical access to the skull base for reconstruction of traumatic injuries may be required. A variety of specific surgical approaches to the anterior cranial fossa are discussed, including the classic anterior craniofacial approach as well as less invasive and newer endoscope-assisted approaches to the traumatized skull base.

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Radiographic Analysis of the Vidian Canal and Its Utility in Petrous Internal Carotid Artery Localization

Operative Neurosurgery ◽

10.1093/ons/opx305 ◽

2018 ◽

Vol 15 (5) ◽

pp. 577-583 ◽

Cited By ~ 5

Author(s):

Eric C Mason ◽

Patricia A Hudgins ◽

Gustavo Pradilla ◽

Nelson M Oyesiku ◽

C Arturo Solares

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Skull Base ◽

Internal Carotid ◽

Expert Knowledge ◽

Average Distance ◽

Surgical Approaches ◽

Endoscopic Endonasal ◽

Computed Tomographic ◽

Vidian Canal

Abstract BACKGROUND Endoscopic endonasal surgery of the skull base requires expert knowledge of the anatomy and a systematic approach. The vidian canal is regarded as a reliable landmark to localize the petrous internal carotid artery (pICA) near the second genu, which can be used for orientation in deep skull base approaches. There is controversy about the relationship between the vidian canal and the pICA. OBJECTIVE To further establish the vertical relationship between the vidian canal and the pICA to aid in surgical approaches to the skull base. METHODS We utilized a collection of institutional review board-approved computed tomographic (CT) angiograms (CTAs). Fifty CTAs were studied bilaterally for 100 total sides. The vidian canal was visualized radiographically to determine whether it terminates below, at, or above the level of the pICA. RESULTS Sixty-six of 100 vidian canals terminated inferior to the pICA (66%), which was the most common relationship observed. The average distance inferior to the pICA was 1.01 mm on the right, 1.18 mm on the left, and 1.09 mm of the total 66 sides. Less commonly, the vidian canal terminated at the level of the pICA canal in 34 sides (34%). The vidian canal was not observed to terminate superior to the pICA in any of the 50 CTAs studied. CONCLUSION The vidian canal terminates inferior to the pICA most commonly, but often terminates at the level of the pICA. Careful drilling clockwise inferior to superior around the vidian canal should allow for safe pICA localization in most cases.

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