Variants of the Anterior Subtemporal Approach to the Gasserian Ganglion and Related Structures: An Anatomical Study With Relevant Implications for Keyhole Surgery

被引：0

作者：

Sponton, Lucas Serrano ^{[1
]}

Archavlis, Eleftherios ^{[2
]}

Conrad, Jens ^{[2
]}

Nimer, Amr ^{[3
]}

Ayyad, Ali ^{[4
]}

Januschek, Elke ^{[1
]}

Jussen, Daniel ^{[5
]}

Czabanka, Marcus ^{[5
]}

Schumann, Sven ^{[6
]}

Kantelhardt, Sven R. ^{[2
,7
]}

机构：

[1] Johann Wolfgang Goethe Univ Frankfurt Main Acad Ho, Dept Neurosurg, Sana Clin Offenbach, Offenbach, Germany

[2] Mainz Univ Med Ctr, Dept Neurosurg, Mainz, Germany

[3] Imperial Coll Healthcare, Charing Cross Hosp, Dept Neurosurg, London, England

[4] Saarland Univ Med Ctr, Dept Neurosurg, Homburg, Germany

[5] Frankfurt Am Main Univ Med Ctr, Dept Neurosurg, Frankfurt, Germany

[6] Mainz Univ Med Ctr, Inst Funct & Clin Anat, Mainz, Germany

[7] Dept Neurosurg, Vivantes Clin Berlin Friedrichshein, Berlin, Germany

来源：

WORLD NEUROSURGERY | 2023年 / 176卷

关键词：

Gasserian ganglion; Keyhole anterior subtemporal approach; Trigeminal ganglion; FACIAL-NERVE; SKULL BASE; TRIGEMINAL-SCHWANNOMAS; OPHTHALMIC ARTERY; PETROCLIVAL MENINGIOMAS; MICROSURGICAL ANATOMY; INTERDURAL APPROACH; CAVERNOUS SINUS; MIDDLE FOSSA; EXPERIENCE;

D O I：

10.1016/j.wneu.2023.05.106

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

BACKGROUND: The advantages and limitations of different craniotomy positions and approach trajectories to the gasserian ganglion (GG) and related structures using an anterior subtemporal approach have not been studied sys-tematically. Knowledge of these features is of importance when planning keyhole anterior subtemporal (kAST) ap-proaches to the GG to optimize access and minimize risks.METHODS: Eight formalin-fixed heads were used bilat-erally to assess temporal lobe retraction (TLR), trigeminal exposure, and relevant anatomical aspects of extra-and transdural classic anterior subtemporal (CLAST) ap-proaches compared with slightly dorsally and ventrally allocated corridors.RESULTS: TLR to the GG and foramen ovale was found to be lower via the CLAST approach (P < 0.001). Using the ventral variant, TLR to access the foramen rotundum was minimized (P < 0.001). The overall TLR was maximal using the dorsal variant (P < 0.001) owing to interposition of the arcuate eminence. An extradural CLAST approach required wide exposure of the greater petrosal nerve (GPN) and middle meningeal artery (MMA) sacrifice. Both maneuvers were spared using a transdural approach. Using CLAST, medial dissection >39 mm can enter the Parkinson triangle, jeopardizing the intracavernous internal carotid artery. The ventral variant enabled access to the anterior portion of the GG and foramen ovale without the need for MMA sacrifice or GPN dissection.CONCLUSIONS: The CLAST approach provides high versatility to approach the trigeminal plexus, minimizing TLR. However, an extradural approach jeopardizes the GPN and requires MMA sacrifice. The risk of cavernous sinus violation exists when progressing medially beyond 4 cm. The ventral variant has some advantages to access the ventral structures and avoid MMA and GPN manipulation. In contrast, the usefulness of the dorsal variant is rather limited owing to the greater TLR required.

引用

页码：E587 / E597

页数：11