Commentary: Microsurgical Anatomy of the Endoscopy-Assisted Retrosigmoid Intradural Suprameatal Approach to the Meckel's Cave

2021 ◽  
Author(s):  
Jaafar Basma ◽  
L Madison Michael
Keyword(s):  
Microsurgical Anatomy ◽  
Meckel’S Cave ◽  
Meckel's Cave

Microsurgical Anatomy of the Endoscopy-Assisted Retrosigmoid Intradural Suprameatal Approach to the Meckel's Cave

2021 ◽  
Author(s):  
Yuanzhi Xu ◽  
Benjamin K Hendricks ◽  
Maximiliano Alberto Nunez ◽  
Ahmed Mohyeldin ◽  
Juan C Fernandez-Miranda ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Internal Auditory Canal ◽  
Semicircular Canals ◽  
Petrous Apex ◽  
Microsurgical Anatomy ◽  
Meckel’S Cave ◽  
Meckel's Cave ◽  
Trigeminal Root

Abstract BACKGROUND Understanding the microsurgical anatomical features of the endoscopy-assisted retrosigmoid intradural suprameatal approach (RISA) is critical for surgeons treating petroclival tumors or lesions in the cerebellopontine region that extend into Meckel's cave. OBJECTIVE To evaluate increased exposure for Meckel's cave in the RISA and assess the surgical landmarks for this approach. METHODS A standard retrosigmoid craniotomy to the cerebellopontine region was performed in 4 cadaveric specimens (8 hemispheres) with microscope-assisted endoscopy. The length and depth of the drilling region from the suprameatal tubercle to the petrous apex were analyzed. After opening Meckel's cave and mobilizing the trigeminal root completely, the landmarks for this approach were investigated. RESULTS The endoscopy-assisted RISA facilitates mobilization of the trigeminal root and enhances surgical exposure in the region of Meckel's cave and the petrous apex with increases of 10.1 ± 1.3 mm in depth, 21.4 ± 3.2 mm in length, and 6.4 ± 0.6 mm in height. The posterior and superior semicircular canals, internal auditory canal, superior petrous sinus, and internal carotid artery (petrous segment) served as important landmarks for this approach. One case illustration is presented to describe the application of this approach. CONCLUSION The RISA is suitable mainly for lesions in the posterior fossa that extend into Meckel's cave. The endoscopy-assisted reach optimizes accessibility to the petrous apex region, obviates the need for extensive drilling, and decreases the risk of internal carotid artery injury. Better realization and recognition of microsurgical landmarks and parameters of this approach are crucial for successful outcomes.

Retrosigmoid Intradural Suprameatal Approach: Advantages and Disadvantages from an Anatomical Perspective

2006 ◽  
Vol 59 (suppl_1) ◽  
pp. ONS-1-ONS-6 ◽  
Author(s):  
Amitabha Chanda ◽  
Anil Nanda
Keyword(s):  
Trigeminal Nerve ◽  
Internal Auditory Canal ◽  
Semicircular Canals ◽  
Petrous Apex ◽  
Microsurgical Anatomy ◽  
Meckel’S Cave ◽  
Advantages And Disadvantages ◽  
Meckel's Cave ◽  
Trigeminal Root ◽  
Neurovascular Structures

Abstract OBJECTIVE: To assess the advantages and disadvantages of the retrosigmoid intradural suprameatal approach by studying the microsurgical anatomy. This study was performed primarily to assess the advantages of the retrosigmoid intradural suprameatal approach by measuring the amount of increased exposure it provides for lesions of the cerebellopontine and petroclival region as well as to identify the disadvantages of the approach. METHODS: Twenty sides of 10 cadaver heads (embalmed and injected) were dissected under ×3 to ×40 magnification. A standard retrosigmoid craniotomy was made. The cerebellopontine cistern was entered to expose the neurovascular structures, and the internal auditory canal was opened by drilling the margin of the internal auditory meatus. After this, the suprameatal tubercle was drilled, followed by additional drilling to resect the petrous apex. The trigeminal root was mobilized completely after opening Meckel's cave. During drilling, care was taken to preserve the posterior and superior semicircular canals, petrosal sinus, and the internal carotid artery. RESULTS: The approach enhanced the exposure of the cerebellopontine cistern and Meckel's cave. There was an additional exposure of 10.7 ± 1.16 mm length of trigeminal nerve on the right side and an additional 10.7 ± 1.25 mm on the left. This helped to mobilize and further retract the trigeminal root. Although it facilitated the view of the neurovascular structures medial to the internal acoustic meatus, the depth of exposure did not vary much from a traditional retrosigmoid approach nor did it increase the angle of exposure or the visualization of the clivus and more medially located structures. CONCLUSION: This approach is suitable for lesions mainly in the posterior fossa with some extension into the middle fossa in the anterolateral direction. The key benefits of this approach are the length of trigeminal nerve exposure and the subsequent mobilization that improves visualization of the structures medial to the internal auditory canal, to the petrous apex, Meckel's cave, and the posterior end of the cavernous sinus.

Endoscopic Endonasal Approach to Meckel's Cave

2012 ◽  
Vol 73 (S 02) ◽  
Author(s):  
A. Karkas ◽  
J. Keller ◽  
P. Theodosopoulos ◽  
L. Zimmer
Keyword(s):  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Meckel’S Cave ◽  
Endoscopic Endonasal ◽  
Meckel's Cave

Importance of the Meckel's Cave Anatomy in Skull Base Surgery

Skull Base ◽  
2007 ◽  
Vol 16 (S 1) ◽  
Author(s):  
Funda Batay ◽  
Aykut Karasu ◽  
Ossama Al-Mefty
Keyword(s):  
Skull Base ◽  
Skull Base Surgery ◽  
Meckel’S Cave ◽  
Meckel's Cave

Meckel's Cave and Somatotopy of the Trigeminal Ganglion

2021 ◽  
Vol 148 ◽  
pp. 178-187
Author(s):  
Jacob D. Bond ◽  
Zhaoyang Xu ◽  
Han Zhang ◽  
Ming Zhang
Keyword(s):  
Trigeminal Ganglion ◽  
Meckel’S Cave ◽  
Meckel's Cave

scholarly journals Metastases in Meckel's Cave

2007 ◽  
Vol 17 (1) ◽  
pp. 41-47 ◽  
Author(s):  
Susanne E. Theuer ◽  
Niklaus Krayenbühl ◽  
Hans Scheffel ◽  
Yasuhiro Yonekawa ◽  
Spyros S. Kollias
Keyword(s):  
Meckel’S Cave ◽  
Meckel's Cave

scholarly journals Epidermoid Cyst in Meckel's Cave With Unusual Computed Tomography and Magnetic Resonance Imaging Findings

2010 ◽  
Vol 50 (8) ◽  
pp. 701-704 ◽  
Author(s):  
Atsushi ARAI ◽  
Takashi SASAYAMA ◽  
Junji KOYAMA ◽  
Atsushi FUJITA ◽  
Kohkichi HOSODA ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Computed Tomography ◽  
Magnetic Resonance ◽  
Epidermoid Cyst ◽  
Imaging Findings ◽  
Resonance Imaging ◽  
Meckel’S Cave ◽  
Meckel's Cave

Intradural chordoma of the Meckel's cave: A challenging differential diagnosis

2012 ◽  
Vol 32 (5) ◽  
pp. 577-582 ◽  
Author(s):  
Valeria Barresi ◽  
Maria Caffo ◽  
Concetta Alafaci ◽  
Francesca Granata ◽  
Giovanni Tuccari
Keyword(s):  
Differential Diagnosis ◽  
Meckel’S Cave ◽  
Meckel's Cave
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