Application of Surface Landmarks Combined with Image-Guided Sinus Location in the Retrosigmoid Approach and Their Clinic-Image Relationship Analysis

Abstract

Objectives During craniotomy for cerebellopontine angle (CPA) lesions, the exact exposure of the margin of the venous sinuses complex remains an essential but risky part of the procedure. Here, we revealed the exact position of the asterion and sinus complex by combining preoperative image information and intraoperative cranial landmarks, and analyzed their clinic-image relationship.

Methods Ninety-four patients who underwent removal of vestibular schwannoma (VS) through retrosigmoid craniotomies were enrolled in the series. To determine the exact location of the sigmoid sinus and the transverse sinus and sigmoid sinus junction (TSSJ), we used preoperative images, such as computed tomography (CT) and/or magnetic resonance imaging (MRI) combined with intraoperative anatomical landmarks. The distance between the asterion and the sigmoid sinus was measured using MRI T1 sequences with gadolinium and/or the CT bone window.

Results In 94 cases of retrosigmoid craniotomies, the asterion lay an average of 12.71 mm on the posterior to the body surface projection to the TSSJ. Intraoperative cranial surface landmarks were used in combination with preoperative image information to identify the distance from the asterion to the sigmoid sinus at the transverse sinus level, allowing for an appropriate initial burr hole (the margin of the TSSJ).

Conclusion By combining intraoperative anatomical landmarks and preoperative image information, the margin of the TSSJ, in particular, the inferior margin of the transverse sinus, can be well and thoroughly identified in the retrosigmoid approach.

Keywords

retrosigmoid approach - sinus localization - image - surface landmarks

• References

• 1 Day JD, Fukushima T, Giannotta SL. Innovations in surgical approach: lateral cranial base approaches. Clin Neurosurg 1996; 43: 72-90
• 2 Gharabaghi A, Rosahl SK, Feigl GC. et al. Image-guided lateral suboccipital approach: part 2-impact on complication rates and operation times. Neurosurgery 2008;62(3, suppl 1):24–29, discussion 29
• 3 Hamasaki T, Morioka M, Nakamura H, Yano S, Hirai T, Kuratsu J. A 3-dimensional computed tomographic procedure for planning retrosigmoid craniotomy. Neurosurgery 2009;64(5, suppl 2):241–245, discussion 245–246
• 4 Gharabaghi A, Rosahl SK, Feigl GC. et al. Surgical planning for retrosigmoid craniotomies improved by 3D computed tomography venography. Eur J Surg Oncol 2008; 34 (02) 227-231
• 5 Hill DL, Hawkes DJ, Crossman JE. et al. Registration of MR and CT images for skull base surgery using point-like anatomical features. Br J Radiol 1991; 64 (767): 1030-1035
• 6 Hwang RS, Turner RC, Radwan W. et al. Relationship of the sinus anatomy to surface landmarks is a function of the sinus size difference between the right and left side: anatomical study based on CT angiography. Surg Neurol Int 2017; 8 (01) 58
• 7 Lang Jr J, Samii A. Retrosigmoidal approach to the posterior cranial fossa. An anatomical study. Acta Neurochir (Wien) 1991; 111 (3-4): 147-153
• 8 Ojemann RG. Retrosigmoid approach to acoustic neuroma (vestibular schwannoma). Neurosurgery 2001; 48 (03) 553-558
• 9 Li RC, Liu JF, Li K. et al. localization of anterosuperior point of transverse-sigmoid sinus junction using a reference coordinate system on lateral skull surface. Chin Med J (Engl) 2016; 129 (15) 1845-1849
• 10 Pérez AJ, Hernández LC, Ornia M, García Y. [The noninvasive study of cerebral veins and dural sinuses: comparison of two MR angiography techniques]. Radiologia (Madr) 2006; 48 (02) 87-98
• 11 Ribas GC, Rhoton Jr AL, Cruz OR, Peace D. Suboccipital burr holes and craniectomies. Neurosurg Focus 2005; 19 (02) E1
• 12 Avci E, Kocaogullar Y, Fossett D, Caputy A. Lateral posterior fossa venous sinus relationships to surface landmarks. Surg Neurol 2003; 59 (05) 392-397 , discussion 397
• 13 Bozbuga M, Boran BO, Sahinoglu K. Surface anatomy of the posterolateral cranium regarding the localization of the initial burr-hole for a retrosigmoid approach. Neurosurg Rev 2006; 29 (01) 61-63
• 14 Ucerler H, Govsa F. Asterion as a surgical landmark for lateral cranial base approaches. J Craniomaxillofac Surg 2006; 34 (07) 415-420
• 15 Roberts DW, Strohbehn JW, Hatch JF, Murray W, Kettenberger H. A frameless stereotaxic integration of computerized tomographic imaging and the operating microscope. J Neurosurg 1986; 65 (04) 545-549
• 16 da Silva Jr EB, Leal AG, Milano JB, da Silva Jr LF, Clemente RS, Ramina R. Image-guided surgical planning using anatomical landmarks in the retrosigmoid approach. Acta Neurochir (Wien) 2010; 152 (05) 905-910
• 17 Tanaka Y, Kobayashi S, Unoki T, Nagashima H, Iwashita T. Illumination of mastoid air cell for suboccipital craniotomy: technical note. Neurosurgery 1995; 36 (05) 1049-1050 , discussion 1051
• 18 Xia L, Zhang M, Qu Y. et al. Localization of transverse-sigmoid sinus junction using preoperative 3D computed tomography: application in retrosigmoid craniotomy. Neurosurg Rev 2012; 35 (04) 593-598 , discussion 598–599