A New Methodology for Laboratory Evaluation of Neurosurgical Approaches Based on the Volume and Shape of the Surgical Space with a Mathematical Model to Quantify the Surgical Maneuverability in Laboratory Settings

Asem Salma; Abdulrahman Alkandari; Steffen Sammet; Mario Ammirati

doi:10.1055/s-0032-1304558

Journal of Neurological Surgery Part B: Skull Base, Inhaltsverzeichnis

Skull Base 2012; 73(01): 064-070
DOI: 10.1055/s-0032-1304558

Original Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

A New Methodology for Laboratory Evaluation of Neurosurgical Approaches Based on the Volume and Shape of the Surgical Space with a Mathematical Model to Quantify the Surgical Maneuverability in Laboratory Settings^[*]

Asem Salma

¹Department of Neurological Surgery;

,

Abdulrahman Alkandari

¹Department of Neurological Surgery;

,

Steffen Sammet

²Department of Radiology, Ohio State University Medical Center, Columbus, Ohio.

,

Mario Ammirati

¹Department of Neurological Surgery;

› Institutsangaben

Abstract

We conducted this study to validate the volume/shape of the surgical exposure and to introduce a mathematical model to quantify the maneuverability in a surgical space. We executed the pterional and lateral supraorbital approach four times in fresh cadavers in skull base laboratory. The surgical volumes were filled with a computed tomography (CT)-imageable mixture; CT scans were obtained to evaluate the volume and shape of the surgical space. The volume of the surgical space was 23.60 and 32.90 mL for the lateral supraorbital and pterional approach, respectively, (p < 0.05). The three-dimensional shape of the lateral supraorbital approach was cylindrical and that of the pterional approach pyramidal. The volume of the surgical approach can be used to define, together with other variables, the maneuverability (maneuvering in a surgical volume) by using the following formula where M, A, V, and L represent the maneuverability, the degree of the surgical freedom, the volume of the surgical exposure, and the surgical depth, respectively. Volume and shape of the surgical exposure are two objective parameters that can be used to define and contrast different microsurgical approaches in a laboratory setting. The volume of the surgical exposure may be integrated into a mathematical formula defining maneuverability.

Keywords

anatomical study - cadaveric study - neurosurgical approach - surgical operability

Volltext

Referenzen

References
1 Yasargil MG, Antic J, Laciga R, Jain KK, Hodosh RM, Smith RD. Microsurgical pterional approach to aneurysms of the basilar bifurcation. Surg Neurol 1976; 6 (2) 83-91
2 Yasargil MG. Microneurosurgery. Stuttgart-New York: Georg Thieme Verlag; 1984: 215-233
3 Hernesniemi J, Ishii K, Niemelä M , et al. Lateral supraorbital approach as an alternative to the classical pterional approach. Acta Neurochir Suppl (Wien) 2005; 94: 17-21
4 Romani R, Lehecka M, Gaal E , et al. Lateral supraorbital approach applied to olfactory groove meningiomas: experience with 66 consecutive patients. Neurosurgery 2009; 65 (1) 39-52, discussion 52–53
5 Ammirati M, Bernardo A. Analytical evaluation of complex anterior approaches to the cranial base: an anatomic study. Neurosurgery 1998; 43 (6) 1398-1407, discussion 1407–1408
6 Ammirati M, Kim HK, Cho YD. Anatomo-radiological evaluation of lateral approaches to the skull base. Skull Base Surg 1998; 8 (3) 105-117
7 Di Rocco F, Oi S, Samii A , et al. Neuronavigational endoscopic endonasal sellar and parasellar surgery using a 2-mm-diameter lens rigid-rod endoscope: a cadaver study. Neurosurgery 2007; 60 (4) , Suppl (Suppl. 02) 394-400, discussion 400
8 Clatterbuck RE, Bernardo A, Spetzler RF. Discovering the novel surgical approach. Clin Neurosurg 2003; 50: 36-44
9 Figueiredo EG, Deshmukh P, Nakaji P , et al. The minipterional craniotomy: technical description and anatomic assessment. Neurosurgery 2007; 61 (5) , Suppl (Suppl. 02) 256-264, discussion 264–265
10 Figueiredo EG, Deshmukh P, Zabramski JM, Preul MC, Crawford NR, Spetzler RF. The pterional-transsylvian approach: an analytical study. Neurosurgery 2008; 62 (6) , Suppl (Suppl. 03) 1361-1367
11 Jittapiromsak P, Little AS, Deshmukh P, Nakaji P, Spetzler RF, Preul MC. Comparative analysis of the retrosigmoid and lateral supracerebellar infratentorial approaches along the lateral surface of the pontomesencephalic junction: a different perspective. Neurosurgery 2008; 62 (5) , Suppl (Suppl. 02) ONS279-ONS287, discussion ONS287–ONS288
12 Pillai P, Baig MN, Karas CS, Ammirati M. Endoscopic image-guided transoral approach to the craniovertebral junction: an anatomic study comparing surgical exposure and surgical freedom obtained with the endoscope and the operating microscope. Neurosurgery 2009; 64 (5) , Suppl (Suppl. 02) 437-442, discussion 442–444
13 Tanriover N, Ulm AJ, Rhoton Jr AL, Yasuda A. Comparison of the transvermian and telovelar approaches to the fourth ventricle. J Neurosurg 2004; 101 (3) 484-498
14 Ulm AJ, Tanriover N, Kawashima M, Campero A, Bova FJ, Rhoton Jr A. Microsurgical approaches to the perimesencephalic cisterns and related segments of the posterior cerebral artery: comparison using a novel application of image guidance. Neurosurgery 2004; 54 (6) 1313-1327, discussion 1327–1328

A New Methodology for Laboratory Evaluation of Neurosurgical Approaches Based on the Volume and Shape of the Surgical Space with a Mathematical Model to Quantify the Surgical Maneuverability in Laboratory Settings[*]

A New Methodology for Laboratory Evaluation of Neurosurgical Approaches Based on the Volume and Shape of the Surgical Space with a Mathematical Model to Quantify the Surgical Maneuverability in Laboratory Settings^[*]