J Neurol Surg B Skull Base 2014; 75 - a079
DOI: 10.1055/s-0034-1383985

Anterior Clinoidectomy to Anterior Petrosectomy through Modified Subtemporal Pterional Keyhole Approach

Hammadi Firas 1, P. Dodier 2, E. Aboud 1, D. A. Ayyad 3
  • 1ANI Arkansas Neuroscience Institute, United States
  • 2Vienna Medical University Scholl, Austria
  • 3Mainz University Hospital, Germany

The authors conducted a microanatomical cadaver study to explore and access the skull base through keyhole approach to perform total resection of skull base tumors. The minimally invasive approach represents an elegant, less invasive and traumatic access to this anatomically complex area—simultaneously guaranteeing wide exposure if adequately planned and performed. Total resection of skull base tumors represents major challenges to neurosurgeons, due to the close relationship to critical structures. Up-to-now, such interventions were dependent on wider and more invasive approaches, Perneczky et al have shown that keyhole approaches, could reduce surgery-related trauma and still offer satisfactory visibility in the deep location. Methods: We conducted this anatomical study on 15 cadavers, over a period of 2 years. Standard skin incision and pterional minicraniotomy, approximately (08×0.8 in), were performed. The aim of this study was to perform anterior clinoidectomy to anterior petrosectomy with the intention to access and expose the following critical structures: cavernous sinus, Sylvian fissure, optic canal, the ventral brainstem, basilar tip, Meckel cave, upper half third of clivus, and circle of Willis. Results: Our proposed minimally invasive approach circumvents the necessity of longer bone drill avoiding unnecessary brain retraction using CSF draining techniques, ultimately leading to a sufficient exposure of the skull base and reducing morbidity rate.