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J Neurol Surg B Skull Base 2021; 82(06): 659-667
DOI: 10.1055/s-0040-1713755
Original Article

Transmastoid Trautman's Triangle Combined Low Retrosigmoid Approach for Foramen Magnum Meningiomas: Surgical Anatomy and Technical Note

Guangfu Di 
1   Department of Neurosurgery, First Affiliated Hospital (Yijishan Hospital) of Wannan Medical College, Wuhu, China
2   Department of Human Anatomy, School of Basic Medicine, Wannan Medical College, Wuhu, China
,
Wei Zhou
1   Department of Neurosurgery, First Affiliated Hospital (Yijishan Hospital) of Wannan Medical College, Wuhu, China
,
Xinyun Fang
1   Department of Neurosurgery, First Affiliated Hospital (Yijishan Hospital) of Wannan Medical College, Wuhu, China
2   Department of Human Anatomy, School of Basic Medicine, Wannan Medical College, Wuhu, China
,
Qiang Li
2   Department of Human Anatomy, School of Basic Medicine, Wannan Medical College, Wuhu, China
,
Lean Sun
1   Department of Neurosurgery, First Affiliated Hospital (Yijishan Hospital) of Wannan Medical College, Wuhu, China
,
Xiaochun Jiang
1   Department of Neurosurgery, First Affiliated Hospital (Yijishan Hospital) of Wannan Medical College, Wuhu, China
2   Department of Human Anatomy, School of Basic Medicine, Wannan Medical College, Wuhu, China
› Author Affiliations Funding This work was supported by the Key research and development plan project of Anhui Province (1804h0802023) and the Funding of “Peak” Training Program for Scientific Research of Yijishan Hospital (PF2019003).
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Abstract

Objective This study was aimed to assess the potential of utilizing a transmastoid Trautman's triangle combined low retrosigmoid approach for ventral and ventrolateral foramen magnum meningiomas (FMMs) surgical treatment.

Methods We simulated this transmastoid Trautman's triangle combined low retrosigmoid approach using five adult cadaveric heads to explore the associated anatomy in a step-by-step fashion, taking pictures of key positions as appropriate. We then employed this approach in a single overweight patient with a short neck who was suffering from large ventral FMMs and cerebellar tonsillar herniation.

Results Through cadaver studies, we were able to confirm that this transmastoid Trautman's triangle combined with low retrosigmoid approach achieves satisfactory cranial nerve and vasculature visualization while also offering a wide view of the whole of the ventrolateral medulla oblongata. We, additionally, have successfully employed this approach to treat a single patient suffering from large ventral FMMs with cerebellar tonsillar herniation.

Conclusion This transmastoid Trautman's triangle combined low retrosigmoid approach may represent a complement to treatment strategies for ventral and ventrolateral FMMs, particularly in patients with the potential for limited surgical positioning due to their being overweight, having a short neck and suffering from cerebellar tonsillar herniation.

Keywords

Trautman's triangle - retrosigmoid approach - foramen magnum - meningiomas - microanatomy

Supplementary Material



Publication History

Received: 30 January 2020

Accepted: 15 April 2020

Article published online:
09 March 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
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