J Neurol Surg A Cent Eur Neurosurg 2014; 75(01): 053-057
DOI: 10.1055/s-0033-1342935
Technical Note
Georg Thieme Verlag KG Stuttgart · New York

The Suprameatal Dural Flap for Superior Petrosal Vein Protection during the Retrosigmoid Intradural Suprameatal Approach

Pietro Mortini
1   Department of Neurosurgery, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy
,
Filippo Gagliardi
1   Department of Neurosurgery, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy
,
Nicola Boari
1   Department of Neurosurgery, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy
,
Alfio Spina
1   Department of Neurosurgery, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy
,
Michele Bailo
1   Department of Neurosurgery, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy
,
Alberto Franzin
1   Department of Neurosurgery, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy
› Author Affiliations
Further Information

Publication History

03 August 2012

31 December 2012

Publication Date:
14 May 2013 (online)

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Abstract

Object The drilling of the suprameatal bone during the retrosigmoid intradural suprameatal approach (RISA) puts the superior petrosal vein complex at risk of heating and mechanical injury, which may lead to cerebellar swelling and infarction. We present a new technique to protect the superior petrosal venous complex during suprameatal bone drilling.

Material and methods A microanatomical laboratory investigation on cadaver was conducted. The surgical technique is described and intraoperative schematic pictures are provided.

Results The surgical steps of this technique and the related intraoperative images are reported. One case illustration regarding the removal of a large petrous apex meningioma with Meckel cave extension is described to demonstrate the application of the technique in a clinical setting.

Conclusions Reflecting a dural flap onto the posterior trigeminal nerve root and the superior petrosal vein complex can be a simple way to protect the nerve and the vein during the suprameatal bone drilling during the RISA.