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J Neurol Surg B Skull Base 2024; 85(01): 095-105
DOI: 10.1055/s-0042-1759873
Original Article

Mandibular Fossa Approach to Petroclival and Anterior Pontine Lesions

Redi Rahmani
1   The Loyal and Edith Davis Neurosurgical Research Laboratory, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, United States
,
Irakliy Abramov
1   The Loyal and Edith Davis Neurosurgical Research Laboratory, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, United States
,
Visish M. Srinivasan
1   The Loyal and Edith Davis Neurosurgical Research Laboratory, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, United States
,
Mohamed A. Labib
1   The Loyal and Edith Davis Neurosurgical Research Laboratory, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, United States
,
Lena Mary Houlihan
1   The Loyal and Edith Davis Neurosurgical Research Laboratory, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, United States
,
Joshua S. Catapano
1   The Loyal and Edith Davis Neurosurgical Research Laboratory, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, United States
,
Peter Q. Quinn
2   Department of Oral and Maxillofacial Surgery, University of Pennsylvania School of Dental Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, United States
,
Michael T. Lawton
1   The Loyal and Edith Davis Neurosurgical Research Laboratory, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, United States
,
Mark C. Preul
1   The Loyal and Edith Davis Neurosurgical Research Laboratory, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, United States
› Author Affiliations Funding This study was supported by funds from the Newsome Chair in Neurosurgery Research held by Dr. Preul and by funds from the Barrow Neurological Foundation.
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Abstract

Objective To describe the anatomy related to a novel approach to the petroclival region through the mandibular fossa for the treatment of petroclival and anterior pontine lesions.

Design Five dry skulls were examined for surgical approach. Three adult cadaveric heads underwent bilateral dissection. One cadaveric head was evaluated with computed tomography after dissection.

Setting This study was performed in an academic medical center.

Participants Neurosurgical anatomy researchers performed this study using dry skulls and cadaveric heads.

Main Outcome Measurements This was a proof-of-concept anatomical study.

Results The mandibular fossa approach uses a vertical preauricular incision above the facial nerve branches. Removal of the temporomandibular joint exposes the mandibular fossa. The anterior boundary is the mandibular nerve at the foramen ovale, and the posterior boundary is the jugular foramen. The chorda tympani, eustachian tube, and tensor tympani muscle are sectioned. The carotid artery is transposed out of the petrous canal, and a petrosectomy is performed from Meckel's cave to the foramen magnum and anterior occipital condyle. Dural opening exposes the anterior pons, vertebrobasilar junction, bilateral vertebral arteries, and the ipsilateral anterior and posterior inferior cerebellar arteries. At completion, the temporomandibular joint is reconstructed with a prosthetic joint utilizing a second incision along the mandible.

Conclusions The mandibular fossa approach is a new trajectory to the petroclival region and the anterior pons. It combines the more anterior angle of endoscopic approaches along with the enhanced control of open approaches. Further study is necessary before this approach is used clinically.

Keywords

glenoid fossa - mandibular fossa - petrosectomy - petrous carotid - superficial temporal artery - temporomandibular joint

Note

The abstract was presented at the North American Skull Base Meeting; Phoenix, AZ; February 18–20, 2022 (abstract A113).




Publication History

Received: 26 August 2022

Accepted: 12 November 2022

Article published online:
03 January 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Hasanbelliu A, Andaluz N, Di Somma A. et al. Extended anterior petrosectomy through the transcranial middle fossa approach and extended endoscopic transsphenoidal-transclival approach: qualitative and quantitative anatomic analysis. World Neurosurg 2020; 138: e405-e412
    CrossrefPubMedGoogle Scholar
  • 2 Abdel Aziz KM, Sanan A, van Loveren HR, Tew Jr JM, Keller JT, Pensak ML. Petroclival meningiomas: predictive parameters for transpetrosal approaches. Neurosurgery 2000; 47 (01) 139-150 , discussion 150–152
    PubMedGoogle Scholar
  • 3 Kim JW, Jung HW, Kim YH. et al. Petroclival meningiomas: long-term outcomes of multimodal treatments and management strategies based on 30 years of experience at a single institution. J Neurosurg 2019; 132 (06) 1675-1682
    CrossrefPubMedGoogle Scholar
  • 4 Nanda A, Javalkar V, Banerjee AD. Petroclival meningiomas: study on outcomes, complications and recurrence rates. J Neurosurg 2011; 114 (05) 1268-1277
    CrossrefPubMedGoogle Scholar
  • 5 Xie S, Xiao XR, Li H. et al. Surgical treatment of pontine cavernous malformations via subtemporal transtentorial and intradural anterior transpetrosal approaches. Neurosurg Rev 2020; 43 (04) 1179-1189
    CrossrefPubMedGoogle Scholar
  • 6 Bossi Todeschini A, Montaser AS, Hardesty DA, Carrau RL, Prevedello DM. The limits of the endoscopic endonasal transclival approach for posterior fossa tumors. J Neurosurg Sci 2018; 62 (03) 322-331
    CrossrefPubMedGoogle Scholar
  • 7 Kaplan PA, Ruskin JD, Tu HK, Knibbe MA. Erosive arthritis of the temporomandibular joint caused by Teflon-Proplast implants: plain film features. AJR Am J Roentgenol 1988; 151 (02) 337-339
    CrossrefPubMedGoogle Scholar
  • 8 Katzberg RW, Laskin DM. Radiographic and clinical significance of temporomandibular joint alloplastic disk implants. AJR Am J Roentgenol 1988; 151 (04) 736-737
    CrossrefPubMedGoogle Scholar
  • 9 Granquist EJ, Bouloux G, Dattilo D. et al. Outcomes and survivorship of biomet microfixation total joint replacement system: results from an FDA postmarket study. J Oral Maxillofac Surg 2020; 78 (09) 1499-1508
    CrossrefPubMedGoogle Scholar
  • 10 Tayebi Meybodi A, Gadhiya A, Borba Moreira L, Lawton MT. Coding cerebral bypasses: a proposed nomenclature to better describe bypass constructs and revascularization techniques. J Neurosurg 2021; 136 (01) 163-174
    CrossrefPubMedGoogle Scholar
  • 11 Catapano JS, Rumalla K, Srinivasan VM, Lawrence PM, Larson Keil K, Lawton MT. A taxonomy for brainstem cavernous malformations: subtypes of pontine lesions. Part 1: basilar, peritrigeminal, and middle peduncular. J Neurosurg 2022; 137 (05) 1462-1476
    CrossrefPubMedGoogle Scholar
  • 12 Tedeschi H, Rhoton Jr AL. Lateral approaches to the petroclival region. Surg Neurol 1994; 41 (03) 180-216
    CrossrefPubMedGoogle Scholar
  • 13 Erkmen K, Pravdenkova S, Al-Mefty O. Surgical management of petroclival meningiomas: factors determining the choice of approach. Neurosurg Focus 2005; 19 (02) E7
    CrossrefPubMedGoogle Scholar
  • 14 Aum D, Rassi MS, Al-Mefty O. Petroclival meningiomas and the petrosal approach. Handb Clin Neurol 2020; 170: 133-141
    CrossrefPubMedGoogle Scholar
  • 15 Sbaihat A, Bacciu A, Pasanisi E, Sanna M. Skull base chondrosarcomas: surgical treatment and results. Ann Otol Rhinol Laryngol 2013; 122 (12) 763-770
    CrossrefPubMedGoogle Scholar
  • 16 Singh N, Singh DK, Ahmad F, Kumar R. The retrosigmoid approach: workhorse for petroclival meningioma surgery. Asian J Neurosurg 2019; 14 (01) 188-192
    Article in Thieme ConnectPubMedGoogle Scholar
  • 17 Couldwell WT, Fukushima T, Giannotta SL, Weiss MH. Petroclival meningiomas: surgical experience in 109 cases. J Neurosurg 1996; 84 (01) 20-28
    CrossrefPubMedGoogle Scholar
  • 18 Behari S, Tyagi I, Banerji D. et al. Postauricular, transpetrous, presigmoid approach for extensive skull base tumors in the petroclival region: the successes and the travails. Acta Neurochir (Wien) 2010; 152 (10) 1633-1645
    CrossrefPubMedGoogle Scholar
  • 19 Sen CN, Sekhar LN. The subtemporal and preauricular infratemporal approach to intradural structures ventral to the brain stem. J Neurosurg 1990; 73 (03) 345-354
    CrossrefPubMedGoogle Scholar
  • 20 Beer-Furlan A, Vellutini EA, Balsalobre L, Stamm AC. Endoscopic endonasal approach to ventral posterior fossa meningiomas: from case selection to surgical management. Neurosurg Clin N Am 2015; 26 (03) 413-426
    CrossrefPubMedGoogle Scholar
  • 21 Koutourousiou M, Fernandez-Miranda JC, Vaz-Guimaraes Filho F. et al. Outcomes of endonasal and lateral approaches to petroclival meningiomas. World Neurosurg 2017; 99: 500-517
    CrossrefPubMedGoogle Scholar
  • 22 Silveira-Bertazzo G, Manjila S, London Jr NR, Prevedello DM. Techniques and challenges of the expanded endoscopic endonasal access to the ventrolateral skull base during the “far-medial” and “extreme medial” approaches. Acta Neurochir (Wien) 2020; 162 (03) 597-603
    CrossrefPubMedGoogle Scholar
  • 23 Weinberg S, Kryshtalskyj B. Facial nerve function following temporomandibular joint surgery using the preauricular approach. J Oral Maxillofac Surg 1992; 50 (10) 1048-1051
    CrossrefPubMedGoogle Scholar
  • 24 Nellestam P, Eriksson L. Preauricular approach to the temporomandibular joint: a postoperative follow-up on nerve function, hemorrhage and esthetics. Swed Dent J 1997; 21 (1–2): 19-24
    PubMedGoogle Scholar
  • 25 Johnson NR, Roberts MJ, Doi SA, Batstone MD. Total temporomandibular joint replacement prostheses: a systematic review and bias-adjusted meta-analysis. Int J Oral Maxillofac Implants 2017; 46 (01) 86-92
    CrossrefPubMedGoogle Scholar
  • 26 Amarista FJ, Mercuri LG, Perez D. Temporomandibular joint prosthesis revision and/or replacement survey and review of the literature. J Oral Maxillofac Surg 2020; 78 (10) 1692-1703
    CrossrefPubMedGoogle Scholar
  • 27 McManus LJ, Stringer MD, Dawes PJ. Iatrogenic injury of the chorda tympani: a systematic review. J Laryngol Otol 2012; 126 (01) 8-14
    CrossrefPubMedGoogle Scholar
  • 28 Keidar E, De Jong R, Kwartowitz G. Tensor Tympani Syndrome. Treasure Island, FL: StatPearls; 2021
    Google Scholar
  • 29 Loader B, Beicht D, Hamzavi JS, Franz P. Tenotomy of the middle ear muscles causes a dramatic reduction in vertigo attacks and improves audiological function in definite Meniere's disease. Acta Otolaryngol 2012; 132 (05) 491-497
    CrossrefPubMedGoogle Scholar
  • 30 Vaz-Guimaraes F, Nakassa ACI, Gardner PA, Wang EW, Snyderman CH, Fernandez-Miranda JC. Endoscopic endonasal approach to the ventral jugular foramen: anatomical basis, technical considerations, and clinical series. Oper Neurosurg (Hagerstown) 2017; 13 (04) 482-491
    CrossrefPubMedGoogle Scholar