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DOI: 10.1055/s-0030-1247632
© Thieme Medical Publishers
Surgical Simulation of Extradural Anterior Clinoidectomy through the Trans-superior Orbital Fissure Approach Using a Dissectable Three-dimensional Skull Base Model with Artificial Cavernous Sinus
Publikationsverlauf
Publikationsdatum:
29. Januar 2010 (online)
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ABSTRACT
Extradural anterior clinoidectomy via the trans-superior orbital fissure (SOF) approach can provide extensive exposure of the anterior clinoid process and safe drilling under direct view. This technique requires peeling of the dura propria of the temporal lobe from the lateral wall of the SOF. Therefore, cadaveric dissection is mandatory to acquire surgical technique. However, chances for cadaveric dissection are limited. We propose modification of our three-dimensional (3-D) skull base model made from surgically dissectable artificial bone with artificial cavernous sinus including multiple membranous layers and neurovascular structures to simulate extradural anterior clinoidectomy via the trans-SOF approach. The 3-D skull base model precisely reproduced the dura propria of the temporal lobe, periosteal bridge, and inner reticular layer in the cavernous sinus and SOF using silicone and varnish. The cranial nerves and blood vessels were made from rubber fibers and vinyl tube. Simulation of extradural anterior clinoidectomy via the trans-SOF approach could be performed on the model using a high-speed drill under the operating microscope. The steps of reconstruction of the skull base model and dissection promote clear understanding of the 3-D anatomy and techniques of extradural anterior clinoidectomy via the trans-SOF approach.
KEYWORDS
Anterior clinoid process - superior orbital fissure - cavernous sinus - anterior clinoidectomy - training model
REFERENCES
-
1 McAlea K, Forderhase P, Hejmadi U, Nelson C.
Materials and applications for the SLS selective laser sintering process . In: Chartoff R Proceedings of the 7th International Conference on Rapid Prototyping. Dayton; University of Dayton 1997: 23-33 - 2 Suzuki M, Ogawa Y, Kawano A, Hagiwara A, Yamaguchi H, Ono H. Rapid prototyping of temporal bone for surgical training and medical education. Acta Otolaryngol. 2004; 124 400-402
- 3 Mori K. Three-dimensional temporal bone model for training in skull base surgery [in Japanese]. Jpn J Neurosurg (Tokyo). 2008; 17 940-945
- 4 Mori K, Yamamoto T, Oyama K, Ueno H, Nakao Y, Honma K. Modified three-dimensional skull base model with artificial dura mater, cranial nerves, and venous sinuses for training in skull base surgery: technical note. Neurol Med Chir (Tokyo). 2008; 48 582-587 discussion 587-588
- 5 Mori K, Yamamoto T, Oyama K, Nakao Y. Modification of three-dimensional prototype temporal bone model for training in skull-base surgery. Neurosurg Rev. 2009; 32 233-238 discussion 238-239
- 6 Mori K. Dissectable modified three-dimensional temporal bone and whole skull base models for training in skull base approaches. Skull Base. 2009; 19 333-344
- 7 Noguchi A, Balasingam V, Shiokawa Y, McMenomey S O, Delashaw Jr J B. Extradural anterior clinoidectomy. Technical note. J Neurosurg. 2005; 102 945-950
- 8 Day J D, Giannotta S L, Fukushima T. Extradural temporopolar approach to lesions of the upper basilar artery and infrachiasmatic region. J Neurosurg. 1994; 81 230-235
- 9 De Jesús O, Sekhar L N, Riedel C J. Clinoid and paraclinoid aneurysms: surgical anatomy, operative techniques, and outcome. Surg Neurol. 1999; 51 477-487 discussion 487-488
- 10 Dolenc V V. A combined epi- and subdural direct approach to carotid-ophthalmic artery aneurysms. J Neurosurg. 1985; 62 667-672
- 11 Dolenc V V, Roger L. Microsurgical Anatomy and Surgery of the Central Skull Base. Wien; Springer-Verlag 2003
- 12 Yonekawa Y, Ogata N, Imhof H G et al.. Selective extradural anterior clinoidectomy for supra- and parasellar processes. Technical note. J Neurosurg. 1997; 87 636-642
- 13 Coscarella E, Başkaya M K, Morcos J J. An alternative extradural exposure to the anterior clinoid process: the superior orbital fissure as a surgical corridor. Neurosurgery. 2003; 53 162-166 discussion 166-167
- 14 Froelich S C, Aziz K MA, Levine N B, Theodosopoulos P V, van Loveren H R, Keller J T. Refinement of the extradural anterior clinoidectomy: surgical anatomy of the orbitotemporal periosteal fold. Neurosurgery. 2007; 61(5 Suppl 2) 179-185 discussion 185-186
- 15 Natori Y, Rhoton Jr A L. Microsurgical anatomy of the superior orbital fissure. Neurosurgery. 1995; 36 762-775
- 16 Kawase T, van Loveren H, Keller J T, Tew J M. Meningeal architecture of the cavernous sinus: clinical and surgical implications. Neurosurgery. 1996; 39 527-534 discussion 534-536
- 17 Ozveren M F, Uchida K, Aiso S, Kawase T. Meningovenous structures of the petroclival region: clinical importance for surgery and intravascular surgery. Neurosurgery. 2002; 50 829-836 discussion 836-837
Kentaro MoriM.D. Ph.D.
Professor, Department of Neurosurgery, Juntendo University, Shizuoka Hospital
1129 Nagaoka, Izunokuni, Shizuoka 410-2295, Japan
eMail: kmori@med-juntendo.jp