The Challenge of Access to the Pontomesencephalic Junction: An Anatomical Study of Lateral Approach and Exposure

Pakrit Jittapiromsak; Anhua Wu; Peter Nakaji; Robert F Spetzler; Mark C Preul

doi:10.1055/s-0030-1249571

Skull Base, Inhaltsverzeichnis

Skull Base 2010; 20(5): 311-320
DOI: 10.1055/s-0030-1249571

ORIGINAL ARTICLE

The Challenge of Access to the Pontomesencephalic Junction: An Anatomical Study of Lateral Approach and Exposure

Pakrit Jittapiromsak¹ , Anhua Wu² , Peter Nakaji³ , Robert F. Spetzler³ , Mark C. Preul³

¹Division of Neurological Surgery, Chulalongkorn Hospital, Chulalongkorn University, Bangkok, Thailand
²Department of Neurosurgery, The First Affiliated Hospital of China Medical University, Shenyang, Liao Ning, P.R. China
³Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona

Abstract

ABSTRACT

We quantitatively compared relative merits of lateral approaches to the pontomesencephalic junction (PMJ): anterior petrosectomy, subtemporal transtentorial, posterior petrosectomy, and retrosigmoid transtentorial. In dissected cadaveric heads, lengths of exposure were measured anteriorly from CN V along the pontomesencephalic sulcus (PMS); posterosuperiorly along the lateral mesencephalic sulcus (LMS); and posteroinferiorly along the interpeduncular sulcus (IPS). Subtemporal transtentorial approach provided best anterior exposure along the PMS (23.8 ± 4.5 mm). Posterosuperior exposures were comparable for all approaches except anterior petrosectomy (limited). Posteroinferior exposure was most with subtemporal transtentorial approach (13.2 ± 2.8 mm). CN V entry/exit point was identified through all approaches, except for subtemporal transtentorial; shortest surgical depth with posterior petrosectomy was 43.7 ± 5.5 mm. PMS-LMS-IPS convergence point: reached through all approaches, except for anterior petrosectomy (limited); shortest surgical depth with posterior petrosectomy was 40.3 ± 4.3 mm. Anterior petrosectomy provides direct anterolateral views of the pons not afforded by subtemporal approach. Subtemporal transtentorial approach provides optimal posterolateral view to the PMJ and cerebellar peduncles. Retrosigmoid transtentorial approach offers wide exposure of the lateral surface, limited on the posteroinferior PMJ by the cerebellum. The small opening of posterior petrosectomy creates an awkward corridor to anterior PMJ targets but provides a direct and shortest route to the cerebellar peduncles.

KEYWORDS

Petrosal approach - pontomesencephalic junction - retrosigmoid approach - subtemporal approach - surgical-anatomical study

Volltext

Referenzen

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Mark C PreulM.D.

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