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Title: Anatomical and Objective Evaluation of the Main Surgical Approaches to Pontine Intra-Axial Lesions
Authors: CAVALCANTI, Daniel D.FIGUEIREDO, Eberval G.PREUL, Mark C.SPETZLER, Robert F.
Citation: WORLD NEUROSURGERY, v.121, p.E207-E214, 2019
Abstract: OBJECTIVE: Apparently similar intra-axial pontine lesions may demand distinct surgical approaches. Selecting the optimal approach reduces unnecessary manipulation of tracts and nuclei. This study aims to reveal a quantitative analysis of main surgical corridors dealing with intrinsic pontine pathology. METHODS: Six approaches were performed repeatedly in 10 cadaveric heads: 1) retrosigmoid, 2) retrolabyrinthine, 3) subtemporal transtentorial, 4) anterior petrosectomy, 5) combined petrosal approach, and 6) suboccipital telovelar. Six safe entry zones were studied: peritrigeminal, supratrigeminal, lateral pontine, supracollicular, infracollicular, and median sulcus of fourth ventricle. A neuronavigation device was used to collect 3-dimensional coordinates from fixed points over the edge of craniotomies and brainstem surface; 4 variables were studied: 1) angles of attack; 2) areas of exposure; 3) lengths of exposure; and 4) trajectories. RESULTS: The mean area of exposure generated by the retrosigmoid approach over the brainstem was 538.6 +/- 161.0 mm(2), whereas that yielded by the retrolabyrinthine was 475.0 +/- 173.4 mm(2). There were no significant differences between both when considering areas of exposure and angles. Adding a tentorial cut to the subtemporal approach exposed the superior part of the lateral surface of pons; the area of exposure increased a mean of 33% (P < 0.001). CONCLUSIONS: In addition to producing similar areas and angles of attack, the retrolabyrinthine yields a more orthogonal trajectory to lateral pons than the retrosigmoid approach. Adding a tentorial cut and anterior petrosectomy significantly increased areas and lengths of exposure of a regular subtemporal approach. The combined approach significantly increased angles of attack to both the supratrigeminal and lateral pontine safe zones.
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Artigos e Materiais de Revistas Científicas - FM/MNE
Departamento de Neurologia - FM/MNE

Artigos e Materiais de Revistas Científicas - LIM/26
LIM/26 - Laboratório de Pesquisa em Cirurgia Experimental

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