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dc.contributorSistema FMUSP-HC: Faculdade de Medicina da Universidade de São Paulo (FMUSP) e Hospital das Clínicas da FMUSP
dc.contributor.authorCAVALCANTI, Daniel D.
dc.contributor.authorFIGUEIREDO, Eberval G.
dc.contributor.authorPREUL, Mark C.
dc.contributor.authorSPETZLER, Robert F.
dc.identifier.citationWORLD NEUROSURGERY, v.121, p.E207-E214, 2019
dc.description.abstractOBJECTIVE: 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.eng
dc.relation.ispartofWorld Neurosurgery
dc.subjectCavernous malformationeng
dc.subjectSafe entry zoneseng
dc.subjectSurgical anatomyeng
dc.subjectSurgical approacheseng
dc.subject.othersafe entry zoneseng
dc.subject.otherbrain-stem gliomaseng
dc.subject.othercavernous malformationseng
dc.subject.othermicrosurgical anatomyeng
dc.subject.otherrhomboid fossaeng
dc.titleAnatomical and Objective Evaluation of the Main Surgical Approaches to Pontine Intra-Axial Lesionseng
dc.rights.holderCopyright ELSEVIER SCIENCE INCeng
dc.subject.wosClinical Neurologyeng
dc.type.categoryoriginal articleeng
dc.type.versionpublishedVersioneng, Daniel D.:Barrow Neurol Inst, Dept Neurosurg, Phoenix, AZ 85013 USA, Mark C.:Barrow Neurol Inst, Dept Neurosurg, Phoenix, AZ 85013 USA, Robert F.:Barrow Neurol Inst, Dept Neurosurg, Phoenix, AZ 85013 USA
hcfmusp.publisher.cityNEW YORKeng
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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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