Peritrigeminal Safe Entry Zone Access to Anterolateral Pons Using the Presigmoid Retrolabyrinthine Suprameatal Approach: A Cadaveric Morphometric Study

Samer S. Hoz, Mayur Sharma, Paolo Palmisciano, Mark D. Johnson, Mustafa Ismail, Ahmed Muthana, Teeba A. Al-Ageely, Jonathan A. Forbes, Charles J. Prestigiacomo, Mario Zuccarello, Norberto Andaluz

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

BACKGROUND AND OBJECTIVES: Access to the anterolateral pontine lesions can be achieved through the peritrigeminal and supratrigeminal safe entry zones using Kawase, retrosigmoid, or translabyrinthine approaches. However, these approaches entail shallow extensive dissection, tangential access, and compromise vestibulocochlear function. We aimed to investigate infratentorial presigmoid retrolabyrinthine approach to access pontine lesions through the peritrigeminal zone. METHODS: We performed 10 presigmoid retrolabyrinthine suprameatal approach dissections in 5 cadaveric heads. Anatomic-radiological characteristics and variations were evaluated. Six morphometric parameters were measured and analyzed to predict surgical accessibility. RESULTS: The pontine infratrigeminal area was accessible in all patients. The mean exposed area of the anterolateral pontine surface was 98.95 cm2 (±38.11 cm2). The mean length of the exposed trigeminal nerve was 7.9 cm (±2.9 cm). Preoperative anatomic-radiological parameters may allow to select patients with favorable anatomy that offers appropriate surgical accessibility to the anterior pontine cavernoma through a presigmoid retrolabyrinthine corridor. CONCLUSION: Anterolateral pontine lesions can be accessed through a minimally invasive infratentorial presigmoid retrolabyrinthine approach by targeting the infratrigeminal safe entry zone. Further clinical studies should be conducted to evaluate the viability of this technique for treating these complex pathologies in real clinical settings.

Original languageEnglish (US)
Pages (from-to)E303-E307
JournalOperative Neurosurgery
Volume25
Issue number6
DOIs
StatePublished - Dec 14 2023

Bibliographical note

Publisher Copyright:
© 2023 Oxford University Press. All rights reserved.

Keywords

  • Brainstem cavernomas
  • Peritrigeminal area
  • Pontine cavernomas
  • Retrolabyrinthine
  • Safe entry zones
  • Sigmoid sinus
  • Trigeminal root entry zone

PubMed: MeSH publication types

  • Journal Article

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