Endoscope-assisted retrosigmoid intradural suprameatal approach to the middle fossa: anatomical and surgical considerations.
BACKGROUND
Lesions involving the posterior and middle fossa may be reached by several surgical approaches depending mostly on tumors' location and characteristics. The retrosigmoid intradural suprameatal approach has been used to remove tumors of the posterior fossa extending into Meckel's cave and the middle fossa. With large tumors, this approach may allow exposure of the oculomotor and optic nerves, the supraclinoid internal carotid and communicating posterior arteries.


METHODS
Three formaldehyde-fixed specimens have been prepared on both sides using the conventional retrosigmoidal-suprameatal approach. The entire endoscopic preparations have been documented via a digital recording system, using a 5mm endoscope with a 25 degrees perspective. The authors describe the anatomical corridor and technique of the endoscope-assisted retrosigmoid intradural suprameatal approach to lesions that are located predominantly within the posterior fossa and supratentorial extension into Meckel's cave, sellar and parasellar region.


CONCLUSIONS
The endoscope-assisted suprameatal approach provides exposure of the antero-medial middle fossa even in cases of skull base lesions that have not caused significant displacement of neurovascular structures.
Ebner
F H
FH
Department of Neurosurgery, University Hospital of Tuebingen, Hoppe-Seyler-Strasse 3, 72076 Tübingen, Germany. florianebner@virgilio.it
Koerbel
A
A
Kirschniak
A
A
Roser
F
F
Kaminsky
J
J
Tatagiba
M
M
D002102:Cadaver; D035301:Cranial Fossa, Middle / Q000033:anatomy & histology* / Q000601:surgery; D004388:Dura Mater / Q000033:anatomy & histology* / Q000601:surgery; D006801:Humans; D008953:Models, Anatomic; D044583:Neuroendoscopy / Q000379:methods*; D019292:Skull Base Neoplasms / Q000473:pathology / Q000601:surgery