title: Epidural anterior petrosectomy with subdural visualization of sphenobasal vein via the anterior transpetrosal approach--technical case report.
abstract: The drainage of the superficial middle cerebral vein (SMCV) is classified into four subtypes. The sphenobasal vein (SBV) drains from the SMCV to the pterygoid venous plexus at the temporal skull base. Epidural procedures in the standard anterior transpetrosal approach (ATPA) may damage the route of the SBV. We report a case in which modified surgical procedures via the ATPA were used to preserve the SBV. A 45-year-old man complained of right facial pain. Magnetic resonance images revealed a right cerebellopontine tumor suggestive of an epidermoid cyst. Right carotid angiography revealed that the SMCV drained into the pterygoid venous plexus via the SBV. The convexity dura mater of the temporal lobe was cut and the anterior part of the temporal lobe was retracted subdurally. The SBV was visualized from the subdural side. The basal dura mater of the temporal lobe posterior to the SBV was cut and the posterior part of the temporal lobe was retracted epidurally. After dissecting the dura mater medial to the greater petrosal nerve and to the edge of the petrous apex, the petrous apex was exposed and drilled out without injuring the SBV. The superior petrous sinus and the tentorium were cut. The tumor compressed the root exit zone of the trigeminal nerve. The tumor was grossly totally removed. The modified ATPA (epidural anterior petrosectomy with subdural visualization of the SBV) is effective in preserving the SBV.
authors: Department of Neurosurgery, Saiseikai Yokohamashi Tobu Hospital, 3-6-1 Shimosueyoshi, Tsurumi-ku, Yokohama, Kanagawa, 230-8765, Japan. shinya3917@gmail.com
authors: Shinya
authors: S
authors: Ichimura
authors: Kazunari
authors: K
authors: Yoshida
authors: Hiroshi
authors: H
authors: Kagami
authors: Makoto
authors: M
authors: Inaba
authors: Maaya
authors: M
authors: Orii
authors: Yohei
authors: Y
authors: Kitamura
authors: Isako
authors: I
authors: Saga
authors: Masahiro
authors: M
authors: Toda
mesh_terms: D002339:Carotid Arteries / Q000473:pathology; D002530:Cerebellopontine Angle / Q000473:pathology / Q000601:surgery; D002533:Cerebral Angiography; D002550:Cerebral Veins / Q000601:surgery*; D003392:Cranial Sinuses / Q000601:surgery*; D004322:Drainage; D004814:Epidermal Cyst / Q000601:surgery; D004824:Epidural Space / Q000601:surgery*; D005157:Facial Pain / Q000209:etiology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010579:Petrous Bone / Q000601:surgery*; D011184:Postoperative Period; D013355:Subdural Space / Q000601:surgery*