title: Microsurgical and endoscopic anatomy of the extended retrosigmoid inframeatal infratemporal approach.
abstract: BACKGROUND
  Different and often complex routes are available to deal with jugular foramen tumors with extracranial extension.
  
  
  OBJECTIVE
  To describe a novel extension of the retrosigmoid approach useful to expose the extracranial area abutting the posterior fossa skull base.
  
  
  METHODS
  A navigation-guided, endoscope-assisted retrosigmoid inframeatal approach was performed on 6 cadaveric heads in the semisitting position, displaying an area from the internal acoustic meatus to the lower cranial nerves and exposing the intrapetrous internal carotid artery. We then continued removing the temporal bone located between the sigmoid sinus and the hearing apparatus, reaching the infratemporal area just lateral to the jugular fossa. This drilling, which we refer to as posterolateral inframeatal drilling, has not previously been described. Drilling of the horizontal segment of the occipital squama allowed good visualization of the uppermost cervical internal carotid artery, internal jugular vein, and lower extracranial cranial nerves.
  
  
  RESULTS
  We were able to provide excellent exposure of the inframeatal area and of the posterior infratemporal fossa from different operative angles, preserving the neurovascular structures and the labyrinth in all specimens. The intradural operative window on the extracranial compartment was limited by the venous sinuses and the hearing apparatus and presented a mean width of 8.52 mm. Sigmoid sinus transection led to better visualization of the lateral half of the jugular foramen and of the uppermost cervical internal carotid artery.
  
  
  CONCLUSIONS
  The navigation-guided endoscope-assisted extended retrosigmoid inframeatal infratemporal approach provides an efficient and versatile route for resection of jugular foramen tumors with extracranial extension.
authors.affiliation: *Dardinger Microneurosurgical Skull Base Laboratory, Department of Neurological Surgery and ¶Department of Radiology and Wright Center of Innovation in Biomedical Imaging, Wexner Medical Center, The Ohio State University, Columbus, Ohio; ‡Department of Neurosurgery, Umberto I General Hospital, Università Politecnica delle Marche, Ancona, Italy; §International Neuroscience Institute, Hannover, Germany.
authors.forename: Roberto
authors.initials: R
authors.lastname: Colasanti
authors.forename: Al-Rahim A
authors.initials: AR
authors.lastname: Tailor
authors.forename: Mehrnoush
authors.initials: M
authors.lastname: Gorjian
authors.forename: Jun
authors.initials: J
authors.lastname: Zhang
authors.forename: Mario
authors.initials: M
authors.lastname: Ammirati
mesh_terms: D001932:Brain Neoplasms / Q000601:surgery*; D002102:Cadaver; D006801:Humans; D044583:Neuroendoscopy / Q000379:methods*; D038361:Neuronavigation / Q000379:methods*; D019635:Neurosurgical Procedures / Q000379:methods*; D014680:Veins