title: Petroclival tumor model--technical note and educational implications.
abstract: Petroclival area lesions are rare, and their surgery is challenging due to the deep location and to the complex relationships between the tumor and the neurovascular structures. The objective is to present a petroclival tumor model simulating the distorted anatomy of a real petroclival lesion and propose its use to practice microsurgical removal while preserving neurovascular structures. Four embalmed cadaver heads were used in this study. An endoscopic endonasal transclival approach was used to access the dura in front of the trigeminal nerve; a pediatric Foley was inserted above the trigeminal nerve and was gradually inflated (one-balloon technique). If a larger tumor model was desired, an additional balloon was placed below the trigeminal nerve (two-balloon technique). A pre-mixed tumor polymer was injected into the petroclival space and allowed to harden to create an implanted tumor. A post-implant CT scan was done to evaluate the location and volume of the implanted artificial tumor. Tumors were subsequently excised via retrosigmoid and anterior petrosal approaches. Six petroclival tumors were successfully developed: three were small (9.41-10.36 ml) and three large (21.05-23.99 ml). During dissection, distorted anatomy created by the tumor model mimicked that of real surgery. We have established a petroclival tumor model with adjustable size which offers opportunities to study the distorted anatomy of the area and that is able to be used as a training tool to practice microsurgical removal of petroclival lesions. The practice dissection of this tumor model can be a bridge between a normal anatomic dissection and real surgery.
authors.affiliation: Section of Neurosurgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.|Dardinger Microneurosurgical Skull Base Laboratory, Department of Neurological Surgery, Wexner Medical Center, The Ohio State University Medical Center, Columbus, OH, USA.
authors.forename: Jung-Shun
authors.initials: JS
authors.lastname: Lee
authors.affiliation: Dardinger Microneurosurgical Skull Base Laboratory, Department of Neurological Surgery, Wexner Medical Center, The Ohio State University Medical Center, Columbus, OH, USA.
authors.forename: Al-Rahim
authors.initials: AR
authors.lastname: Tailor
authors.affiliation: Dardinger Microneurosurgical Skull Base Laboratory, Department of Neurological Surgery, Wexner Medical Center, The Ohio State University Medical Center, Columbus, OH, USA.
authors.forename: Tariq
authors.initials: T
authors.lastname: Lamki
authors.affiliation: Department of Radiology and Wright Center of Innovation in Biomedical Imaging, Wexner Medical Center, The Ohio State University, Columbus, OH, USA.
authors.forename: Jun
authors.initials: J
authors.lastname: Zhang
authors.affiliation: Dardinger Microneurosurgical Skull Base Laboratory, Department of Neurological Surgery, Wexner Medical Center, The Ohio State University Medical Center, Columbus, OH, USA.
authors.forename: Shahriar
authors.initials: S
authors.lastname: Irani
authors.affiliation: Dardinger Microneurosurgical Skull Base Laboratory, Department of Neurological Surgery, Wexner Medical Center, The Ohio State University Medical Center, Columbus, OH, USA. lemoko60@me.com.
authors.forename: Mario
authors.initials: M
authors.lastname: Ammirati
mesh_terms: D002102:Cadaver; D002530:Cerebellopontine Angle / Q000601:surgery*; D003388:Cranial Fossa, Posterior / Q000033:anatomy & histology / Q000601:surgery*; D004388:Dura Mater / Q000033:anatomy & histology*; D006801:Humans; D009296:Nasal Cavity / Q000033:anatomy & histology / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000379:methods; D010579:Petrous Bone / Q000033:anatomy & histology / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D014276:Trigeminal Nerve / Q000601:surgery
keywords: Artificial petroclival tumor; Balloon technique; Microsurgical dissection; Neurosurgical training; Tumor model