The Tentorial Bridge to Deep Skull Base Exposure: Anatomical Morphometric Study.

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The Tentorial Bridge to Deep Skull Base Exposure: Anatomical Morphometric Study.

World Neurosurg. 2018 Mar 15;:

Authors: Vasquez CA, Thompson J, Youssef AS

Abstract
BACKGROUND: Skull base surgeons have adopted splitting the tentorium in order to expand the exposure, minimize brain retraction and combine the supra and infratentorial compartments for resection of large skull base lesions.
OBJECTIVE: To describe stepwise techniques for splitting the tentorium to access deeply located skull base lesions and morphometrically assess the gained exposure.
METHODS: Surgical exposure was performed through a transylvian, subtemporal, posterior transpetrosal and combined posterior supra/infratentorial - trans-sinus approach. We used a custom software program built in Matlab (Mathworks, Natick MA), to trace the surgical exposure region-of-interest (ROI) for area analysis with the ability to accurately assess most irregular areas. Qualitative morphometric assessment was done of the gain in anatomical exposure achieved by splitting the tentorium.
RESULTS: In the trans-sylvian transtentorial approach, the mean surface area increased 154.17%, from 0.14 cm2 before expansion to 0.32 cm2 after expansion. In the subtemporal transtentorial approach, the mean surface area increased 137.61 %, from 0.66 cm2 before expansion to 1.52 cm2 after expansion. In the posterior transpetrosal transtentorial approach, the mean surface area increased 171.06%, from 1.08 cm2 before expansion to 2.81 cm2 after expansion. In the combined supra/infratentorial transsinus approach, the mean surface area increased 222.03%, from 0.78 cm2 before expansion to 2.38 cm2 after expansion.
CONCLUSION: With splitting of the tentorium, a substantial area of expansion is obtained thus minimizing the necessity of brain retraction and improving the visualization of deep neurovascular structures in the skull base.

PMID: 29551719 [PubMed - as supplied by publisher]

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