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The transsylvian corridor through minimally invasive transcranial approaches: a comparative anatomical study

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Abstract

Minimally invasive transcranial approaches (MITAs) continue to expand in popularity in neurosurgery. Only few MITAs allow sufficient sylvian exposure to enable wide use of the transsylvian corridor. In this study, we aim to compare the transsylvian corridor in two MITAs: the minipterional (MPTa) and the extended supraorbital eyebrow approaches (XSEa). Eight cadaver heads were used to quantify the surgical exposure and maneuverability along the sylvian fissure and the insular lobe provided by the MPTa and the XSEa. Surgical exposure was calculated by means of the exposed length of the sylvian fissure and by the area framed within three extreme points in the insular lobe. Maneuverability was assessed by means of the surgical freedom along the sylvian cistern. XSEa provides twice the frontal exposure and half of the temporal exposure in comparison to the MPTa (p < 0.001 and p = 0.02, respectively). No significant differences were found between the two craniotomies in the length of the exposure of the sylvian fissure, area of insular exposure, or surgical freedom. Both the MPTa and the XSEa afford sufficient grades of exposure along the sylvian fissure and the insular lobe, although the viewing angle is significantly different between the two approaches. Such properties allow either to be used for microsurgery deep within the sylvian cistern. The use of additional corridors, such as the subfrontal route (XSEa) and pretemporal route (MPTa), may influence selection of either the minipterional or the extended supraorbital approaches according to the origin of the surgical pathology addressed.

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Authors and Affiliations

  1. Department of Neurosurgery, Wexner Medical Center, The Ohio State University, 410 W 10th Ave, Columbus, OH, 43210, USA

    Rafael Martinez-Perez, Thiago Albonette-Felicio, Douglas A. Hardesty, Takuma Hara, Ricardo L. Carrau & Daniel M. Prevedello

  2. Department of Neurosurgery, Rush University, Chicago, IL, USA

    Andre Beer-Furlan

  3. Department of Head and Neck Surgery, Wexner Medical Center, The Ohio State University, Columbus, OH, USA

    Douglas A. Hardesty, Ricardo L. Carrau & Daniel M. Prevedello

  4. Department of Neurosurgery, Stanford University, Palo Alto, CA, USA

    Ahmed Mohyeldin

Authors
  1. Rafael Martinez-Perez
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  2. Andre Beer-Furlan
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  3. Thiago Albonette-Felicio
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  4. Douglas A. Hardesty
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  5. Ahmed Mohyeldin
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  6. Takuma Hara
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  7. Ricardo L. Carrau
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  8. Daniel M. Prevedello
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Corresponding authors

Correspondence to Rafael Martinez-Perez or Daniel M. Prevedello.

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Conflict of interest

Daniel M. Prevedello is a consultant for Integra LifeSciences Corp. and Stryker Corporation. Daniel Prevedello has equity on 3 rivers LLC, eLUM Technologies, LLC, and Soliton LLC. Daniel Prevedello receives royalties from ACE Medical, KLS Martin, and Mizuho.

Ethical approval and informed consent

Informed consent and ethical approval were not deemed necessary by the local ethics in view of the design of the study. Anatomical dissections, measurements, and analysis were performed at the Anatomical Laboratory for VisuoSpatial Innovations in Otolaryngology and Neurosurgery (ALT-VISION) at The Ohio State University.

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Martinez-Perez, R., Beer-Furlan, A., Albonette-Felicio, T. et al. The transsylvian corridor through minimally invasive transcranial approaches: a comparative anatomical study. Neurosurg Rev 44, 2619–2627 (2021). https://doi.org/10.1007/s10143-020-01439-4

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  • DOI: https://doi.org/10.1007/s10143-020-01439-4

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