Sylvian and Insular Exposure in the Extended Minipterional Approach: Landmarks, benefits, and quantitative analysis based on a cadaveric study.

Sylvian and Insular Exposure in the Extended Minipterional Approach: Landmarks, benefits, and quantitative analysis based on a cadaveric study.:

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Sylvian and Insular Exposure in the Extended Minipterional Approach: Landmarks, benefits, and quantitative analysis based on a cadaveric study.

World Neurosurg. 2020 Apr 03;:

Authors: Martinez-Perez R, Hardesty DA, Li R, Carrau RL, Prevedello DM

Abstract

OBJECTIVE: The Minipterional approach (MPTa) has been widely accepted as a minimally invasive technique in the treatment of anterior and middle cranial fossa lesions. However, this craniotomy does not facilitate the exposure of the distal Sylvian fissure or a wide Sylvian dissection. We describe a modification of the MPTa, the extended minipterional approach (eMPTa), that improves access to the distal Sylvian fissure with minimal additional bony removal. We define the ideal posterior landmark for this craniotomy, the preauricular line, based on an anatomic cadaveric study.

METHODS: Insular and sylvian exposure offered by the MPTa and eMPTa were compared in 5 cadaveric heads. Anatomic exposure of the eMPTa and its anatomic relation to different landmarks were also evaluated.

RESULTS: The eMPTA extending posteriorly to the preauricular line offers improved surgical exposure of the Sylvian fissure (30.5 vs. 13 mm; p<0.001) and the insula (31 vs. 10 mm; p<0.001) in comparison to the MPTa. The frontal precentral artery, an important landmark for performing a distal-to-proximal Sylvian dissection, is 17 ± 5.2 mm anterior to the preauricular line, the posterior limit of the eMPTa, whereas it is 6.5 ± 3.6 mm posterior to the traditional posterior limit of the MPTa.

CONCLUSION: The eMPTA offers improved access to the Sylvian fissure allowing a wider fissure splitting while only requiring extending the posterior limit of the MPT craniotomy up to the preauricular line. This may allow for improved freedom of movement deep in the Sylvian cistern and potentially expand the indications of the MPTa.

PMID: 32251832 [PubMed - as supplied by publisher]