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Anatomical basis of the extended subtemporal approach to the cerebellopontine angle: its value and limitations

Bases anatomiques de l'abord sous-temporal élargi de l'angle ponto-cérébreux: intérêt et limites

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Summary

The cerebellopontine angle is an anatomic region situated deeply at the anterolateral aspect of the brainstem, access to which is complicated by the presence of neurovascular bundles. The functional importance of these cranial n. (trigeminal, facial, vestibulo= cochlear, glossopharyngeal, vagus and accessory) calls for the use of special surgical routes of access in certain cases. In particular, tumors situated between the vestibulocochlear-facial bundle behind and the trigeminal n. in front are difficult to reach by the suboccipital and subtemporal transmeatal routes. The endeavor to preserve hearing in particular situations, where the side opposite the tumor is no longer functional, justifies the use of a subtemporal transmeatal route extended by opening the tentorium cerebelli. This anatomic and experimental surgical study deals with the possibilities of this route of approach.

Résumé

L'angle ponto-cérébelleux est une région anatomique profondément située à la face antérolatérale du tronc cérébral et dont l'accès est rendu délicat par la présence de pédicules vasculonerveux. L'importance fonctionnelle de ces n. crâniens (trijumeau, facial, vestibulo-cochléaire, glossopharyngien, vague et accessoire) justifie dans certains cas, l'utilisation de voies chirurgicales particulières. En effet, les processus tumoraux, situés entre le paquet acoustico-facial en arrière, et le n. trijumeau en avant, sont d'accès délicat par les voies sous-occipitale et sous-temporale transcanalaire. La tentative de préservation de l'audition dans les situations particulières où le côté contro-latéral à la tumeur n'est plus fonctionnel, justifie l'utilisation d'une voie anatomique sous-temporale transcanalaire élargie par ouverture de la tente du cervelet. L'étude anatomique et chirurgicale expérimentale expose les possibilités de cette voie d'abord.

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References

  1. Bochenek Z, Kukwa A (1975) An extended approach through the middle cranial fossa to the internal auditory meatus and the cerebello-pontine angle. Acta Otolaryngol (Stockh) 80: 410–414

    CAS  Google Scholar 

  2. Bonnal J, Louis R, Combalbert A (1964) L'abord temporal transtentoriel de l'angle ponto-cérébelleux et du clivus. Neurochirurgie 10: 3–12

    CAS  PubMed  Google Scholar 

  3. Bouchet A, Cuilleret J (1982) Anatomie topographique, descriptive et fonctionnelle, le système nerveux central. 2e ed, Simep, Villeurbanne

    Google Scholar 

  4. Bremond G, Garcin M, Magnan J, Pradoura JP, Pech-Bourg (1976) Anatomie du complexe acoustico-facial. Acta Otorhinolaryngol Belg 30: 145–150

    CAS  PubMed  Google Scholar 

  5. Cabanis EA, Doyon D (1988) Atlas d'IRM de l'encéphale et de la moelle. Masson, Paris

    Google Scholar 

  6. Caparosa RJ (1967) Surgery of the internal auditory meatus development, surgical anatomy and surgical techniques. Laryngoscope 77: 2077–2102

    CAS  PubMed  Google Scholar 

  7. Charachon R, Accouyer R (1976) Notes techniques sur le repérage du conduit auditif interne. Acta Otorhinolaryngol Belg 30: 77–83

    Google Scholar 

  8. Charachon R (1981) La voie suspétreuse. J Fr Otorhinolaryngol 30: 597–605

    CAS  PubMed  Google Scholar 

  9. Cohadon F, Castel JP (1968) Incidence de quelques constatations anatomiques sur les voies d'abord chirurgical du conduit auditif interne. Rev Laryngol Otol Rhinol (Bord) 89: 643–657

    CAS  Google Scholar 

  10. Cohadon F, Castel JP, Leman P, Portmann M (1969) Situation et rapport du conduit auditif interne. CR Assoc Anat 144: 1666–1672

    Google Scholar 

  11. Cordova Moran R (1975) Estudio anatomo-radiologico del conducto auditivo interno. Thèse Lima, Perou

  12. Cushing H (1900) A method of total extirpation of the gasserian ganglion for trigeminal neuralgia by a route through the temporal fossa and beneath the middle meningeal artery. JAMA 34: 1305

    Google Scholar 

  13. Daniels DL (1984) Magnetic resonance imaging of the internal auditory canal. Radiology 151: 105–108

    CAS  PubMed  Google Scholar 

  14. Fisch U (1970) Transtemporal surgery of the internal auditory canal. Adv Otorhinolaryngol 17: 202–239

    Google Scholar 

  15. Gantz BJ (1986) Middle cranial fossa accoustic neuroma excision: results and complications. Ann Otorhinolaryngol 95: 454–459

    CAS  Google Scholar 

  16. Girard L (1938) Atlas d'anatomie et de médecine opératoire du labyrinthe osseux. Maloine, Paris

  17. Guerrier Y, Guerrier B (1976) Anatomie topographique et chirurgicale du rocher. Acta Otorhinolaryngol Belg 30: 22–50

    CAS  PubMed  Google Scholar 

  18. Hartley F (1892) Intercranial neurectomy of the second and third divisions of the Vth nerve: a new method. New York Med J 55: 317–319

    Google Scholar 

  19. Horsley V (1900) An adress on the surgical treatment of trigeminal neuralgia. Practitioner 65: 25

    Google Scholar 

  20. House WF (1961) Surgical exposure of the internal auditory canal and its contents through the middle cranial fossa. Laryngoscope 71: 1363–1385

    CAS  PubMed  Google Scholar 

  21. House WF, Hitselberger WE (1969) The middle fossa approach for removal of small acoustic tumors. Acta Otolaryngol (Stockh) 67: 413–427

    CAS  Google Scholar 

  22. House WF, Hitselberger WE, Horn KL (1986) The middle fossa transpetrous approach to the anterior-superior cerebelopontine angle. Am J Otol 7: 1–4

    CAS  PubMed  Google Scholar 

  23. Kartush JM, Kemink JL, Graham MD (1985) The arcuata eminence, topographic orientation in middle cranial fossa surgery. Ann Otol Rhinol Laryngol 94: 25–28

    CAS  PubMed  Google Scholar 

  24. Kien P, Castel JP, Dautheribes M, Guérin J, Bébéar JP, Caillé JM (1986) Intérêt de l'IRM dans le bilan préchirurgical des neurinomes de l'acoustique. Etude de 30 cas. Communication à la Société de Neurochirurgie de langue Française-Société de Neuroradiologie. Paris 11 décembre

  25. Kurze T, Doyle JB (1962) Extradural intracranial (middle fossa) approach to the internal auditory canal. J Neurosurg 19: 1033–1037

    CAS  PubMed  Google Scholar 

  26. Lang J (1985) Anatomy of the brainsteim and the lower cranial nerves, vessels, and surrounding structures. Am J Otol (suppl) pp 1–19

    CAS  PubMed  Google Scholar 

  27. Legent F (1963) Contribution à l'étude de la voie d'abord temporo-extra-durale du rocher. Thèse Paris, n∘ 179

  28. Lufkin R, Ross L (1986) Magnetic resonance imaging of the brainstem and cranial nerves. Surg Radiol Anat 8: 49–66

    CAS  PubMed  Google Scholar 

  29. Lufkin R, Rauschning W, Seeger L, Basset L, Hanafee W (1987) Anatomic correlation of cadaver cryomicrotomy with resonance imaging. Surg Radiol Anat 9: 299–302

    Article  CAS  PubMed  Google Scholar 

  30. Morrison AW, King TT (1973) Experiences with a translabyrinthine-transtentorial approach to the cerebellopontine angle. J Neurosurg 38: 382–390

    CAS  PubMed  Google Scholar 

  31. Parisier SC (1977) The middle cranial fossa approach to the internal auditory canal-an anatomical study stressing critical distances between surgical landmarks. Laryngoscope (suppl) 87: 1–20

    CAS  Google Scholar 

  32. Pialoux P, Freyss G, Narcy Ph, Saint-Macary M, Davaine F (1972) Contribution à l'anatomie stereotaxique du conduit auditif interne et la première portion du facial. Ann Otolaryngol Chir Cervicofac 89: 141–142

    Google Scholar 

  33. Portmann M (1972) Aperçu sur les techniques chirurgicales concernant le conduit auditif interne. Cah ORL (Montpellier) 7: 777–782

    Google Scholar 

  34. Portmann M, Sterkers JM, Charachon R, Chouard CH (1973) Le conduit auditif interne (anatomie, pathologie, chirurgie). Arnette, Paris

    Google Scholar 

  35. Rauschning W (1983) Computed tomography and cryomicrotomy of lumbar spine specimens, a new technique for multiplanar anatomic correlations. Spine 8: 170–180

    CAS  PubMed  Google Scholar 

  36. Rhoton AL (1974) Microsurgery of the internal acousticus meatus. Surg Neurol 2: 311–318

    PubMed  Google Scholar 

  37. Roos EH, Lufkin (1986) Magnetic resonance imaging of the temporal bone. In: Swartz JD (ed) Imaging of temporal bone. Thieme Verlag, New York

    Google Scholar 

  38. Rosomoff HL (1971) The subtemporal transtentorial approach to the cerebellopontine angle. Laryngoscope 81: 1448–1454

    CAS  PubMed  Google Scholar 

  39. Seeger W (1985) Differential approaches in microsurgery of the brain. Springer-Verlag, Wien

    Google Scholar 

  40. Shiobara R, Ohira T, Kanzaki J, Toya S (1988) A modified extended middle cranial fossa approach for acoustic nerves tumors, results of 125 operations. J Neurosurg 68: 358–365

    CAS  PubMed  Google Scholar 

  41. Sterkers JM, Batisse R, Gandon J, Cannoni M, Vaneeclo FM (1985) Les voies d'abord du rocher. Arnette, Paris

    Google Scholar 

  42. Wigand ME, Haid T, Berg M, Rettinger G (1982) The enlarged transtemporal approach to the cerebello-pontine angle, technique and indications. Acta Otorhinolaryngol 2: 571–582

    Google Scholar 

  43. Zanaret M (1979) La voie sus-pétreuse. Problèmes techniques. Possibilités actuelles. Thèse Marseille

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Authors and Affiliations

  1. Laborutoire d'Anatomie et Organogenèse de l'UERI, University of Bordeaux II, F-33076, Bordeaux Cedex, France

    M. Dautheribes, A. Migueis, J. M. Vital & J. Guérin

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  1. M. Dautheribes
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  2. A. Migueis
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  3. J. M. Vital
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  4. J. Guérin
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Supported by a grant from the Calouste Gulbenkian Foundation (Portugal)

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Dautheribes, M., Migueis, A., Vital, J.M. et al. Anatomical basis of the extended subtemporal approach to the cerebellopontine angle: its value and limitations. Surg Radiol Anat 11, 187–195 (1989). https://doi.org/10.1007/BF02337820

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  • DOI: https://doi.org/10.1007/BF02337820

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