Article
The combined presigmoidal approach – own experience with the increasingly outmoded approach over the last seven years
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Authors
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Siamak Asgari
- Neurochirurgische Klinik, Klinikum Ingolstadt, Ingolstadt, Deutschland
| Published: | June 9, 2017 |
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Outline
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Objective: The combined presigmoidal infra- and supratentorial approach was developed in the 70es and 80es of the last century to reach lesions of the petroclival region, mainly meningiomas. But in the last two decades, this approach was leaved in cause of its enormous time consumption and complication profile. Today, this approach still may have its eligibility in a very small group of patients.
Methods: Over the last 7 years, the senior surgeon used the combined presigmoidal approach in the modification according to Samii and Ammirati in 9 patients. The mean age of the patients was 56 years (38-73 years). 3 patients were female. The indications, clinical results and specific approach-related aspects were analyzed and presented.
Results: Indications were 5 tumors (meningioma, chondrosarcoma, epidermoid, trigeminal schwannoma) and 4 vascular lesions (DAVF, cavernoma). The mean intraoperative approach-related duration time was 150 min.. No approach-related complications occurred (e.g. venous infarction, CSF fistula, wound healing failure). All vascular lesions were resected completely. 2 tumors were resected totally, 2 were resected subtotally, and 1 tumor partially.
Conclusion: The combined presigmoidal approach means a milestone in skull-base surgery during the neurosurgical proceedings over the last 80 years. In experienced hands, this approach gives a safe and multidirectional access to difficult tumors and vascular lesions of the petroclival region and brainstem. Interestingly, in all presented patients alternative routes and concepts could be discussed.
