Akademik Veri Yönetim Sistemi
JOURNAL OF THE ANATOMICAL SOCIETY OF INDIA, cilt.72, sa.1, ss.43-47, 2023 (SCI-Expanded)
Objective: Retrosigmoid approach and presigmoid approach and its derivatives including
retrolabyrinthine, translabyrinthine, and transpetrosal approaches have long been used for reaching
posterior and middle cranial fossa. In neurosurgery perspective, many types of tumors arise
extradurally and surgical resection of these tumors is still challenging. We aimed to describe a
modified way to approach posterior and middle fossa to contribute to the surgical management of
petroclival tumors with posterior extension. Methods: Modified sigmoid approaches were performed
bilaterally in 5 fresh adult cadaver heads. Results: In this approach, it was possible to reach the
middle and posterior fossa with a single craniotomy. Temporal dura matter was dissected from the
temporal bone with extradural gentle dissection. In addition, sigmoid sinus and superior petrosal
sinus (SPS) were dissected off from the petrous bone meticulously. Subsequently, the posterolateral
superior arcuate petrosectomy was performed with high‑speed surgical drill extradurally by protecting
the semicircular canal, labyrinthine channel, and cochlea. Dura matter was elevated for 1.5 cm with
retractor above the mastoid bone. Dura was opened from an alternative area of Trautmann’s triangle.
After having exposed and opened the dura, posterior fossa was reached at the level of 7.−8. cranial
nerves. Conclusion: We described an alternative route which seems to be a feasible way to reach
posterior and middle fossa without mastoidectomy and SPS ligation. Notably, this technique can be
applicable to petroclival tumor surgery after more anatomic studies with cadaveric specimens