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01-05-2010 | Technical Note

Image-guided surgical planning using anatomical landmarks in the retrosigmoid approach

Authors: Erasmo Barros da Silva Jr., André G. Leal, Jerônimo B. Milano, Luis F. Moura da Silva Jr., Rogério S. Clemente, Ricardo Ramina

Published in: Acta Neurochirurgica | Issue 5/2010

Abstract

Objective

The suboccipital lateral or retrosigmoid approach is the main neurosurgical approach to the cerebellopontine angle (CPA). It is mainly used in the treatment of CPA tumors and vascular decompression of cranial nerves. A prospective study using navigation registered with anatomical landmarks in order to identify the transverse and sigmoid sinuses junction (TSSJ) was carried out in a series of 30 retrosigmoid craniotomies. The goal of this study was to determine the accuracy of this navigation technique and to establish the relationship between the location of the asterion and the TSSJ.

Methods

From March through November 2008, 30 patients underwent a retrosigmoid craniotomy for removal of CPA tumors or for surgical treatment of neurovascular syndromes. Magnetic resonance imaging (MRI) T1 sequences with gadolinium (FSPGR with FatSst, 1.5 T GE® Signa) and frameless navigation (Vector vision®, Brainlab®) were used for surgical planning. Registration was performed using six anatomical landmarks. The position of the TSSJ indicated by navigation was the landmark to guide the craniotomy. The location of the asterion was compared with the position of the TSSJ. After craniotomy, the real TSSJ position was compared with the virtual position, as demonstrated by navigation.

Results

There were 19 cases of vestibular schwannomas, 5 petroclival meningiomas, 3 trigeminal neuralgias, 1 angioblastoma, 1 epidermoid cyst and 1 hemifacial spasm. In all cases, navigation enabled the location of the TSSJ and the emissary vein, with an accuracy flaw below 2 mm. The asterion was located directly over the TSSJ in only seven cases. One patient had a laceration of the sigmoid sinus during the craniotomy.

Conclusions

Navigation using anatomical landmarks for registration is a reliable method in the localization of the TSSJ for retrosigmoid craniotomies and thereby avoiding unnecessary sinus exposure. In addition, the method proved to be fast and accurate. The asterion was found to be a less accurate landmark for the localization of the TSSJ using navigation.

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Title: Image-guided surgical planning using anatomical landmarks in the retrosigmoid approach
Authors: Erasmo Barros da Silva Jr.
André G. Leal
Jerônimo B. Milano
Luis F. Moura da Silva Jr.
Rogério S. Clemente
Ricardo Ramina
Publication date: 01-05-2010
Publisher: Springer Vienna
Published in: Acta Neurochirurgica / Issue 5/2010
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI: https://doi.org/10.1007/s00701-009-0553-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Image-guided surgical planning using anatomical landmarks in the retrosigmoid approach

Abstract

Objective

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objective

Methods

Results

Conclusions

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