Introduction: The extracranial jugular foramen, posterior infratemporal region includes many structures that can develop a variety of different pathologies. We compare the surgical maneuverability and visualization provided by the different available approaches to this region to define optimal corridors based on the target region. Additionally, we describe the relationships between the anatomical structures found in each anatomical compartment. Methods: Using three cadaveric specimens, preauricular transcervical and infratemporal, postauricular infratemporal, far lateral, and endoscopic transnasal transsphenoidal approaches were performed. Four anatomical subregions were defined using a vertical plane passing through the stylomastoid foramen and a horizontal plane through the mastoid tip. These compartments were further divided into lateral and medial subcompartments by using a sagittal plane along the long axis of the internal carotid artery. Exposure and maneuverability were assessed with each approach. Results: Anterolateral approaches permitted at least multiangled exposure and allowed surgical maneuvers with almost all the structures of the lateral compartments, particularly those in the perijugular region. The infratemporal approach provided excellent exposure of the lateral compartments and improved exposure and maneuverability in the medial infrapetrous region. Posterolateral approaches provided at least multiangled exposure and allowed maneuverability of the posterior regions. The endoscopic approach allowed exposure of the anterior regions but had mostly limited surgical maneuverability. Conclusion: Detailed knowledge of the topographic anatomy of the extracranial jugular foramen, posterior infratemporal region is fundamental to navigate the region safely during surgery. Although each clinician has preferred approaches to address complex lateral skull base lesions, all the possibilities should be taken into consideration to tailor the surgery for each particular case.
The Extracranial Jugular Foramen and Posterior Infratemporal Fossa Region as Seen through Different Surgical Approaches: An Anatomical Study
Daniele Armocida;
2022-01-01
Abstract
Introduction: The extracranial jugular foramen, posterior infratemporal region includes many structures that can develop a variety of different pathologies. We compare the surgical maneuverability and visualization provided by the different available approaches to this region to define optimal corridors based on the target region. Additionally, we describe the relationships between the anatomical structures found in each anatomical compartment. Methods: Using three cadaveric specimens, preauricular transcervical and infratemporal, postauricular infratemporal, far lateral, and endoscopic transnasal transsphenoidal approaches were performed. Four anatomical subregions were defined using a vertical plane passing through the stylomastoid foramen and a horizontal plane through the mastoid tip. These compartments were further divided into lateral and medial subcompartments by using a sagittal plane along the long axis of the internal carotid artery. Exposure and maneuverability were assessed with each approach. Results: Anterolateral approaches permitted at least multiangled exposure and allowed surgical maneuvers with almost all the structures of the lateral compartments, particularly those in the perijugular region. The infratemporal approach provided excellent exposure of the lateral compartments and improved exposure and maneuverability in the medial infrapetrous region. Posterolateral approaches provided at least multiangled exposure and allowed maneuverability of the posterior regions. The endoscopic approach allowed exposure of the anterior regions but had mostly limited surgical maneuverability. Conclusion: Detailed knowledge of the topographic anatomy of the extracranial jugular foramen, posterior infratemporal region is fundamental to navigate the region safely during surgery. Although each clinician has preferred approaches to address complex lateral skull base lesions, all the possibilities should be taken into consideration to tailor the surgery for each particular case.
I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
