This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Research
Ji Zhang
Sun Yat-sen University Cancer Center
Corresponding Author
ORCiD: https://orcid.org/0000-0003-0963-1629
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Background During craniotomy for the cerebellopontine angle (CPA) lesion by the typical retrosigmoid approach, the exact exposure of the margin of the venous sinuses complex remains an essential but risky step. This study aimed to reveal the exact position of asterion and sinuses by combining preoperative imaging with intraoperative landmarks. and analyse their clinical features.
Methods From February 2008 through November 2019, 94 patients who underwent removal of vestibular schwannoma (VS) through retrosigmoid craniotomies were enrolled in the series. We utilized preoperative images, including computed tomography (CT) and/or magnetic resonance imaging (MRI) combined with intraoperative anatomical landmarks, to determine the exact location of the sigmoid sinus and the transverse and sigmoid sinuses junction (TSSJ). MRI T1 sequences with gadolinium and/or the CT bone window were used to measure the distance relationship of the asterion to the sigmoid sinus.
Results In 94 cases of retrosigmoid craniotomies, we observed the asterion lay 12.71 millimeter on the posterior to the body surface projection of the TSSJ averagely. Intraoperative surface landmarks combined with preoperative image information identifying the distance from the asterion to sigmoid sinus at the transverse sinus level, enabled an appropriate initial burr-hole (the margin of the TSSJ ). Just one case had a minor laceration of the sigmoid sinus when the bone flap was opened.
Conclusions By combining intraoperative anatomical landmarks with preoperative image information, the margin of the venous sinuses, especially the inferior margin of the transverse sinus in the retrosigmoid approach can be well and truly identified. The distance from the intersection of the asterion and occipitomastoid suture to the TSSJ is the shortest between the occipitomastoid suture and the sigmoid sinus.
Keywords
Retrosigmoid approach, Sinus localization, Image, Surface marker
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This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Research
Ji Zhang
Sun Yat-sen University Cancer Center
Corresponding Author
ORCiD: https://orcid.org/0000-0003-0963-1629
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
History
CURRENT STATUS: Posted
Version 1
Posted 12 Jan, 2021
No community comments so far
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Oncology
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background During craniotomy for the cerebellopontine angle (CPA) lesion by the typical retrosigmoid approach, the exact exposure of the margin of the venous sinuses complex remains an essential but risky step. This study aimed to reveal the exact position of asterion and sinuses by combining preoperative imaging with intraoperative landmarks. and analyse their clinical features.
Methods From February 2008 through November 2019, 94 patients who underwent removal of vestibular schwannoma (VS) through retrosigmoid craniotomies were enrolled in the series. We utilized preoperative images, including computed tomography (CT) and/or magnetic resonance imaging (MRI) combined with intraoperative anatomical landmarks, to determine the exact location of the sigmoid sinus and the transverse and sigmoid sinuses junction (TSSJ). MRI T1 sequences with gadolinium and/or the CT bone window were used to measure the distance relationship of the asterion to the sigmoid sinus.
Results In 94 cases of retrosigmoid craniotomies, we observed the asterion lay 12.71 millimeter on the posterior to the body surface projection of the TSSJ averagely. Intraoperative surface landmarks combined with preoperative image information identifying the distance from the asterion to sigmoid sinus at the transverse sinus level, enabled an appropriate initial burr-hole (the margin of the TSSJ ). Just one case had a minor laceration of the sigmoid sinus when the bone flap was opened.
Conclusions By combining intraoperative anatomical landmarks with preoperative image information, the margin of the venous sinuses, especially the inferior margin of the transverse sinus in the retrosigmoid approach can be well and truly identified. The distance from the intersection of the asterion and occipitomastoid suture to the TSSJ is the shortest between the occipitomastoid suture and the sigmoid sinus.
Figure 1
Figure 2
Figure 3
Figure 4
Figure 5
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