Extreme Lateral Supracerebellar Infratentorial Approach: Surgical Anatomy and Review of the Literature
Por:
Giammattei, L, Starnoni, D, Benes, V, Froelich, S, Cossu, G, Borsotti, F, Majovsky, M, Sufianov, A, Fava, A, di Russo, P, Elbabaa, S, Gonzalez-Lopez, P, Messerer, M and Daniel, R
Publicada:
1 mar 2021
Ahead of Print:
1 ene 2021
Resumen:
OBJECTIVE: The extreme lateral supracerebellar infratentorial (ELSI) approach has the potential to access several distinct anatomical regions that are otherwise difficult to reach. We have illustrated the surgical anatomy through cadaveric dissections and provided an extensive review of the literature to highlight the versatility of this approach, its limits, and comparisons with alternative approaches.
METHODS: The surgical anatomy of the ELSI has been described using 1 adult-injected cadaveric head. Formalized noninjected brain specimens were also dissected to describe the brain parenchymal anatomy of the region. An extensive review of the literature was performed according to each targeted anatomical region. Illustrative cases are also presented.
RESULTS: The ELSI approach allows for wide exposure of the middle and posterolateral incisural spaces with direct access to centrally located intraaxial structures such as the splenium, pulvinar, brainstem, and mesial temporal lobe. In addition, for skull base extra-axial tumors such as petroclival meningiomas, the ELSI approach represents a rapid and adequate method of access without the use of extensive skull base approaches.
CONCLUSIONS: The ELSI approach represents one of the most versatile approaches with respect to its ability to address several anatomical regions centered at the posterior and middle incisural spaces. For intra-axial pathologies, the approach allows for access to the central core of the brain with several advantages compared with alternate approaches that frequently involve significant brain retraction and cortical incisions. In specific cases of skull base lesions, the ELSI approach is an elegant alternative to traditionally used skull base approaches, thereby avoiding approach-related morbidity.
Filiaciones:
Giammattei, L:
Lariboisiere Hosp, Dept Neurosurg, Paris, France
Starnoni, D:
Univ Hosp Lausanne, Dept Neurosurg, Lausanne, Switzerland
Benes, V:
Charles Univ Prague, Dept Neurosurg, Prague, Czech Republic
Mil Univ Hosp, Prague, Czech Republic
Froelich, S:
Lariboisiere Hosp, Dept Neurosurg, Paris, France
Cossu, G:
Univ Hosp Lausanne, Dept Neurosurg, Lausanne, Switzerland
Borsotti, F:
Univ Hosp Lausanne, Dept Neurosurg, Lausanne, Switzerland
Majovsky, M:
Charles Univ Prague, Dept Neurosurg, Prague, Czech Republic
Mil Univ Hosp, Prague, Czech Republic
Sufianov, A:
Fed Ctr Neurosurg, Dept Neurosurg, Tyumen, Russia
Sechenov Univ, Dept Neurosurg, Moscow, Russia
Fava, A:
Lariboisiere Hosp, Dept Neurosurg, Paris, France
di Russo, P:
Lariboisiere Hosp, Dept Neurosurg, Paris, France
Elbabaa, S:
Arnold Palmer Hosp Children, Dept Pediat Neurosurg, Orlando, FL USA
:
Hosp Gen Univ Alicante, Dept Neurosurg, Alicante, Spain
Messerer, M:
Univ Hosp Lausanne, Dept Neurosurg, Lausanne, Switzerland
Univ Lausanne, Fac Biol & Med, Lausanne, Switzerland
Daniel, R:
Univ Hosp Lausanne, Dept Neurosurg, Lausanne, Switzerland
Sechenov Univ, Dept Neurosurg, Moscow, Russia
Univ Lausanne, Fac Biol & Med, Lausanne, Switzerland
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