Microsurgical and Endoscopic Anatomy of the Retrosigmoid Intradural Suprameatal Approach to Lesions Extending from the Posterior Fossa to the Central Skull Base

Abstract

This article evaluates the accessibility of the posterior part of the central skull base via the extended retrosigmoid intradural suprameatal approach. In formaldehyde-fixed specimens, the retrosigmoid intradural suprameatal approach was performed, and the feasibility of reaching central skull base structures was analyzed. Microscopic and endoscopic techniques were used. The main outcome measures were digital films and screenshots, which were analyzed regarding quantitative and qualitative aspects of visual structures. By drilling off the suprameatal tubercle and part of the petrous apex, Meckel's cave may be opened, the trigeminal nerve mobilized, and the tentorium divided. Thus the parasellar area may be exposed and the posterosuperior space of the cavernous sinus approached. Using an endoscope-assisted technique and following cisternal anatomy, the sellar and parasellar region may be explored even if the working space is narrow. The retrosigmoid intradural suprameatal approach provides optimal accessibility to medially located central skull base structures, in particular to the posterior part of the cavernous sinus. Use of the endoscope may remarkably optimize the accessibility.