Moving toward the petroclival region: a model for quantitative and anatomical analysis of tumor shift

The authors quantitatively assessed the effects of balloon inflation as a model of tumor compression on the brainstem, cranial nerves, and clivus by measuring the working area, angle of attack, and brain shift associated with the retrosigmoid approach.

Six silicone-injected cadaveric heads were dissected bilaterally via the retrosigmoid approach. Quantitative data were generated, including key anatomical points on the skull base and brainstem. All parameters were measured before and after inflation of a balloon catheter (inflation volume 4.8 ml, diameter 20 mm) intended to mimic tumor compression.

Balloon inflation significantly shifted (p < 0.001) the brainstem and cranial nerve foramina (mean [+/- standard deviation] displacement of upper brainstem, 10.2 +/- 3.7 mm; trigeminal nerve exit, 6.99 +/- 2.38 mm; facial nerve exit, 9.52 +/- 4.13 mm; and lower brainstem, 13.63 +/- 8.45 mm). The area of exposure at the petroclivus was significantly greater with balloon inflation than without (change, 316.26 +/- 166.75 mm2; p < 0.0001). Before and after balloon inflation, there was no significant difference in the angles of attack at the origin of the trigeminal nerve (p > 0.5).

This study adds an experimental component to the emerging field of quantitative neurosurgical anatomy. Balloon inflation can be used to model the effects of a mass lesion. The tumor simulation created "natural" retraction and an opening toward the upper clivus. The findings may be helpful in selecting a surgical approach to increase the working space for resection of certain extraaxial tumors.