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The Tentorial Bridge to Deep Skull Base Exposure: Anatomic Morphometric Study.

Ciro A Vasquez1, John A Thompson1, A Samy Youssef1

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World Neurosurgery
|March 20, 2018
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Splitting the tentorium significantly expands surgical exposure for skull base lesions, reducing brain retraction and improving visualization of deep structures.

Keywords:
SubtemporalTentoriumTranspetrosalTranssinusTranssylvian

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Area of Science:

  • Neurosurgery
  • Skull Base Surgery
  • Surgical Anatomy

Background:

  • Tentorial splitting is a technique used by skull base surgeons.
  • It expands exposure, minimizes brain retraction, and combines supratentorial and infratentorial compartments.
  • This facilitates the resection of large skull base lesions.

Purpose of the Study:

  • To describe stepwise techniques for tentorial splitting.
  • To access deeply located skull base lesions.
  • To morphometrically assess the gained surgical exposure.

Main Methods:

  • Surgical exposures were performed via transsylvian, subtemporal, posterior transpetrosal, and combined posterior supratentorial/infratentorial-transsinus approaches.
  • Custom software was used for area analysis of surgical exposure.
  • Qualitative morphometric assessment evaluated the gain in anatomic exposure.

Main Results:

  • Transsylvian transtentorial approach: 154.17% increase in surface area.
  • Subtemporal transtentorial approach: 137.61% increase.
  • Posterior transpetrosal transtentorial approach: 171.06% increase.
  • Combined approach: 222.03% increase.

Conclusions:

  • Tentorial splitting yields substantial expansion of surgical area.
  • This minimizes the need for brain retraction.
  • Improved visualization of deep neurovascular structures in the skull base is achieved.