A proposed classification system for presigmoid approaches: a scoping review.

Area of Science:

• Neurosurgery
• Skull Base Surgery
• Surgical Anatomy

Background:

• Presigmoid approaches are vital for lateral skull base surgery, accessing areas like the internal auditory canal and brainstem.
• Existing classifications for these approaches are heterogeneous and can be imprecise.
• A clear, anatomy-based classification is needed to standardize descriptions.

Purpose of the Study:

• To conduct a scoping review of presigmoid approaches.
• To propose a novel, anatomy-based classification system for presigmoid approaches.
• To enhance clarity and precision in describing surgical corridors.

Main Methods:

• Scoping review of literature from PubMed, EMBASE, Scopus, and Web of Science (up to Dec 2022).
• Included clinical studies on stand-alone presigmoid approaches.
• Summarized findings based on anatomical corridor, trajectory, and target lesions.

Main Results:

• Analyzed 99 clinical studies; common lesions included vestibular schwannomas and petroclival meningiomas.
• Approaches were categorized into anterior (translabyrinthine) and posterior (retrolabyrinthine) corridors.
• Detailed 9 variations within these corridors based on bone resection and trajectory.

Conclusions:

• Presigmoid approaches are increasingly complex with minimally invasive techniques.
• Current nomenclature can be confusing; a standardized classification is essential.
• The proposed classification system offers a simple, precise, and efficient way to describe presigmoid approaches.