Transdural Cisternotomy in the Extended Middle Fossa Approach

Area of Science:

• Neurosurgery
• Skull Base Surgery
• Cerebrospinal Fluid Dynamics

Background:

• Extradural middle cranial fossa approaches (EMFAs) are crucial for central skull base access.
• Extended extradural phases can cause temporal lobe edema and venous infarction, complicating surgery.

Purpose of the Study:

• To introduce and evaluate a novel "transdural cisternotomy" technique for cerebrospinal fluid (CSF) drainage during EMFAs.
• To assess the efficacy of this technique in improving surgical exposure and patient outcomes.

Main Methods:

• Description of the transdural cisternotomy technique, involving CSF release from the chiasmatic cistern during the extradural stage.
• Application of the technique in two cases: petroclival meningioma and petroclival intradural chordoma.

Main Results:

• Both patients with petroclival tumors underwent gross total resection.
• The transdural cisternotomy technique was highly beneficial, facilitating brain relaxation and surgical access.
• Good long-term outcomes were achieved in both cases.

Conclusions:

• Transdural cisternotomy is an easy, reproducible, and effective method for brain relaxation in EMFAs.
• This technique offers a valuable adjunct for managing temporal lobe edema during complex skull base surgeries.