Anatomical Step-by-Step Dissection of Complex Skull Base Approaches for Trainees: Surgical Anatomy of the Translabyrinthine and Transcochlear Approaches
Avital Perry1,2,3, Lucas P Carlstrom1,2,4, Alex Yohan Alexander1,2,5
1Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, Minnesota, United States.
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Summary
This study details the translabyrinthine and transcochlear approaches for skull base surgery, offering a 3D anatomical guide for trainees. These hearing-sacrificing techniques provide excellent access to posterior fossa pathologies with minimal cerebellar retraction.
Area of Science:
- Neurosurgery
- Otolaryngology
- Anatomy
Background:
- Traditional 2D atlases lack 3D anatomical detail crucial for complex skull base surgery.
- Step-by-step surgical dissections enhance learning of intricate skull base techniques.
Purpose of the Study:
- To create a comprehensive, 3D anatomical resource for skull base surgical approaches.
- To document the translabyrinthine and transcochlear approaches for trainee education.
Main Methods:
- Performed translabyrinthine and transcochlear approaches on six cadaveric specimens.
- Photodocumented each step of the surgical dissections.
- Included illustrative case examples to supplement the dissections.
Main Results:
- These approaches provide lateral windows into the posterior fossa for accessing petrous apex and brainstem pathologies.
- The transcochlear approach extends access anteriorly to the prepontine region and clivus.
- Key considerations include patient positioning, landmark identification, dural opening, and closure.
Conclusions:
- Translabyrinthine and transcochlear approaches are essential for lateral skull base and posterior fossa pathologies.
- These hearing-sacrificing methods offer unique visualization of neurovascular structures with minimal retraction.
- The study provides a practical, high-yield surgical learning resource for neurosurgery and otolaryngology trainees.