| A novel technique for planning surgical approaches to the pineal region by using external cranial landmarks. | |
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MedLine Citation:
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PMID: 20397897 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECT: The infratentorial supracerebellar approach to the pineal region presents special challenges during patient positioning. The head must be flexed and the body positioned to allow an operative trajectory under the straight sinus. Image guidance is not useful during positioning because registration and navigation take place after the head is fixed in its final position. Therefore, a reliable method of positioning based on external, easily identifiable landmarks to estimate the surgical trajectory along the straight sinus toward the pineal region is needed. Based on observation, the authors hypothesized that a line between 2 palpable external landmarks, the inion and the bregma, often approximates the surgical trajectory along the straight sinus. They tested this hypothesis by quantifying the relationship between the straight sinus and the bregma, and describe a method for estimating the working angle during patient positioning. METHODS: The midsagittal, Gd-enhanced, T1-weighted MR images of 102 patients were analyzed. Demographic data and the presence or absence of tentorial pathological entities was recorded. The slant of the straight sinus was classified as common, high, or low, based on a previously described classification system. A line along the bottom of the straight sinus (that is, the straight-sinus line) was extended superiorly to its intersection with the calvaria, and the distance from this intersection point to the bregma was measured. RESULTS: The intersection point of the straight-sinus line and the calvaria was on average 2 ± 8.2 mm (these values are expressed as the mean ± SD throughout) anterior to the bregma (range 19.9 mm anterior to 19.1 mm posterior). The distance from the intersection point to the bregma was not statistically significantly different in younger or older patients, or in patients with or without tumors involving the pineal region. In patients with a low slant of the straight sinus, the intersection point was 5.3 ± 6.3 mm anterior to the bregma, whereas in patients with a high slant of the straight sinus, the intersection point was 0.21 ± 9.1 mm posterior to the bregma (p = 0.015). CONCLUSIONS: The straight-sinus line, which defines the working angle for the supracerebellar infratentorial approach, intersects the calvaria very close to the bregma in the majority of patients. Therefore, ideal patient positioning can be achieved by flexing the patient's head to optimize the working angle defined by an imaginary line connecting the torcula (inion) to the bregma. |
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Authors:
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Vikram V Nayar; Ronald J Benveniste; Frederick F Lang |
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Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't Date: 2010-04-16 |
Journal Detail:
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Title: Journal of neurosurgery Volume: 113 ISSN: 1933-0693 ISO Abbreviation: J. Neurosurg. Publication Date: 2010 Nov |
Date Detail:
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Created Date: 2010-11-02 Completed Date: 2010-11-22 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0253357 Medline TA: J Neurosurg Country: United States |
Other Details:
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Languages: eng Pagination: 1000-3 Citation Subset: AIM; IM |
Affiliation:
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Department of Neurosurgery and the Brain Tumor Center, University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adolescent Adult Female Humans Magnetic Resonance Imaging Male Neurosurgical Procedures / methods* Patient Positioning* Pineal Gland / surgery* Skull / surgery* |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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