REVIEW
As abordagens transpetrosas posteriores envolvem a remoção de porções do osso petroso e a criação de uma via de acesso à fossa craniana posterior. O triângulo de Trautmann, delimitado pelo seio petrosal superior, canal semicircular posterior, bulbo jugular e seio sigmoide, é a janela através da qual a fossa posterior é acessada, e sua exposição é um passo comum em todas as variantes das abordagens transpetrosas posteriores: a retrolabiríntica, a translabiríntica e a transcoclear. A avaliação radiológica pré-operatória desempenha um papel importante no planejamento e execução dessas abordagens, e diferentes modalidades de imagem, como TC e RM, podem ser usadas. No entanto, devido à variabilidade anatômica significativa, a facilidade da abordagem pode ser muito afetada. Informações detalhadas sobre a anatomia óssea, incluindo o grau de aeração do mastoide, a posição e dominância do seio sigmoide, bem como a altura do bulbo jugular são parâmetros importantes a serem considerados para garantir uma cirurgia segura e eficaz, minimizando o risco de complicações. Portanto, o objetivo deste artigo é revisar a avaliação radiológica e a correlação, bem como a anatomia microneurocirúrgica das abordagens transpetrosas posteriores.
The posterior transpetrosal approaches involve removing portions of the petrous bone and creating a pathway to access the posterior cranial fossa. The Trautmann’s triangle, delimited by the superior petrosal sinus, posterior semicircular canal, jugular bulb and sigmoid sinus, is the window through which the posterior fossa is accessed, and its exposure is a common step in all variants of the posterior transpetrosal approaches: the retrolabyrinthine, the translabyrinthine and the transcochlear approaches. Preoperative radiological assessment plays a critical role in planning and performing these approaches, and different imaging modalities, such as CT and MRI, may be used. However, due to significant anatomical variability, the ease of the approach, may be greatly affected. Detailed information on the bony anatomy, including the degree of mastoid aeration, the position and dominance of the sigmoid sinus as well as the height of the jugular bulb are important parameters to be considered to ensure safe and effective surgery while minimizing the risk of complications. Therefore, the aim of this manuscript is to review the radiological assessment and correlation as well as the microneurosurgical anatomy of the posterior transpetrosal approaches.
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1MD, MSc, MBA, Instituto de Neurologia, Neurocirurgia e Coluna do Nordeste, Real Hospital Português, Recife, PE, Brazil.
2MD, PhD, Real Instituto de Otorrino e Fono, Real Hospital Português, Recife, PE, Brazil.
3MD, PhD, Medical Sciences Center, Federal University of Pernambuco – UFPE, Recife, PE, Brazil.
Received Mar 30, 2023
Accepted Apr 12, 2023
