Experience and Balance: Long-Term Trends in Preferred Skull Base Approach for a Case Series of Cavernous Malformation Resections
Document Type
Article
Abstract
BACKGROUND: Skull base approaches are a foundation of modern cerebrovascular surgery; however, their application over time has varied. OBJECTIVE: To assess trends in skull base approach selection for cavernous malformation (CM) resection. METHODS: This is a retrospective case series of all first-time CM resections by a single surgeon from 1997 to 2021. Cases were classified by craniotomy and approach. Four sets of common comparator skull base approaches were identified by coauthor consensus: pterional and orbitozygomatic; retrosigmoid, extended retrosigmoid (xRS), and far-lateral; suboccipital and torcular; and trans-cerebellar peduncle (MCP) and transcerebellopontine angle. Counts were binned by 5-year or 10-year clusters for descriptive statistical assessment of temporal trends. RESULTS: In total, 372 primary CM resections met the study criteria and were included. Orbitozygomatic approach use increased during the second 5-year period, after which the pterional approach rapidly became and remained the preferred approach. During the first two 5-year periods, the far-lateral approach was preferred to the retrosigmoid and xRS approaches, but the xRS approach grew in popularity and accounted for >50% of operations in this comparator group. Trans-MCP use compared with the transcerebellopontine angle approach closely mirrored the change in xRS use. The midline suboccipital approach accounted for a larger proportion (range, 62%-88%) of cases than the torcular approach (range, 12%-38%) across all periods. CONCLUSION: The xRS and trans-MCP approaches have been increasingly used over time, while the orbitozygomatic and far-lateral approaches have become less common. These trends seem to reflect versatility, efficiency, and safety of these techniques.
Publication Date
4-21-2023
Publication Title
Operative neurosurgery (Hagerstown, Md.)
E-ISSN
2332-4260
PubMed ID
37083737
Digital Object Identifier (DOI)
10.1227/ons.0000000000000718
Recommended Citation
Devia, Diego A.; Graffeo, Christopher S.; Benner, Dimitri; Scherschinski, Lea; Thomas, George; Koester, Stefan W.; Srinivasan, Visish M.; and Lawton, Michael T., "Experience and Balance: Long-Term Trends in Preferred Skull Base Approach for a Case Series of Cavernous Malformation Resections" (2023). Neurosurgery. 1796.
https://scholar.barrowneuro.org/neurosurgery/1796