Stereoscopic Surgical Video of Combined Petrosectomy With Virtual Reality Headset: 3-Dimensional Operative Video

Operative Neurosurgery, Apr 2019

The use of 3-dimensional (3D) videos allows students to visualize surgical procedures from the perspective of the surgeon without missing the essential parts.1 This 3D commented video demonstrates the operative technique and surgical nuances of the combined petrosectomy, visualize using virtual reality headsets.

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Stereoscopic Surgical Video of Combined Petrosectomy With Virtual Reality Headset: 3-Dimensional Operative Video

Abstract The use of 3-dimensional (3D) videos allows students to visualize surgical procedures from the perspective of the surgeon without missing the essential parts.1 This 3D commented video demonstrates the operative technique and surgical nuances of the combined petrosectomy, visualize using virtual reality headsets. Historically, traditional intradural cisternal routes using suboccipital and pterional approaches have been proposed to remove petroclival tumors.2-5 It allows rapid identification of neurovascular structures and a short exposure time. However, access to the petroclival region is far, not direct, and requires intradural cerebral retraction.6 In order to improve the access for tumoral dissection, lateral transpetrosal approaches have been proposed.7-12 The extradural route shortened the distance to the petroclival region, allows to better preserve the veins, to decrease the cerebral retraction, to interrupt early the tumor vascular supply, and a larger extent of resection.6 Transpetrosal approaches includes middle fossa approach8,10 (removing the petrous apex), posterior petrosal approach9,13,14 (removing of presigmoid retrolabyrinthine bone), and translabyrinthine petrosectomy.12 A combined petrosectomy may be used to approach larger tumor extending across the clival midline, upward to the tentorium or downward to the lower cranial nerves.6,10,15,16 Alternatively, according to Nanda, a retro-sigmoid approach may need to be performed to avoid critical draining veins injury.10,17 Good resection and outcomes are obtained when experienced surgeons use familiar approaches and microsurgical techniques.10 Virtual reality, Combined petrosectomy, Skull base meningioma, Skull base surgery View largeDownload slide Watch now at https://academic.oup.com/ons/article-lookup/doi/10.1093/ons/opy228 View largeDownload slide Watch now at https://academic.oup.com/ons/article-lookup/doi/10.1093/ons/opy228 Video 1 Stereoscopic Surgical Video of Combined Petrosectomy With Virtual Reality Headset: 3-Dimensional Operative Video Video 1 Stereoscopic Surgical Video of Combined Petrosectomy With Virtual Reality Headset: 3-Dimensional Operative Video Close Disclosure The authors have no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this article. REFERENCES 1. Gallagher K , Jain S , Okhravi N . Making and viewing stereoscopic surgical videos with smartphones and virtual reality headset . Eye  . 2016 ; 30 ( 4 ): 503 - 504 . Google Scholar Crossref Search ADS PubMed   2. Bambakidis NC , Kakarla UK , Kim LJ et al.  Evolution of surgical approaches in the treatment of petroclival meningiomas: a retrospective review . Neurosurgery  . 2008 ; 62 ( 6 suppl 3 ): 1182 - 1191 . Google Scholar PubMed   3. Goel A . Extended lateral subtemporal approach for petroclival meningiomas: report of experience with 24 cases . Br J Neurosurg  . 1999 ; 13 ( 3 ): 270 - 275 . Google Scholar Crossref Search ADS PubMed   4. Samii M , Tatagiba M . Experience with 36 surgical cases of petroclival meningiomas . Acta Neurochir  . 1992 ; 118 ( 1-2 ): 27 - 32 . Google Scholar Crossref Search ADS PubMed   5. Spallone A , Makhmudov UB , Mukhamedjanov DJ , Tcherekajev VA . Petroclival meningioma. An attempt to define the role of skull base approaches in their surgical management . Surg Neurol  . 1999 ; 51 ( 4 ): 412 - 420 . Google Scholar Crossref Search ADS PubMed   6. Fournier HD , Mercier P , Roche PH . Surgical anatomy of the petrous apex and petroclival region . Adv Tech Stand Neurosurg  . 2007 ; 32 : 91 - 146 . Google Scholar Crossref Search ADS PubMed   7. Kawase T , Shiobara R , Toya S . Anterior transpetrosal-transtentorial approach for sphenopetroclival meningiomas: Surgical method and results in 10 patients . Neurosurgery  . 1991 ; 28 ( 6 ): 869 - 876 . Google Scholar Crossref Search ADS PubMed   8. Kawase T , Shiobara R , Toya S . Middle fossa transpetrosal-transtentorial approaches for petroclival meningiomas selective pyramid resection and radicality . Acta Neurochir  . 1994 ; 129 ( 3-4 ): 113 - 120 . Google Scholar Crossref Search ADS PubMed   9. Al-Mefty O , Fox JL , Smith RR . Petrosal approach for petroclival meningiomas . Neurosurgery  . 1988 ; 22 ( 3 ): 510 - 517 . Google Scholar Crossref Search ADS PubMed   10. Almefty R , Dunn IF , Pravdenkova S , Abolfotoh M , Al-Mefty O . True petroclival meningiomas: results of surgical management . J Neurosurg  . 2014 ; 120 ( 1 ): 40 - 51 . Google Scholar Crossref Search ADS PubMed   11. Sekhar LN , Jannetta PJ , Burkhart LE , Janosky JE . Meningiomas involving the clivus: a six-year experience with 41 patients . Neurosurgery  . 1990 ; 27 ( 5 ): 764 - 781 . Google Scholar Crossref Search ADS PubMed   12. Couldwell WT , Fukushima T , Giannotta SL , Weiss MH . Petroclival meningiomas: surgical experience in 109 cases . J Neurosurg  . 1996 ; 84 ( 1 ): 20 - 28 . Google Scholar Crossref Search ADS PubMed   13. Hakuba A , Nishimura S , Jang BJ . A combined retroauricular and preauricular transpetrosal-transtentorial approach to clivus meningiomas . Surg Neurol  . 1988 ; 30 ( 2 ): 108 - 116 . Google Scholar Crossref Search ADS PubMed   14. Sekhar LN , Schessel DA , Bucur SD , Raso JL , Wright DC . Partial labyrinthectomy petrous apicectomy approach to neoplastic and vascular lesions of the petroclival area . Neurosurgery  . 1999 ; 44 ( 3 ): 537 - 550 . Google Scholar Crossref Search ADS PubMed   15. Roche P-H , Fournier H-D , Sameshima T , Fukushima T . The combined petrosal approach. Anatomical principles, surgical technique and indications . Neurochirurgie  . 2008 ; 54 ( 1 ): 1 - 10 . Google Scholar Crossref Search ADS PubMed   16. Troude L , Carissimi M , Lavieille J-P , Roche P-H . How I do it: the combined petrosectomy . Acta Neurochir  . 2016 ; 158 ( 4 ): 711 - 715 . Google Scholar Crossref Search ADS PubMed   17. Nanda A , Patra DP , Savardekar AR , Maiti TK , Mohammed N . Resection of petroclival meningioma through retrosigmoid approach-concepts and nuances: 3-dimensional operative video . Oper Neurosurg  . 2018 ; 15 ( 4 ): 473 . Google Scholar Crossref Search ADS   Acknowledgment We are indebted to Mathias Rostagno (sound engineer, video editor) for technical help. COMMENT The authors demonstrate a technically excellent depiction of surgery for one of the most challenging lesions in cranial neurosurgery, a petroclival meningioma. While narrated videos of such an operation are not new, the modality the authors employ, a stereoscopic 3D version suitable for viewing with a virtual reality headset, is. The combined petrosectomy approach is a critically important part of the armamentarium for any practicing or aspiring cranial base neurosurgeon, and takes years to become proficient at, much less master. Currently, cadaver dissection is paramount in this learning process. The authors' nuanced descriptions of exposing the internal auditory canal, and handling involved neural and vascular structures, is especially informative. As visual and augmented reality technology continues to evolve, it will be especially important for our discipline to embrace such advances in order to teach the next generation of neurosurgeons to perform high-level surgeries such as this. As in the aviation industry, it would be ideal if skull base neurosurgeons could “simulate” these challenging operations numerous times before every attempting them in the operating room. These simulations could even be patient specific, based on the individual anatomy and pathology. Virtual reality will undoubtedly become another way that we can all strive to fulfill Dr Albert Rhoton's charge for us all to be more “accurate, gentle, and safe” in our treatment of neurosurgical disease. The authors should be congratulated for embracing emerging technologies for educational purposes. Edward Angus McKay Duckworth Boise, Idaho Copyright © 2018 by the Congress of Neurological Surgeons This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model)


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Bernard, Florian, Troude, Lucas, Laccourreye, Laurent, Roche, Pierre-Hugues, Fournier, Henri-Dominique. Stereoscopic Surgical Video of Combined Petrosectomy With Virtual Reality Headset: 3-Dimensional Operative Video, Operative Neurosurgery, 2019, 638-639, DOI: 10.1093/ons/opy228