Asterion yerleşiminin posterolateral intrakraniyal girişimler açısından morfometrik değerlendirilmesi
Abstract
Amaç: Beyin cerrahisinde, fossa cranii
posterior’a ulaşmayı gerektiren cerrahi girişimlerde, cranium’a giriş noktası yüzeyel anatomik belirgin noktaların
yardımıyla belirlenir. Asterion’un, cranium’un posteroateralinde kemik
yüzeyindeki belirgin noktalar ve sulcus
sinus transversi (SST), sulcus sinus
sigmoidei (SSS) veya bunlara ait bileşke ile olan ilişkisinin morfometrik
olarak incelenmesi amaçlandı.
Gereç ve Yöntem:
Çalışmada, Dokuz Eylül Üniversitesi Tıp Fakültesi
Anatomi Anabilim Dalı Laboratuvarı kemik koleksiyonunda mevcut, yaşı ve
cinsiyeti bilinmeyen 172 adet erişkine ait bütün kuru kemik cranium’lar ile 10 adet calvaria’sı kaldırılmış kuru kemik cranium’lar değerlendirildi. Ölçümler
0.01 mm’ye duyarlı dijital kumpas ve 1 mm’ye duyarlı mezura kullanılarak
yapıldı.
Bulgular: Asterion-inion 61,61±4,08 mm, asterion-processus
mastoideus 47,81±5,09 mm, asterion-Henle
çıkıntısı 41,63±3,95 mm, asterion-opisthion
61,71±3,69 mm, asterion-processus
zygomaticus’un kökü sağda 55,11±3,86 mm, solda 54,37±4,35 mm olarak
ölçüldü. Calvaria’sı kaldırılmış kuru
kemik cranium’larda asterion’un dört cranium’da bilateral, bir cranium’da
unilateral sol tarafta SST içinde olduğu, diğerlerinde SSS-SST bileşkesi içinde
lokalize olduğu gözlendi.
Sonuç: Asterion, SST, SSS veya bunlara ait bileşkenin içinde yer aldığı ve asterion’un izdüşümü hizasında sinus
yapılara ait oluk genişliğinin 10,25±2,18 mm olduğu saptandı. Asterion’dan yaklaşık 10 mm üstü ve
altının girişim açısından sinus
transversus veya sinus sigmoideus
yaralanma riski taşıyacağı için, fossa
cranii posterior’a yapılacak cerrahi girişimlerde, yüzeyel belirgin
noktaların yardımıyla asterion’un
yerinin belirlenmesi, venöz sinüslerin korunmasını sağlayabilir.
References
- Day JD, Fukushima T, Giannotta SL. Innovations in surgical approach: Lateral cranial base approaches. Clin Neurosurg 1996;43(1):72-90.
- Lang J Jr, Samii A. Retrosigmoid approach to the posterior cranial fossa: An anatomical study. Acta Neurochir 1991;111(3-4):147-53.
- Ribas GC, Rhoton AL Jr, Cruz OR, Peace D. Suboccipital burr holes and craniectomies. Neurosurg Focus 2005;19(2):E1.
- Aslan A, Kobayashi T, Diop D, Balyan FR, Russo A, Taibah A. Anatomical relationship between the position of the sigmoid sinus and regional mastoid pneumatization. Eur Arch Otorhinolaryngol 1996;253(8):450-3.
- Bozbuga M, Boran BO, Sahinoglu K. Surface anatomy of the posterolateral cranium regarding the localization of the initial burr–hole for a retrosigmoid approach. Neurosurg Rev 2006;29(1):61-3.
- Lang J. Inferior skull base anatomy. In: Sekhar LN, Schramm VK Jr (eds). Tumors of the Cranial Base: Diagnosis and Treatment. Mt. Kisco: Futura; 1987:461-529.
- Oliveira E, Rhoton AL Jr, Peace D. Microsurgical anatomy of the region of the foramen magnum. Surg Neurol 1985;24(3):293-352.
- Standring S. Gray’s Anatomy. 40th ed. London, England: Churchill Livingstone Elsevier; 2008:412.
- Rhoton AL Jr. Surface and superficial surgical anatomy of the posterolateral cranial base: Significance for surgical planning and approach. Neurosurgery 1996;38(6):1083-4.
- Sheng B, lv F, Xiao Z, et al. Anatomical relationship between cranial surface landmarks and venous sinus in posterior cranial fossa using CT angiography. Surg Radiol Anat 2012;34(8):701-8.
- Ozveren MF, Uchida K, Aiso S, Kawase T. Meningovenous structures of the petroclival region: Clinical importance for surgery and intravascular surgery. Neurosurgery 2002;50(4):829-37.
- Sripairojkul B, Adultrakoon A. Anatomical position of the asterion and its underlying structure. J Med Assoc Thai 2000;83(9):1112-5.
- MacLennon RN. Interrater reliability with SPSS for Windows 5.0. Am Statist 1993;47(3):292-6.
- Ucerler H, Govsa F. Asterion as a surgical landmark for lateral cranial base approaches. J Craniomaxillofac Surg 2006;34(7):415-20.
- Sekhar LN. Anatomic position of the asterion. Neurosurgery 1998;42(1):198-9.
- Hamasaki T, Morioka M, Nakamura H, Yano S, Hirai T, Kuratsu J. A 3‐Dimensional computed tomographic procedure for planning retrosigmoid craniotomy. Neurosurgery 2009;64(5):241-6.
- Avci E, Kocaogullar Y, Fossett D, Caputy A. Lateral posterior fossa venous sinus relationships to surface landmarks. Surg Neurol 2003;59(5):392-7.
- Ugur HC, Dogan I, Kahilogullari G, et al. New practical landmarks to determine sigmoid sinus free zones for suboccipital approaches: an anatomical study. J Craniofac Surg 2013;24(5):1815-8.
- Yasargil MG, Smith RD, Gasser JC. The microsurgical approach to acoustic neuromas. Adv Tech Stand Neurosurg 1977;4(2):93-128.
- Teranishi Y, Kohno M, Sora S,Sato H. Determination of the keyhole position in a lateral suboccipital retrosigmoid approach. Neurol Med Chir 2014;54(4):261-6.
- Day JD, Tschabitscher M. Anatomic position of the asterion. Neurosurgery 1998;42(1):198-9.
- Yamashima T, Lee JH, Tobias S, Kim CH, Chang JH, Kwon JT. Surgical procedure “simplified retrosigmoid approach” for C‐P angle lesions. J Clin Neurosci 2004;11(2):168-71.
- Day JD, Kellogg JX, Tschabitscher M, Fukushima T. Surface and superficial surgical anatomy of the posterolateral cranial base: significance for surgical planning and approach. Neurosurgery 1996;38(6):1079-84.
- Mwachaka PM, Hassanalı J, Odula PO. Anatomic position of the asterion in Kenyans for posterolateral surgical approaches to cranial cavity. Clin Anat 2010;23(1):30-3.
- Yaşargil MG, Fox JL. The microsurgical approach to acoustic neurinomas. Surg Neurol 1974;2(6):393-8.
- Tedeshi T, Rhoton AL. Lateral approaches to the petroclival region. Surg Neurol 1994;41(3):180-216.
Abstract
Aim: In neurosurgery, surgical approaches that require
access to fossa crani posterior is done with the help of superficial anatomic
landmarks to determine the entrance point. It was aimed to morphometrically examine
asterion and its relation with superficial landmarks in the postero-lateral
aspect of cranium, groove for transverse sinus (GTS), groove for sigmoid sinus
(GSS) and GTS-GSS junction.
Materials and Methods: In this study, 172 dry adult
human crania and 10 crania with removed calvaria studied which are belong to
Anatomy Laboratory, School of Medicine, Dokuz Eylul University. Measurements
were performed by using a digital caliper sensitive to 0.01 mm and tape measure
sensitive 1 mm.
Results: Measured parameters were as asterion-inion
61.61±4.08 mm, asterion-mastoid process 47.81±5.09 mm, asterion-Henle spine
41.63±3.95 mm, asterion-opisthion 61.71±3.69 mm, asterion-posterior root of
zygomatic process 55.11±3.86 mm on the right side and 54.37±4.35 mm on the left
side. In crania with removed calvaria, asterion was found to be located
bilaterally in GTS in four crania, unilaterally on left side in one cranium and
in others in GTS-GSS complex.
Conclusion: Asterion takes place within
the GSS, GTS or its junction. At the projection point of asterion width of the
groove related to venous sinuses was determined as 10.25±2.18 mm. Determination
of location of asterion with the help of superficial landmarks may provide
protection of venous sinuses during surgical procedures performed in posterior
cranial fossa, since transverse or sigmoid sinus will be at risk of injury 10
mm above or below from the asterion.
References
- Day JD, Fukushima T, Giannotta SL. Innovations in surgical approach: Lateral cranial base approaches. Clin Neurosurg 1996;43(1):72-90.
- Lang J Jr, Samii A. Retrosigmoid approach to the posterior cranial fossa: An anatomical study. Acta Neurochir 1991;111(3-4):147-53.
- Ribas GC, Rhoton AL Jr, Cruz OR, Peace D. Suboccipital burr holes and craniectomies. Neurosurg Focus 2005;19(2):E1.
- Aslan A, Kobayashi T, Diop D, Balyan FR, Russo A, Taibah A. Anatomical relationship between the position of the sigmoid sinus and regional mastoid pneumatization. Eur Arch Otorhinolaryngol 1996;253(8):450-3.
- Bozbuga M, Boran BO, Sahinoglu K. Surface anatomy of the posterolateral cranium regarding the localization of the initial burr–hole for a retrosigmoid approach. Neurosurg Rev 2006;29(1):61-3.
- Lang J. Inferior skull base anatomy. In: Sekhar LN, Schramm VK Jr (eds). Tumors of the Cranial Base: Diagnosis and Treatment. Mt. Kisco: Futura; 1987:461-529.
- Oliveira E, Rhoton AL Jr, Peace D. Microsurgical anatomy of the region of the foramen magnum. Surg Neurol 1985;24(3):293-352.
- Standring S. Gray’s Anatomy. 40th ed. London, England: Churchill Livingstone Elsevier; 2008:412.
- Rhoton AL Jr. Surface and superficial surgical anatomy of the posterolateral cranial base: Significance for surgical planning and approach. Neurosurgery 1996;38(6):1083-4.
- Sheng B, lv F, Xiao Z, et al. Anatomical relationship between cranial surface landmarks and venous sinus in posterior cranial fossa using CT angiography. Surg Radiol Anat 2012;34(8):701-8.
- Ozveren MF, Uchida K, Aiso S, Kawase T. Meningovenous structures of the petroclival region: Clinical importance for surgery and intravascular surgery. Neurosurgery 2002;50(4):829-37.
- Sripairojkul B, Adultrakoon A. Anatomical position of the asterion and its underlying structure. J Med Assoc Thai 2000;83(9):1112-5.
- MacLennon RN. Interrater reliability with SPSS for Windows 5.0. Am Statist 1993;47(3):292-6.
- Ucerler H, Govsa F. Asterion as a surgical landmark for lateral cranial base approaches. J Craniomaxillofac Surg 2006;34(7):415-20.
- Sekhar LN. Anatomic position of the asterion. Neurosurgery 1998;42(1):198-9.
- Hamasaki T, Morioka M, Nakamura H, Yano S, Hirai T, Kuratsu J. A 3‐Dimensional computed tomographic procedure for planning retrosigmoid craniotomy. Neurosurgery 2009;64(5):241-6.
- Avci E, Kocaogullar Y, Fossett D, Caputy A. Lateral posterior fossa venous sinus relationships to surface landmarks. Surg Neurol 2003;59(5):392-7.
- Ugur HC, Dogan I, Kahilogullari G, et al. New practical landmarks to determine sigmoid sinus free zones for suboccipital approaches: an anatomical study. J Craniofac Surg 2013;24(5):1815-8.
- Yasargil MG, Smith RD, Gasser JC. The microsurgical approach to acoustic neuromas. Adv Tech Stand Neurosurg 1977;4(2):93-128.
- Teranishi Y, Kohno M, Sora S,Sato H. Determination of the keyhole position in a lateral suboccipital retrosigmoid approach. Neurol Med Chir 2014;54(4):261-6.
- Day JD, Tschabitscher M. Anatomic position of the asterion. Neurosurgery 1998;42(1):198-9.
- Yamashima T, Lee JH, Tobias S, Kim CH, Chang JH, Kwon JT. Surgical procedure “simplified retrosigmoid approach” for C‐P angle lesions. J Clin Neurosci 2004;11(2):168-71.
- Day JD, Kellogg JX, Tschabitscher M, Fukushima T. Surface and superficial surgical anatomy of the posterolateral cranial base: significance for surgical planning and approach. Neurosurgery 1996;38(6):1079-84.
- Mwachaka PM, Hassanalı J, Odula PO. Anatomic position of the asterion in Kenyans for posterolateral surgical approaches to cranial cavity. Clin Anat 2010;23(1):30-3.
- Yaşargil MG, Fox JL. The microsurgical approach to acoustic neurinomas. Surg Neurol 1974;2(6):393-8.
- Tedeshi T, Rhoton AL. Lateral approaches to the petroclival region. Surg Neurol 1994;41(3):180-216.
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Health Care Administration |
| Journal Section | Research Articles |
| Authors | |
| Publication Date | June 28, 2019 |
| Submission Date | March 22, 2018 |
| Published in Issue | Year 2019Volume: 58 Issue: 2 |
