Optimizing workflow in combined petrosectomy approaches: surgical technique and case series.
BACKGROUND AND OBJECTIVES: The combined petrosectomy is one of the workhorse skull base approaches to the petroclival region. Traditionally, this approach starts with a temporo-suboccipital craniotomy, followed by the mastoidectomy/anterior petrosectomy, and completed with the dural opening/tumor resection. This sequence of events (neurosurgery-neuro-otology-neurosurgery) involves at least two handoffs and change of surgical teams and instrumentation. This report describes a resequencing of events and a modification on the technique used to craft the temporo-suboccipital craniotomy. With aims to reduce handoffs between surgical teams and improves operating room workflow.
METHODS: Adhering to PROCESS guidelines, a case series is provided in addition to the surgical technique and surgical images.
RESULTS: This article describes the technique for performing a combined petrosectomy with descriptive illustrations. This shows that the temporal bone drilling may be performed prior to the craniotomy to allow for direct visualization of the dura and sinuses prior to completing the craniotomy. In doing so, only one transition between the otolaryngologist and neurosurgeon is necessary, thereby improving operating room workflow and time management. A series of ten patients is presented illustrating the feasibility of this procedure and providing operative details that were previously absent in the peer-reviewed literature.
CONCLUSION: Combined petrosectomy while often performed in a three-step manner with the neurosurgeon starting the craniotomy, can be performed as described here in a two-step manner with similar outcomes and reasonable operating time.
Published In/Presented At
Piper, K., Peto, I., Tay, V. Q., Tai, A., Danner, C., Boyev, K. P., Van Loveren, H., & Agazzi, S. (2023). Optimizing workflow in combined petrosectomy approaches: surgical technique and case series. World neurosurgery, S1878-8750(23)00442-4. Advance online publication. https://doi.org/10.1016/j.wneu.2023.03.118
Medical Education | Medicine and Health Sciences
USF-LVHN SELECT Program, USF-LVHN SELECT Program Students