Quantitative anatomic comparison of the extended pterional transtemporal transtentorial approach and the subtemporal transtentorial approach to the petroclival region.

AIM: The anatomic characters and applicability of the extended pterional transtemporal transtentorial (EPTT) approach versus the subtemporal transtentorial (ST) approach for surgical treatment of petroclival tumors were evaluated. MATERIAL AND METHODS: Ten sides from five adult Chinese injected cadavers were manipulated using both two approaches. Four deep bony anatomic landmarks were specified in the skull base to create two adjoining triangles that were respectively located in the anterior and posterior petroclival region. The real, projected area and the percentage of the projected area were determined and calculated to compare the deep exposure from the two approaches. RESULTS: There was no difference regarding the percentage of the projected area was calculated in the anterior triangles (EPTT, 21.5±12.5%; ST, 28.8±14.9%; p=0.1948), but a significant difference was present in the posterior triangles (EPTT, 74.0±4.5%; ST, 51.5±4.3%; p < 0.01). Compared with the ST approach, the EPTT approach provides an equivalent percentage of projected area in the middle cranial fossa and a wider exposed area in the posterior cranial fossa. CONCLUSION: Through anatomic comparative analysis the EPTT approach provides better exposure and is more appropriate than the ST approach for large and giant petroclival tumors predominantly in the posterior cranial fossa with extensive invasion to parasellar structures and the cavernous sinus.

The anatomy of proximal femoral autografts for pelvic reconstruction: a cadaveric study.

PURPOSE: One important reconstruction procedure following pelvic tumor resection is ipsilateral femoral autograft reconstruction in which the autograft is transposed onto the defect and a conventional total hip replacement is implanted in the autograft. The purpose of this study is to provide anatomical evidence for this reconstruction by measurement of proximal femoral autografts. METHODS: The anatomical study of proximal femoral autografts was performed on thirteen fresh-frozen Chinese male cadavers. Four parameters were measured and included the diameter of the femoral head (DFH), the distance from the apex of the greater trochanter perpendicular to the medial cortex edge of the femoral neck (DAM), the length between the apex of the femoral head and the midpoint of osteotomy line under the lesser trochanter (LAM), and the width of the greater trochanter from anterior to posterior (WG). The correlation between height and each of the various parameters was analyzed using the Spearman's correlation. RESULTS: The median (first and third quartile) values of the measurements for the above mentioned parameters were 49 mm (48-52.7 mm), 58.5 mm (54.5-60.9 mm), 102 mm (96-105.2 mm) and 48 mm (46.5-51 mm), respectively. There was a positive correlation between height and each of these four parameters (P < 0.05). CONCLUSIONS: The proximal femoral autograft reconstruction may be a good option after resection of a pelvic tumor because of the provision of biological reconstruction. However, an individual preoperative plan should be carefully performed following evaluating the size of the bone defect after tumor resection and height and width of the remaining greater trochanter prior to conventional hip replacement.

Reliable techniques to avoid damaging the superficial radial nerve due to percutaneous Kirschner wire fixation of the distal radius fracture through the radial styloid process.

PURPOSE: The use of percutaneous Kirschner wires for fixation of unstable fractures of the distal radius has been widely accepted as the least invasive procedure. However, the injury to the superficial branch of the radial nerve (SBRN) is common. Our purpose in this study was to develop a reliable technique to avoid damaging the SBRN. METHODS: Twenty cadaver forearms were dissected to identify the SBRN distribution, and 18 forearms were used to undergo placement of three Kirschner wires (KW-A, KW-B, and KW-C). The KW-A, KW-B, and KW-C were driven in the frontal plane into the distal radius, and KW-A and KW-C through the tip of radial styloid process at different angles. The SBRN distribution and its relationship with the KW insertion were identified. Fifty-three patients with unstable distal radius fractures were fixed with external fixator and augmented with 1-3 KW, and the injury rates of SBRN were evaluated. RESULTS: We found a blind region of the SBRN bound by its first bifurcations into radial and ulnar branches and the line crossing the tip of the styloid process. The mean distance of the three wires (KW-A, KW-C, and KW-B) to the closest nerve branch was 4.5, 4.4, and 3.4 mm, respectively. The injury of SBRN occurred in two of 53 patients. CONCLUSION: The injury rate of the SBRN can be effectively reduced when the Kirschner wire is placed along the curve AB and as in proximity to the TRSP as possible under fluoroscopic guidance. Our pinning technique is therefore reliable and practical.