Skip to main content
. 2024 Dec 12;5:104163. doi: 10.1016/j.bas.2024.104163

Table 1.

Surgical steps performed by faculty during the cadaveric head masterclass, followed by trainees on the 3D-printed model.

Tuberculum sellae meningioma: anterolateral skull base approach
  • 1)

    Patient positioning

  • 2)

    Skin incision

  • 3)

    Pterional craniotomy. Including burr-hole(s) placement & dural identification

  • 4)

    Sphenoid wing drilling

  • 5)

    Extradural dissection

  • 6)

    Identification of the dorsal surface of the anterior clinoid process, optic strut & optic canal

  • 7)

    Extradural anterior clinoidectomy

  • 8)

    Dural opening

  • 9)

    Identification of the interoptic space, carotid artery and tumor

  • 10)

    Tumor debulking with anterior circulation vessels preservation

  • 11)

    Identification of the contralateral carotid artery and infundibulum

  • 12)

    Optic canals exploration

 Petroclival chordoma: anterior petrosal approach
  • 1)

    Patient positioning

  • 2)

    Skin incision

  • 3)

    Subtemporal craniotomy. Including burr-hole(s) placement & dural identification

  • 4)

    Basitemporal drilling

  • 5)

    Extradural dissection

  • 6)

    Identification of the middle meningeal artery and greater petrosal superficial nerve (including stimulation)

  • 7)

    Interdural dissection to expose the petrous apex

  • 8)

    Kawase space identification with boundaries definition

  • 9)

    Drilling of the petrous apex defining the limits namely the posterior fossa dura, internal auditory meatus and the petrous ridge

  • 10)

    Identification of the Glasscock triangle and petrous carotid artery

  • 11)

    Ligation of the superior petrosal sinus, dural opening and Meckel's cave opening

  • 12)

    Tumor excision

  • 13)

    Identification of Vth, VIth, VII/VIIIth nerves and basilar artery
Falcotentorial meningioma: occipital transtentorial approach
  • 1)

    Patient positioning

  • 2)

    Skin incision

  • 3)

    Anatomical landmarks identification (sutures)

  • 4)

    Occipital craniotomy. Including burr-hole(s) placement & dural identification

  • 5)

    Exposure of the posterior sagittal sinus, medial transverse sinus and torcula

  • 6)

    Dural opening

  • 7)

    Development of the interhemispheric corridor

  • 8)

    Ipsilateral tentorial incision

  • 9)

    Falcine incision

  • 10)

    Transfalcine contralateral tentorial incision

  • 11)

    Disconnection of the tumor from the sinus rectus

  • 12)

    Tumor excision

  • 13)

    Visualization of the vein of Galen, internal cerebral veins and splenium

 Falcotentorial meningioma: supracerebellar infratentorial approach
  • 1)

    Patient positioning

  • 2)

    Skin incision (sitting vs. lateral). Surface marking for transverse sinus

  • 3)

    Anatomical landmarks identification (inion)

  • 4)

    Midline suboccipital craniotomy. Including burr-hole(s) placement & dural identification

  • 5)

    Exposure of the transverse sinuses and torcula

  • 6)

    Dural opening and ligation of the occipital sinus

  • 7)

    Development of the supracerebellar corridor including the precentral cerebellar vein

  • 8)

    Tumor identification

  • 9)

    Tumor detachment from the falcotentorial attachment

  • 10)

    Tumor excision

  • 11)

    Visualization of the vein of Galen, internal cerebral veins, basal veins of Rosenthal, midbrain and splenium
Vestibular schwannoma: retrosigmoid approach
  • 1)

    Patient positioning

  • 2)

    Skin incision

  • 3)

    Anatomical landmarks identification (asterion)

  • 4)

    Retrosigmoid craniotomy. Including burr-hole(s) placement & dural identification

  • 5)

    Exposing the transverse sinus and posterior part of the sigmoid sinus by drilling

  • 6)

    Dural opening

  • 7)

    Identification of the lateral cerebellomedullary cistern

  • 8)

    Lower cranial nerves identification

  • 9)

    Exposure of the dorsal surface of the tumor and surface nerve mapping

  • 10)

    Tumor debulking and dissection of the capsule aided by facial nerve stimulation

  • 11)

    Internal acoustic meatus opening

  • 12)

    Tumor excision

  • 13)

    Identification of IVth, Vth, VIth, VIIth nerves, and superior, anteroinferior and posteroinferior cerebellar arteries

 Vestibular schwannoma: translabyrinthine approach
  • 1)

    Patient positioning

  • 2)

    Skin incision

  • 3)

    Anatomical landmarks identification (spine of Henle, mastoid tip, posterior root of zygoma, triangle of attack)

  • 4)

    Mastoid surface drilling

  • 5)

    Identification of the mastoid antrum and lateral semicircular canal and incus

  • 6)

    Mastoid segment of the facial nerve identification

  • 7)

    Labyrinthectomy

  • 8)

    Trautmann's triangle and internal acoustic meatus identification

  • 9)

    Exposure of tegmen dura, presigmoid dura and superior petrosal sinus

  • 10)

    Durotomy and visualization of the tumor within the meatus and cerebellopontine angle