{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,22]],"date-time":"2026-03-22T00:23:52Z","timestamp":1774139032689,"version":"3.50.1"},"reference-count":26,"publisher":"Georg Thieme Verlag KG","issue":"S 02","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Neurol Surg B Skull Base"],"published-print":{"date-parts":[[2022,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\n          Introduction\u2003Proposed landmarks to predict the anatomical location and trajectory of the sigmoid sinus have varying degrees of reliability. Even with neuronavigation technology, landmarks are crucial in planning and performing complex approaches to the posterolateral skull base. By combining two major dependable structures\u2014the asterion (A) and transverse process of the atlas (TPC1)\u2014we investigate the A-TPC1 line in relation to the sigmoid sinus and in partitioning surgical approaches to the region.<\/jats:p><jats:p>\n          Methods\u2003We dissected six cadaveric heads (12 sides) to expose the posterolateral skull base, including the mastoid and suboccipital bone, TPC1 and suboccipital triangle, distal jugular vein and internal carotid artery, and lower cranial nerves in the distal cervical region. We inspected the A-TPC1 line before and after drilling the mastoid and occipital bones and studied the relationship of the sigmoid sinus trajectory and major muscular elements related to the line. We retrospectively reviewed 31 head and neck computed tomography (CT) angiograms (62 total sides), excluding posterior fossa or cervical pathologies. Bone and vessels were reconstructed using three-dimensional segmentation software. We measured the distance between the A-TPC1 line and sigmoid sinus at different levels: posterior digastric point (DP), and maximal distances above and below the digastric notch.<\/jats:p><jats:p>\n          Results\u2003A-TPC1 length averaged 65\u2009mm and was posterior to the sigmoid sinus in all cadaver specimens, coming closest at the level of the DP. Using the transverse-asterion line as a rostrocaudal division and skull base as a horizontal plane, we divided the major surgical approaches into four quadrants: distal cervical\/extreme lateral and jugular foramen (anteroinferior), presigmoid\/petrosal (anterosuperior), retrosigmoid\/suboccipital (posterosuperior), and far lateral\/foramen magnum regions (posteroinferior). Radiographically, the A-TPC1 line was also posterior to the sigmoid sinus in all sides and came closest to the sinus at the level of DP (mean, 7\u2009mm posterior; range, 0\u201318.7\u2009mm). The maximal distance above the DP had a mean of 10.1\u2009mm (range, 3.6\u201319.5\u2009mm) and below the DP 5.2\u2009mm (range, 0\u201320.7\u2009mm).<\/jats:p><jats:p>\n          Conclusion\u2003The A-TPC1 line is a helpful landmark reliably found posterior to the sigmoid sinus in cadaveric specimens and radiographic CT scans. It can corroborate the accuracy of neuronavigation, assist in minimizing the risk of sigmoid sinus injury, and is a useful tool in planning surgical approaches to the posterolateral skull base, both preoperatively and intraoperatively.<\/jats:p>","DOI":"10.1055\/s-0041-1731032","type":"journal-article","created":{"date-parts":[[2021,7,5]],"date-time":"2021-07-05T23:46:11Z","timestamp":1625528771000},"page":"e467-e473","source":"Crossref","is-referenced-by-count":1,"special_numbering":"S","title":["The Asterion-to-Transverse Process of the Atlas Line as a Surgical Landmark"],"prefix":"10.1055","volume":"83","author":[{"given":"Jaafar","family":"Basma","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dom E.","family":"Mahoney","sequence":"additional","affiliation":[{"name":"Faculty of Health Sciences, University of Bristol, Bristol, United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christos","family":"Anagnostopoulos","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, North Bristol Trust, Bristol, United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"suffix":"II","given":"L. Madison","family":"Michael","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeffrey M.","family":"Sorenson","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David G.","family":"Porter","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, North Bristol Trust, Bristol, United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Angelo","family":"Pichierri","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, North Bristol Trust, Bristol, United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2021,7,5]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","first-page":"S93","DOI":"10.1097\/00006123-200009001-00013","article-title":"The cerebellopontine angle and posterior fossa cranial nerves by the retrosigmoid approach","volume":"47","author":"A L Rhoton Jr","year":"2000","journal-title":"Neurosurgery"},{"key":"ref2","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1007\/978-3-7091-6549-2_4","article-title":"Presigmoid approaches to skull base lesions","volume":"23","author":"M T Lawton","year":"1997","journal-title":"Adv Tech Stand Neurosurg"},{"issue":"04","key":"ref3","doi-asserted-by":"crossref","first-page":"559","DOI":"10.3171\/jns.1986.64.4.0559","article-title":"Lateral suboccipital approach for vertebral and vertebrobasilar artery lesions","volume":"64","author":"R C Heros","year":"1986","journal-title":"J Neurosurg"},{"key":"ref4","first-page":"35","article-title":"The far lateral approach to the inferior clivus and the upper cervical region. 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