{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T17:54:33Z","timestamp":1786125273927,"version":"build-2736575974"},"reference-count":28,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND AND OBJECTIVES:<\/jats:title>\n                    <jats:p>The posterior petrosal approach is a technically challenging procedure used to treat complex, deep-seated lesions. The petrosal ridge, located between the middle and posterior fossae, can be anatomically compared with the sphenoid ridge, which separates the anterior and middle fossae. Analogous to the orbitotemporal periosteal fold, which connects the orbit to the middle fossa dura, the endolymphatic sac (ELS) acts as a fold connecting the vestibule to the posterior fossa dura. This fold presents an obstacle to further elevating the dura from the posterior surface of the petrous bone. The objective of this study is to provide anatomic details and key landmarks for the preservation and safe peeling of the ELS, thereby expanding the surgical field during posterior petrosectomy and combined petrosal approaches.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>Five formalin-fixed cadaveric heads were injected with colored silicone, and 10 sides were used for cadaveric dissections.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>At the level of the superomedial margin of the operculum, the periosteal layer is incised to enter a surgical plane between the dura propria and the ELS. The dura is then peeled away from the posterior aspect of the ELS, and the periosteal layer is further incised along the ELS. A dural thickening continuing medially from the operculum, corresponding to the Tubingen line, allows access to the plane between the dural leaflets before reaching the full extent of the ELS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSION:<\/jats:title>\n                    <jats:p>Analogous to the orbitotemporal periosteal fold in anterior approaches, the ELS can be safely peeled from the dura of the posterior fossa, thereby enhancing the extradural exposure in these approaches.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1227\/ons.0000000000001663","type":"journal-article","created":{"date-parts":[[2025,6,16]],"date-time":"2025-06-16T09:01:57Z","timestamp":1750064517000},"page":"312-319","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Optimizing Extradural Exposure in the Posterior Petrosal Approach: The Role of Endolymphatic Sac Peeling"],"prefix":"10.1227","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0897-2229","authenticated-orcid":false,"given":"Tancredo","family":"Alc\u00e2ntara","sequence":"first","affiliation":[{"name":"Experimental Neurosurgery and Skull Base Laboratory, Department of Neurosurgery, Lariboisi\u00e8re Hospital, Assistance Publique - H\u00f4pitaux de Paris, Paris, France;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9452-075X","authenticated-orcid":false,"given":"Jerold","family":"Justo","sequence":"additional","affiliation":[{"name":"Experimental Neurosurgery and Skull Base Laboratory, Department of Neurosurgery, Lariboisi\u00e8re Hospital, Assistance Publique - H\u00f4pitaux de Paris, Paris, France;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tingting","family":"Jiang","sequence":"additional","affiliation":[{"name":"Experimental Neurosurgery and Skull Base Laboratory, Department of Neurosurgery, Lariboisi\u00e8re Hospital, Assistance Publique - H\u00f4pitaux de Paris, Paris, France;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arianna","family":"Fava","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Lariboisi\u00e8re Hospital, Assistance Publique - H\u00f4pitaux de Paris, Universit\u00e9 Paris Cit\u00e9, Paris, France;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruno","family":"Costa","sequence":"additional","affiliation":[{"name":"Neurosurgery and Neurology Department, Santa Casa de BH, Belo Horizonte, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emmanuel","family":"Mandonnet","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Lariboisi\u00e8re Hospital, Assistance Publique - H\u00f4pitaux de Paris, Universit\u00e9 Paris Cit\u00e9, Paris, France;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thibault","family":"Passeri","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Lariboisi\u00e8re Hospital, Assistance Publique - H\u00f4pitaux de Paris, Universit\u00e9 Paris Cit\u00e9, Paris, France;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S\u00e9bastien","family":"Froelich","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Lariboisi\u00e8re Hospital, Assistance Publique - H\u00f4pitaux de Paris, Universit\u00e9 Paris Cit\u00e9, Paris, France;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2025,6,16]]},"reference":[{"issue":"1 Pt 1","key":"R1-20260115","doi-asserted-by":"crossref","first-page":"63","DOI":"10.2176\/nmc.17pt1.63","article-title":"Clivus meningioma: six cases of total removal","volume":"17","author":"Hakuba","year":"1977","journal-title":"Neurol Med Chir (Tokyo)."},{"issue":"1","key":"R2-20260115","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3171\/2013.10.JNS13673","article-title":"Surgical outcomes of the minimum anterior and posterior combined transpetrosal approach for resection of retrochiasmatic craniopharyngiomas with complicated conditions","volume":"120","author":"Kunihiro","year":"2014","journal-title":"J Neurosurg."},{"issue":"2","key":"R3-20260115","doi-asserted-by":"crossref","first-page":"373","DOI":"10.3171\/2014.8.JNS132406","article-title":"Petroclival meningiomas resected via a combined transpetrosal approach: surgical outcomes in 60 cases and a new scoring system for clinical evaluation","volume":"122","author":"Morisako","year":"2015","journal-title":"J Neurosurg."},{"issue":"2","key":"R4-20260115","doi-asserted-by":"crossref","first-page":"e8","DOI":"10.3171\/foc.2005.19.2.9","article-title":"Combined skull base approaches to the posterior fossa. Technical note","volume":"19","author":"Bambakidis","year":"2005","journal-title":"Neurosurg Focus."},{"issue":"2","key":"R5-20260115","doi-asserted-by":"crossref","first-page":"e7","DOI":"10.3171\/2012.6.FOCUS12133","article-title":"Evolution of the posterior petrosal approach","volume":"33","author":"Gross","year":"2012","journal-title":"Neurosurg Focus."},{"issue":"2","key":"R6-20260115","doi-asserted-by":"crossref","first-page":"e8","DOI":"10.3171\/2012.6.FOCUS12141","article-title":"The history of the combined supra- and infratentorial approach to the petroclival region","volume":"33","author":"Grossi","year":"2012","journal-title":"Neurosurg Focus."},{"key":"R7-20260115","doi-asserted-by":"crossref","first-page":"194","DOI":"10.1016\/j.wneu.2019.03.122","article-title":"Intradural combined transpetrosal approach for primary pontine hemorrhage","volume":"127","author":"Ichimura","year":"2019","journal-title":"World Neurosurg."},{"key":"R8-20260115","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1016\/B978-0-12-822198-3.00035-5","article-title":"Petroclival meningiomas and the petrosal approach","volume":"170","author":"Aum","year":"2020","journal-title":"Handb Clin Neurol."},{"issue":"4","key":"R9-20260115","doi-asserted-by":"crossref","first-page":"1079","DOI":"10.1007\/s00701-022-05124-x","article-title":"The mini-combined transpetrosal approach: an anatomical study and comparison with the combined transpetrosal approach","volume":"164","author":"Fava","year":"2022","journal-title":"Acta Neurochir (Wien)."},{"key":"R10-20260115","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1016\/j.jocn.2017.03.015","article-title":"The combined transpetrosal approach: anatomic study and literature review","volume":"41","author":"Janjua","year":"2017","journal-title":"J Clin Neurosci."},{"issue":"6","key":"R11-20260115","doi-asserted-by":"crossref","first-page":"824","DOI":"10.3171\/jns.1983.58.6.0824","article-title":"Direct microsurgical repair of intracavernous vascular lesions","volume":"58","author":"Dolenc","year":"1983","journal-title":"J Neurosurg."},{"issue":"1-4","key":"R12-20260115","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1007\/BF01405503","article-title":"Frontotemporal epidural approach to trigeminal neurinomas","volume":"130","author":"Dolenc","year":"1994","journal-title":"Acta Neurochir (Wien)."},{"issue":"5 Suppl 2","key":"R14-20260115","first-page":"179","article-title":"Refinement of the extradural anterior clinoidectomy: surgical anatomy of the orbitotemporal periosteal fold","volume":"61","author":"Froelich","year":"2007","journal-title":"Neurosurgery."},{"issue":"1","key":"R15-20260115","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1227\/01.NEU.0000068866.22176.07","article-title":"An alternative extradural exposure to the anterior clinoid process: the superior orbital fissure as a surgical corridor","volume":"53","author":"Coscarella","year":"2003","journal-title":"Neurosurgery."},{"issue":"5","key":"R16-20260115","doi-asserted-by":"crossref","first-page":"1267","DOI":"10.1097\/00006123-199911000-00058","article-title":"Colored silicone injection for use in neurosurgical dissections: anatomic technical note","volume":"45","author":"Sanan","year":"1999","journal-title":"Neurosurgery."},{"issue":"4","key":"R17-20260115","doi-asserted-by":"crossref","first-page":"389","DOI":"10.1001\/archotol.1988.01860160033016","article-title":"Variations in surgical anatomy of the endolymphatic sac","volume":"114","author":"Friberg","year":"1988","journal-title":"Arch Otolaryngol Head Neck Surg."},{"issue":"5","key":"R18-20260115","first-page":"881","article-title":"The endolymphatic duct and sac","volume":"18","author":"Lo","year":"1997","journal-title":"AJNR Am J Neuroradiol."},{"issue":"6","key":"R19-20260115","doi-asserted-by":"crossref","first-page":"488","DOI":"10.1017\/S0022215114001017","article-title":"Endolymphatic sac surgical anatomy and transmastoid decompression of the sac for the management of M\u00e9ni\u00e8re's disease","volume":"128","author":"Locke","year":"2014","journal-title":"J Laryngol Otol."},{"key":"R20-20260115","doi-asserted-by":"crossref","first-page":"15","DOI":"10.3109\/00016489109128039","article-title":"Lymphocyte-macrophage activity in the human endolymphatic sac","volume":"485","author":"Rask-Andersen","year":"1991","journal-title":"Acta Otolaryngol Suppl."},{"issue":"2","key":"R21-20260115","doi-asserted-by":"crossref","first-page":"416","DOI":"10.1227\/00006123-199502000-00028","article-title":"The endolymphatic sac: microsurgical topographic anatomy","volume":"36","author":"Ammirati","year":"1995","journal-title":"Neurosurgery."},{"issue":"11","key":"R22-20260115","doi-asserted-by":"crossref","first-page":"1157","DOI":"10.1111\/j.1365-2826.2010.02060.x","article-title":"Expression and translocation of aquaporin-2 in the endolymphatic sac in patients with Meniere's disease","volume":"22","author":"Maekawa","year":"2010","journal-title":"J Neuroendocrinol."},{"issue":"8","key":"R23-20260115","doi-asserted-by":"crossref","first-page":"e269","DOI":"10.1002\/lary.25242","article-title":"Gene expression demonstrates an immunological capacity of the human endolymphatic sac","volume":"125","author":"M\u00f8ller","year":"2015","journal-title":"Laryngoscope."},{"issue":"1","key":"R24-20260115","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1097\/MAO.0000000000001273","article-title":"History of the endolymphatic sac: from anatomy to surgery","volume":"38","author":"Corrales","year":"2017","journal-title":"Otol Neurotol."},{"issue":"3","key":"R25-20260115","doi-asserted-by":"crossref","first-page":"664","DOI":"10.1177\/000348946707600311","article-title":"Experimental blockage of the endolymphatic duct and sac and its effect on the inner ear of the Guinea pig. A study on endolymphatic hydrops","volume":"76","author":"Kimura","year":"1967","journal-title":"Ann Otol Rhinol Laryngol."},{"issue":"3-4","key":"R26-20260115","doi-asserted-by":"crossref","first-page":"295","DOI":"10.3109\/00016488009127141","article-title":"Obliteration of the ductus reuniens","volume":"89","author":"Kimura","year":"1980","journal-title":"Acta Otolaryngol."},{"issue":"1","key":"R27-20260115","doi-asserted-by":"crossref","first-page":"13","DOI":"10.3109\/00016489709117984","article-title":"Two-phase endolymphatic hydrops: a new dynamic Guinea pig model","volume":"117","author":"Dunnebier","year":"1997","journal-title":"Acta Otolaryngol."},{"issue":"1","key":"R28-20260115","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1007\/PL00007522","article-title":"Cochlear ultrastructure in two-phase endolymphatic hydrops in the Guinea-pig","volume":"259","author":"Dunnebier","year":"2002","journal-title":"Eur Arch Otorhinolaryngol."},{"issue":"1 Suppl Operative","key":"R29-20260115","first-page":"ons99","article-title":"Dural landmark to locate the internal auditory canal in large and giant vestibular schwannomas: the T\u00fcbingen line","volume":"69","author":"Campero","year":"2011","journal-title":"Neurosurgery."}],"container-title":["Operative Neurosurgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.1227\/ons.0000000000001663","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T16:52:56Z","timestamp":1786121576000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.1227\/ons.0000000000001663"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,16]]},"references-count":28,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.1227\/ons.0000000000001663","relation":{},"ISSN":["2332-4252","2332-4260"],"issn-type":[{"value":"2332-4252","type":"print"},{"value":"2332-4260","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,16]]},"assertion":[{"value":"2024-12-19","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-03-15","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}