{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T02:59:36Z","timestamp":1793069976541,"version":"4.5.0"},"reference-count":53,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JNS"],"published-print":{"date-parts":[[2007,10]]},"abstract":"<jats:sec>\n<jats:title>Object<\/jats:title>\n<jats:p> The authors quantitatively assessed the effects of balloon inflation as a model of tumor compression on the brainstem, cranial nerves, and clivus by measuring the working area, angle of attack, and brain shift associated with the retrosigmoid approach.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p> Six silicone-injected cadaveric heads were dissected bilaterally via the retrosigmoid approach. Quantitative data were generated, including key anatomical points on the skull base and brainstem. All parameters were measured before and after inflation of a balloon catheter (inflation volume 4.8 ml, diameter 20 mm) intended to mimic tumor compression.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p> Balloon inflation significantly shifted (p &lt; 0.001) the brainstem and cranial nerve foramina (mean [\u00b1 standard deviation] displacement of upper brainstem, 10.2 \u00b1 3.7 mm; trigeminal nerve exit, 6.99 \u00b1 2.38 mm; facial nerve exit, 9.52 \u00b1 4.13 mm; and lower brainstem, 13.63 \u00b1 8.45 mm). The area of exposure at the petroclivus was significantly greater with balloon inflation than without (change, 316.26 \u00b1 166.75 mm<jats:sup>2<\/jats:sup>; p &lt; 0.0001). Before and after balloon inflation, there was no significant difference in the angles of attack at the origin of the trigeminal nerve (p &gt; 0.5).<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p> This study adds an experimental component to the emerging field of quantitative neurosurgical anatomy. Balloon inflation can be used to model the effects of a mass lesion. The tumor simulation created \u201cnatural\u201d retraction and an opening toward the upper clivus. The findings may be helpful in selecting a surgical approach to increase the working space for resection of certain extraaxial tumors.<\/jats:p><\/jats:sec>","DOI":"10.3171\/jns-07\/10\/0797","type":"journal-article","created":{"date-parts":[[2007,12,13]],"date-time":"2007-12-13T15:49:17Z","timestamp":1197560957000},"page":"797-804","source":"Crossref","is-referenced-by-count":15,"title":["Moving toward the petroclival region: a model for quantitative and anatomical analysis of tumor shift"],"prefix":"10.3171","volume":"107","author":[{"given":"Sam","family":"Safavi-Abbasi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph M.","family":"Zabramski","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pushpa","family":"Deshmukh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cassius V.","family":"Reis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas C.","family":"Bambakidis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas","family":"Theodore","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neil R.","family":"Crawford","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert F.","family":"Spetzler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark C.","family":"Preul","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-1070797","series-title":"Neurosurgery","first-page":"139","article-title":"Petroclival meningiomas: predictive parameters for transpetrosal approaches","volume":"47","author":"Abdel Aziz","year":"2000"},{"key":"b2-1070797","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"510","DOI":"10.1227\/00006123-198803000-00010","article-title":"Petrosal approach for petroclival meningiomas","volume":"22","author":"Al Mefty","year":"1988"},{"key":"b3-1070797","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"60","DOI":"10.3171\/jns.1994.81.1.0060","article-title":"The far lateral\/combined supra- and infratentorial approach. A human cadaveric prosection model for routes of access to the petroclival region and ventral brain stem","volume":"81","author":"Baldwin","year":"1994"},{"key":"b4-1070797","series-title":"Acta Neurochir (Wien)","doi-asserted-by":"publisher","first-page":"155","DOI":"10.1007\/BF01417683","article-title":"The far lateral-combined supra- and infratentorial approach: clinical experience","volume":"134","author":"Baldwin","year":"1995"},{"issue":"2","key":"b5-1070797","series-title":"Neurosurg Focus","first-page":"E8","article-title":"Combined skull base approaches to the posterior fossa. Technical note","volume":"19","author":"Bambakidis","year":"2005"},{"key":"b6-1070797","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"813","DOI":"10.1227\/00006123-199211000-00001","article-title":"Microsurgical removal of petroclival meningiomas: a report of 33 patients","volume":"31","author":"Bricolo","year":"1992"},{"key":"b7-1070797","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"1287","DOI":"10.1097\/00006123-200012000-00005","article-title":"Impact of computed tomographic and magnetic resonance imaging findings on surgical outcome in petroclival meningiomas","volume":"47","author":"Carvalho","year":"2000"},{"key":"b8-1070797","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"147","DOI":"10.1097\/00006123-200207000-00022","article-title":"Partial labyrinthectomy petrous apicectomy approach to the petroclival region: an anatomic and technical study","volume":"51","author":"Chanda","year":"2002"},{"key":"b9-1070797","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"708","DOI":"10.1097\/00006123-200209000-00017","article-title":"Combined petrosal approach to petroclival meningiomas","volume":"51","author":"Cho","year":"2002"},{"key":"b10-1070797","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"20","DOI":"10.3171\/jns.1996.84.1.0020","article-title":"Petroclival meningiomas: surgical experience in 109 cases","volume":"84","author":"Couldwell","year":"1996"},{"key":"b11-1070797","series-title":"Surg Neurol","doi-asserted-by":"publisher","first-page":"293","DOI":"10.1016\/0090-3019(85)90042-4","article-title":"Microsurgical anatomy of the region of the foramen magnum","volume":"24","author":"de Oliveira","year":"1985"},{"issue":"2 Suppl","key":"b12-1070797","series-title":"Neurosurgery","first-page":"ONS-202","article-title":"Quantification and comparison of telovelar and transvermian approaches to the fourth ventricle","volume":"58","author":"Deshmukh","year":"2006"},{"issue":"2 Suppl","key":"b13-1070797","series-title":"Neurosurgery","first-page":"397","article-title":"Quantitative anatomic study of three surgical approaches to the anterior communicating artery complex","volume":"56","author":"Figueiredo","year":"2005"},{"key":"b14-1070797","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"957","DOI":"10.3171\/jns.2006.104.6.957","article-title":"Anatomical and quantitative description of the transcavernous approach to interpeduncular and prepontine cisterns. Technical note","volume":"104","author":"Figueiredo","year":"2006"},{"key":"b15-1070797","series-title":"Surg Neurol","doi-asserted-by":"publisher","first-page":"332","DOI":"10.1016\/j.surneu.2003.12.008","article-title":"Conventional posterior fossa approach for surgery on petroclival meningiomas: a report on an experience with 28 cases","volume":"62","author":"Goel","year":"2004"},{"key":"b16-1070797","series-title":"Neurosurgery","first-page":"550","article-title":"Working area and angle of attack in three cranial base approaches: pterional, orbitozygomatic, and maxillary extension of the orbitozygomatic approach","volume":"50","author":"Gonzalez","year":"2002"},{"key":"b17-1070797","series-title":"Surg Neurol","doi-asserted-by":"publisher","first-page":"108","DOI":"10.1016\/0090-3019(88)90095-X","article-title":"A combined retroauricular and preauricular transpetrosal-transtentorial approach to clivus meningiomas","volume":"30","author":"Hakuba","year":"1988"},{"key":"b18-1070797","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"108","DOI":"10.3171\/jns.2000.93.1.0108","article-title":"Classification and quantification of the petrosal approach to the petroclival region","volume":"93","author":"Horgan","year":"2000"},{"key":"b19-1070797","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"660","DOI":"10.3171\/jns.2001.94.4.0660","article-title":"Transcrusal approach to the petroclival region with hearing preservation. Technical note and illustrative cases","volume":"94","author":"Horgan","year":"2001"},{"key":"b20-1070797","series-title":"Otolaryngology","doi-asserted-by":"publisher","first-page":"ORL-770","DOI":"10.1177\/019459987808600522","article-title":"Surgery of the skull base: transcochlear approach to the petrous apex and clivus","volume":"86","author":"House","year":"1978"},{"key":"b21-1070797","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"869","DOI":"10.1227\/00006123-199106000-00014","article-title":"Anterior transpetrosal-transtentorial approach for sphenopetroclival meningiomas: surgical method and results in 10 patients","volume":"28","author":"Kawase","year":"1991"},{"key":"b22-1070797","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"662","DOI":"10.1227\/01.NEU.0000080070.16099.BB","article-title":"Comparison of the far lateral and extreme lateral variants of the atlanto-occipital transarticular approach to anterior extradural lesions of the craniovertebral junction","volume":"53","author":"Kawashima","year":"2003"},{"key":"b23-1070797","series-title":"Neurosurgery","first-page":"546","article-title":"Surgical management of petroclival meningiomas: defining resection goals based on risk of neurological morbidity and tumor recurrence rates in 137 patients","volume":"56","author":"Little","year":"2005"},{"key":"b24-1070797","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"58","DOI":"10.1227\/00006123-198807000-00012","article-title":"Microsurgical anatomy of the posterior fossa cisterns","volume":"23","author":"Matsuno","year":"1988"},{"key":"b25-1070797","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"63","DOI":"10.3171\/jns.1983.59.1.0063","article-title":"Microsurgical anatomy of the veins of the posterior fossa","volume":"59","author":"Matsushima","year":"1983"},{"issue":"3 Suppl","key":"b26-1070797","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"S29","DOI":"10.1097\/00006123-200009001-00010","article-title":"The cerebellar arteries","volume":"47","author":"Rhoton","year":"2000"},{"issue":"3 Suppl","key":"b27-1070797","series-title":"Neurosurgery","doi-asserted-by":"publisher","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":"Rhoton","year":"2000"},{"key":"b28-1070797","series-title":"Clin Neurosurg","first-page":"11","article-title":"Microsurgical anatomy and neurosurgical pathology","volume":"51","author":"Rhoton","year":"2004"},{"key":"b29-1070797","series-title":"Neurol Res","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1080\/01616412.1984.11739658","article-title":"Microsurgical anatomy of acoustic neuromas","volume":"6","author":"Rhoton","year":"1984"},{"key":"b30-1070797","series-title":"J Fla Med Assoc","first-page":"895","article-title":"Suboccipital\u2013retrolabyrinthine removal of acoustic neuromas","volume":"70","author":"Rhoton","year":"1983"},{"key":"b31-1070797","series-title":"Clin Neurosurg","first-page":"112","article-title":"The three neurovascular complexes in the posterior fossa and vascular compression syndromes (honored guest lecture)","volume":"41","author":"Rhoton","year":"1994"},{"key":"b32-1070797","series-title":"Surg Neurol","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1016\/S0090-3019(01)00479-7","article-title":"Posterior fossa meningiomas: surgical experience in 161 cases","volume":"56","author":"Roberti","year":"2001"},{"issue":"4 Suppl","key":"b33-1070797","series-title":"Neurosurgery","first-page":"219","article-title":"Three-dimensional relationships of the optic radiation","volume":"57","author":"Rubino","year":"2005"},{"key":"b34-1070797","series-title":"Acta Neurochir (Wien)","doi-asserted-by":"publisher","first-page":"6","DOI":"10.1007\/BF01793075","article-title":"The combined supra-infratentorial pre-sigmoid sinus avenue to the petroclival region. Surgical technique and clinical applications","volume":"95","author":"Samii","year":"1988"},{"key":"b35-1070797","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"12","DOI":"10.1227\/00006123-198901000-00003","article-title":"Surgery of petroclival meningiomas: report of 24 cases","volume":"24","author":"Samii","year":"1989"},{"key":"b36-1070797","series-title":"Acta Neurochir (Wien)","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1007\/BF01400723","article-title":"Experience with 36 surgical cases of petroclival meningiomas","volume":"118","author":"Samii","year":"1992"},{"key":"b37-1070797","series-title":"J Clin Neurosci","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1016\/S0967-5868(99)90598-2","article-title":"Resection of large petroclival meningiomas by the simple retrosigmoid route","volume":"6","author":"Samii","year":"1999"},{"key":"b38-1070797","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"235","DOI":"10.3171\/jns.2000.92.2.0235","article-title":"Retrosigmoid intradural suprameatal approach to Meckel's cave and the middle fossa: surgical technique and outcome","volume":"92","author":"Samii","year":"2000"},{"key":"b39-1070797","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"500","DOI":"10.3171\/jns.1984.60.3.0500","article-title":"Cerebellopontine angle meningiomas. Microsurgical excision and follow-up results","volume":"60","author":"Sekhar","year":"1984"},{"key":"b40-1070797","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"764","DOI":"10.1227\/00006123-199011000-00015","article-title":"Meningiomas involving the clivus: a six-year experience with 41 patients","volume":"27","author":"Sekhar","year":"1990"},{"key":"b41-1070797","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"537","DOI":"10.1097\/00006123-199903000-00060","article-title":"Partial labyrinthectomy petrous apicectomy approach to neoplastic and vascular lesions of the petroclival area","volume":"44","author":"Sekhar","year":"1999"},{"key":"b42-1070797","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"553","DOI":"10.1097\/00006123-199903000-00065","article-title":"Suprameatal extension of the retrosigmoid approach: microsurgical anatomy","volume":"44","author":"Seoane","year":"1999"},{"key":"b43-1070797","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"137","DOI":"10.3171\/jns.2006.104.1.137","article-title":"Quantitative analysis of the working area and angle of attack for the retrosigmoid, combined petrosal, and transcochlear approaches to the petroclival region","volume":"104","author":"Siwanuwatn","year":"2006"},{"key":"b44-1070797","series-title":"Surg Neurol","first-page":"412","article-title":"Petroclival meningioma. An attempt to define the role of skull base approaches in their surgical management","volume":"51","author":"Spallone","year":"1999"},{"key":"b45-1070797","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"824","DOI":"10.3171\/jns.2000.92.5.0824","article-title":"Quantitative description of the far-lateral trans-condylar transtubercular approach to the foramen magnum and clivus","volume":"92","author":"Spektor","year":"2000"},{"key":"b46-1070797","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"588","DOI":"10.3171\/jns.1992.76.4.0588","article-title":"The combined supra- and infratentorial approach for lesions of the petrous and clival regions: experience with 46 cases","volume":"76","author":"Spetzler","year":"1992"},{"key":"b47-1070797","series-title":"Clin Neurosurg","first-page":"62","article-title":"Petroclival lesions","volume":"41","author":"Spetzler","year":"1994"},{"issue":"6","key":"b48-1070797","series-title":"Neurosurg Focus","first-page":"E9","article-title":"Anatomical basis of approaches to foramen magnum and lower clival meningiomas: comparison of retrosigmoid and transcondylar approaches","volume":"14","author":"Suhardja","year":"2003"},{"issue":"2 Suppl","key":"b49-1070797","series-title":"Neurosurgery","first-page":"ONS-229","article-title":"One-piece versus two-piece orbitozygomatic craniotomy: quantitative and qualitative considerations","volume":"58","author":"Tanriover","year":"2006"},{"key":"b50-1070797","series-title":"Surg Neurol","doi-asserted-by":"publisher","first-page":"180","DOI":"10.1016\/0090-3019(94)90123-6","article-title":"Lateral approaches to the petroclival region","volume":"41","author":"Tedeschi","year":"1994"},{"key":"b51-1070797","series-title":"Neurosurgery","first-page":"55","article-title":"Natural history of petroclival meningiomas","volume":"52","author":"Van Havenbergh","year":"2003"},{"key":"b52-1070797","series-title":"Adv Techn Stand Neurosurg","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1007\/978-3-7091-7051-9_1","article-title":"Meningiomas of basal posterior cranial fossa","volume":"7","author":"Ya\u015fargil","year":"1980"},{"key":"b53-1070797","series-title":"J Neurol Neurosurg Psychiatry","doi-asserted-by":"publisher","first-page":"341","DOI":"10.1136\/jnnp.62.4.341","article-title":"Petroclival meningiomas: is radical resection always the best option?","volume":"62","author":"Zentner","year":"1997"}],"container-title":["Journal of Neurosurgery"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/107\/4\/article-p797.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/107\/4\/article-p797.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/107\/4\/article-p797.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,4,13]],"date-time":"2023-04-13T01:25:32Z","timestamp":1681349132000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/107\/4\/article-p797.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2007,10]]},"references-count":53,"journal-issue":{"issue":"4"},"URL":"https:\/\/doi.org\/10.3171\/jns-07\/10\/0797","relation":{},"ISSN":["0022-3085","1933-0693"],"issn-type":[{"value":"0022-3085","type":"print"},{"value":"1933-0693","type":"electronic"}],"subject":[],"published":{"date-parts":[[2007,10]]}}}