Anatomical basis of approaches to foramen magnum and lower clival meningiomas: comparison of retrosigmoid and transcondylar approaches
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Bibliographic record
Abstract
OBJECT: Meningiomas of the lower clivus and foramen magnum are among the most challenging of all neurosurgical lesions. Debate continues regarding the most appropriate approach to this eloquent anatomical region. This anatomical study was undertaken to measure and compare the area of surgical exposures of the lower clivus achieved using the retrosigmoid and the extreme-lateral transcondylar (ELT) approaches. METHODS: Thirteen embalmed cadaveric heads were dissected bilaterally via the retrosigmoid approach on one side and the ELT approach on the other. The circumference of the area of exposure was delineated using beaded pins placed into the dura. After removal of the brain, the longest longitudinal and transverse axes of the pinned areas were measured and surface area calculated. The area of surgical exposure was also expressed as a percentage of the total area of the lower clivus. Normalized and adjusted surface areas were calculated using the bimastoid diameter. The areas of exposure were compared using the two-tailed paired Student t-test. The mean area of exposure required using the retrosigmoid approach was 19.8 +/- 14.7 mm2 (range 6-49 mm2) and that using the ELT approach was 27.8 +/- 22.8 mm2 (range 10-90 mm2). The mean percentage of the lower clivus exposed by the retrosigmoid approach was 14.9 +/- 3.6% (range 10-22%) and that exposed by the ELT approach was 20.5 +/- 4.9% (range 10-25%). The ELT approach provided significantly greater area of operative exposure and allowed a significantly higher percentage of lower clivus and foramen magnum exposure than did the retrosigmoid approach (p < 0.05). Normalized and adjusted surface areas, taking into consideration the bimastoid diameter, were also statistically significant in favor of the ELT approach. CONCLUSIONS: The ELT approach provided a significantly greater area of exposure than did the retrosigmoid approach.
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Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from it