Cranial Base Approaches to Intracranial Aneurysms in the Subarachnoid Space

Sekhar, Laligam N.; Kalia, Kamal K.; Yonas, Howard; Wright, Donald C.; Ching, Henry

doi:10.1097/00006123-199409000-00016

Cited by 24 publications

(38 citation statements)

References 38 publications

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“…Of course, more orbital roof may be removed in a piecemeal fashion following a 1-piece craniotomy, but this permanent removal of bone increases the risk of enophthalmos, possibly requiring delayed reconstruction. 6,18,21 Both the 1-and 2-piece TBA provide good visualization of pathology at the anterior cranial fossa floor, planum sphenoidale, and suprasellar region. The increased orbital roof removal in the 2-piece TBA confers a statistically significant increase in 1 of 6 surgical angles measured in our study, the horizontal middle angle.…”

Section: Discussionmentioning

confidence: 99%

The 1-piece transbasal approach: operative technique and anatomical study

Effendi¹,

Rao²,

Momin³

et al. 2014

JNS

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Object The transbasal approach (TBA) is an anterior skull base approach, which provides access to the anterior skull base, sellar-suprasellar region, and clivus. The TBA typically involves a bifrontal craniotomy with orbital bar and/or nasal bone osteotomies performed in 2 separate steps. The authors explored the feasibility of routinely performing this approach in 1 piece with a quantitative cadaveric anatomical study, and present an operative case example of their approach. Methods Seven latex-injected cadaveric heads underwent a 1-piece TBA, followed by additional bone removal typical for a traditional 2-piece approach. Six surgical angles relative to the pituitary stalk, as well as the surface area of the orbital roof osteotomy, were measured before and after additional bone removal. The vertical angle from the frontonasal suture to the foramen cecum was measured in all specimens. In addition to an anatomical study, the authors have used this technique in the operating room, and present an illustrative case of resection of an anterior skull base meningioma. Results Morphometric results were as follows: the vertical angle from the frontonasal suture to the foramen cecum ranged from 17.4° to 29.7° (mean 23.8° ± 4.8°) superiorly. Of the 6 surgical angle measures, only the middle horizontal angle was increased in the 2-piece versus the 1-piece approach (mean 43.4° ± 4.6° vs 43.0° ± 4.3°, respectively; p = 0.049), with a mean increase of 0.4°. The surface area of the orbital osteotomy was increased in the 2-piece versus the 1-piece approach (mean 2467 mm2 ± 360 mm2 vs 2045 mm2 ± 352 mm2, respectively; p < 0.001). The patient in the illustrative clinical case had a good outcome, both clinically and cosmetically. Conclusions The 1-piece TBA provides an alternative to the traditional 2-piece approach. It allows easier reconstruction, potentially decreased operative time, and improved cosmesis. While more of the orbital roof can be removed with the 2-piece approach, this additional bone removal offers only a small increase in 1 of 6 surgical angles that were measured.

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Section: Discussionmentioning

confidence: 99%

The 1-piece transbasal approach: operative technique and anatomical study

Effendi¹,

Rao²,

Momin³

et al. 2014

JNS

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“…As estruturas da base do crânio obscureciam entretanto o campo de visão, impedindo tal manobra. As abordagens utilizando as técnicas de cirurgia de base do crânio vieram solucionar esta limitação [1][2][3][4][5][6][7][8]10,[12][13][14]22 .…”

Section: Porque Realizar Ressecções óSseas Na Base Do Crânio?unclassified

“…A abordagem supraorbitária descrita por Jane e col. 23 e posteriormente modificada e divulgada por Al Mefty 16 consiste na remoção das rebordas orbitárias superior e lateral associada à craniotomia pterional clássica, em flape ósseo único 16 ou dois separadamente 10 . Esta via permite o acesso à órbita, à base anterior do crânio, à região supraselar, ao seio cavernoso e à região da artéria comunicante anterior.…”

Section: Porque Realizar Ressecções óSseas Na Base Do Crânio?unclassified

“…A craniotomia fronto-temporal associada à remoção da reborda orbitária e arco zigomático pode ser confeccionada de diversas maneiras, recebendo as seguintes denominações na literatura: acesso combinado frontotemporal-orbitozigomático 7 , acesso orbitozigomático temporopolar 14 , acesso orbitozigomático subtemporal anterior e transsylviano 10 , acesso crânio-orbitozigomático 1,5 , craniotomia orbitozigomática 13 . A grande vantagem deste acesso é sua ampla exposição à região da cisterna interpeduncular, porção alta do clivus, incisura da tenda e seio cavernoso, possibilitando a movimentação do microscópio em várias direções e acessos subtemporal, subfrontal, transsylviano e pré-temporal.…”

Section: Porque Realizar Ressecções óSseas Na Base Do Crânio?unclassified

“…Todas têm como princípio básico a remoção máxima de estruturas ósseas, permitindo menor retração cerebral. Vários trabalhos têm relatado a remoção da reborda orbitária e/ou do zigoma com diferentes técnicas predominando, contudo, a confecção de craniotomia associada a osteotomia das estruturas da base do crânio separadamente [1][2][3][4][5][6][7][8][9][10][11][12][13] . Em 1991, Ikeda e col. 14 publicaram sobre a craniotomia frontoorbitozigomática temporal em bloco único em dois casos de aneurismas do topo da artéria basilar.…”

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Acesso crânio-orbitozigomático em flape único: técnica cirúrgica e resultados

Giannetti

Faleiro²,

Perpétuo

1999

Arq. Neuro-Psiquiatr.

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RESUMO -Descreve-se o acesso crânio-orbitozigomático em flape único, cuja técnica foi aplicada em sete pacientes (cinco aneurismas da artéria basilar, um neurinoma do trigêmeo e um meningioma da asa menor do esfenóide). Os pacientes foram retrospecticamente analisados do ponto de vista estético e submetidos a tomografia computadorizada com reconstruções tridimensionais e multiplanares. O acesso proporcionou maior campo de trabalho, menor profundidade e maiores possibilidades de angulação do microscópio, permitindo a clipagem satisfatória dos aneurismas e a ressecção completa dos tumores. A paralisia do músculo frontal ocorreu em dois casos e a atrofia do músculo temporal provocou defeito estético significativo em dois pacientes. Não houve enoftalmia ou afundamento do flape ósseo. A técnica apresentada pareceu-nos mais simples e acessível ao nosso meio, dispensando o uso de motores, serras elétricas e de miniplacas. PALAVRAS-CHAVE: acesso cirúrgico, cirurgia de base de crânio, aneurisma intracraniano, técnica operatória. An en bloc cranio-orbitozygomatic approach: surgical technique and resultsABSTRACT -An en bloc cranio-orbitozygomatic approach is described. This technique was applied in seven patients (five basilar artery aneurysms, a trigeminal neuroma, a meningioma of the lesser sphenoid wing). The follow-up period ranged from 3 to 50 months. The patients were retrospectively analysed from the cosmetic point of view, and submitted to computerized tomography with three dimensional and multiplanar reconstructions The access provided a wider operative field with a shorter distance to the pathology and possibility of increased angulation of the microscope. The aneurysms could be cliped and the tumors completelly removed in all cases. A frontalis muscle paralysis occurred in two cases, as well as a temporalis muscle atrophy in another two patients. There were no enophthalmos or bone flap displacements. The surgical technique is simple and do not require drills, electric saws and miniplates.KEY WORDS: surgical approach, skull base surgery, intracranial aneurysm, operative technique.

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