Evaluating the importance of the tentorial angle in the paramedian supracerebellar-transtentorial approach for selective amygdalohippocampectomy.

Autor: Lafazanos S; Department of Neurosurgery, Yeditepe University School of Medicine, İstanbul, Turkey., Türe U; Department of Neurosurgery, Yeditepe University School of Medicine, İstanbul, Turkey. Electronic address: drture@yahoo.com., Harput MV; Department of Neurosurgery, Yeditepe University School of Medicine, İstanbul, Turkey., Gonzalez Lopez P; Department of Neurosurgery, Yeditepe University School of Medicine, İstanbul, Turkey., Fırat Z; Department of Neurosurgery, Yeditepe University School of Medicine, İstanbul, Turkey., Türe H; Department of Anesthesiology, Yeditepe University School of Medicine, İstanbul, Turkey., Dimitriou T; Department of Anatomy, Medical School, Democritus University of Thrace, Alexandroupolis, Greece., Yaşargil MG; Department of Neurosurgery, Yeditepe University School of Medicine, İstanbul, Turkey.
Jazyk: angličtina
Zdroj: World neurosurgery [World Neurosurg] 2015 May; Vol. 83 (5), pp. 836-41. Date of Electronic Publication: 2015 Jan 06.
DOI: 10.1016/j.wneu.2014.12.042
Abstrakt: Objective: A challenging step of the paramedian supracerebellar-transtentorial approach is to expose the anterior portion of the mediobasal-temporal region (MTR), a step that seems most affected by the steepness of the tentorium. The objective of this study was to define magnetic resonance imaging measurements that can predict the level of challenge in exposing the anterior portion of the MTR.
Methods: Cranial magnetic resonance imaging studies of 100 healthy individuals were examined. The tentorial and occipital angles were measured, and the amount of brain tissue that remained hidden on the microscopic view in front of the petrous apex was indirectly estimated. These measurements were statistically compared with the cephalic index of each person.
Results: The mean values for the tentorial and occipital angles were 42° (range 25°-53°) and 98° (range 69°-122°), respectively. The results proved that the higher the tentorial angle, the higher the occipital angle and the greater the amount of hidden brain tissue. Of 100 persons, 3 (3%) were found to be dolichocephalic, 23 (23%) were mesocephalic, and 74 (74%) were brachycephalic. Statistical analysis proved that individuals with a dolichocephalic cranial shape have lower tentorial and occipital angles.
Conclusions: The results provide strong evidence proving that the lesser the tentorial and occipital angles, the easier the exposure of the anterior portion of the MTR during the paramedian supracerebellar-transtentorial approach. The tendency of the cranial shape toward dolichocephaly seems to have the same practical value in choosing the approach. It is easier to expose the anterior portion of the MTR in these individuals.
(Copyright © 2015 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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