Anatomical Step-by-Step Dissection of Complex Skull Base Approaches for Trainees: Surgical Anatomy of the Far Lateral Approach.

Autor:	Graffeo CS; Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States.; Department of Neurosurgery, Barrow Neurologic Institute, Phoenix, Arizona, United States.; Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, Minnesota, United States., Perry A; Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States.; Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, Minnesota, United States., Carlstrom LP; Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States.; Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, Minnesota, United States., Leonel L; Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States.; Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, Minnesota, United States., Nguyen BT; Department of Radiology, Mayo Clinic, Rochester, Minnesota, United States., Morris JM; Department of Radiology, Mayo Clinic, Rochester, Minnesota, United States., Driscoll CLW; Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, United States.; Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States., Link MJ; Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States.; Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, United States., Peris-Celda M; Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States.; Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, United States.; Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, Minnesota, United States.
Jazyk:	angličtina
Zdroj:	Journal of neurological surgery. Part B, Skull base [J Neurol Surg B Skull Base] 2022 Mar 08; Vol. 84 (2), pp. 170-182. Date of Electronic Publication: 2022 Mar 08 (Print Publication: 2023).
DOI:	10.1055/a-1760-2528
Abstrakt:	Introduction  Skull base neuroanatomy is classically taught using surgical atlases. Although these texts are critical and rich resources for learning three-dimensional (3D) relationships between key structures, we believe they could be optimized and complemented with step-by-step anatomical dissections to fully meet the learning needs of trainees. Methods  Six sides of three formalin-fixed latex-injected specimens were dissected under microscopic magnification. A far lateral craniotomy was performed by each of three neurosurgery resident/fellow at varying stages of training. The study objective was the completion and photodocumentation of the craniotomy to accompany a stepwise description of the exposure to provide a comprehensive, intelligible, and anatomically oriented resource for trainees at any level. Illustrative case examples were prepared to supplement approach dissections. Results  The far lateral approach provides a wide and versatile corridor for posterior fossa operation, with access spanning the entire cerebellopontine angle (CPA), foramen magnum, and upper cervical region. Key Steps Include  The study includes the following steps: positioning and skin incision, myocutaneous flap, placement of burr holes and sigmoid trough, fashioning of the craniotomy bone flap, bilateral C1 laminectomy, occipital condyle/jugular tubercle drilling, and dural opening. Conclusion  Although more cumbersome than the retrosigmoid approach, a far lateral craniotomy offers unparalleled access to lesions centered lower or more medially in the CPA, as well as those with significant extension into the clival or foramen magnum regions. Dissection-based neuroanatomic guides to operative approaches provide a unique and rich resource for trainees to comprehend, prepare for, practice, and perform complex cranial operations, such as the far lateral craniotomy. Competing Interests: Conflict of Interest None declared. (Thieme. All rights reserved.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu