The Extended Transorbital Craniotomy

Autor: Mario Zuccarello, Jeffrey T. Keller, Chris Sanders-Taylor, Almaz Kurbanov, Norberto Andaluz
Rok vydání: 2015
Předmět:
Zdroj: Operative Neurosurgery. 11:338-344
ISSN: 2332-4252
Popis: Background Supra-/transorbital approaches are mostly limited to suprasellar and anterior fossa pathologies, whereas lateral supraorbital approaches provide less retrosellar exposure and less overall operative volume, especially in the temporal region. Objective Our cadaveric study proposes removal of the lesser and greater wings of the sphenoid bone to increase both the lateral angle typically achieved with pterional approaches and exposure to the temporal lobe and perisellar region. Methods In 5 cadaveric specimens, our 3 steps to expand transorbital exposures included the following: step 1, standard transorbital craniotomy via a 3-cm supra-eyebrow incision; step 2, removal of the lesser sphenoid wing completed extradurally; and step 3, partial removal of the greater sphenoid wing. Operative extension in sylvian, parasellar, and anterolateral temporal exposures were quantified for each step (t test). Results Step 2 provided the greatest increased exposure in the sylvian and parasellar regions compared with step 3, whereas step 3 provided a significant proportion of the exposure in the lateral temporal region. Finally, the lateral view progressively increased with each subsequent step. Conclusion Our 3-step removal of the lesser and greater wings of the sphenoid bone quantified increased sylvian, anterior temporal, and parasellar exposures for this minimally invasive approach with excellent cosmesis. Its increases the anterolateral view (similar to a subfrontal pterional approach) and offers potential applications to vascular and neoplastic (ie, sphenoid meningiomas) pathologies classically treated via a pterional or frontotemporal orbitozygomatic approach.
Databáze: OpenAIRE
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