The endoscopic transpterional port approach: anatomy, technique, and initial clinical experience
| Autor: | Francesco Doglietto, Mazda K Turel, Krunal Patel, Hugo Andrade-Barazarte, Fred Gentili, Rachel Tymianski, Michael Tymianski, Ivan Radovanovic, Vitor Mendes Pereira, Anne Agur |
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| Rok vydání: | 2020 |
| Předmět: |
MCA = middle cerebral artery
medicine.medical_specialty anatomy Endoscope ICA = internal carotid artery medicine.medical_treatment ETPA = endoscopic transpterional port approach cavernous sinus ACoA = anterior communicating artery CN = cranial nerve PCoA = posterior communicating artery SAH = subarachnoid hemorrhage aneurysms endoscopy mRS = modified Rankin Scale oncology skull base surgical technique transpterional approach Pterion Port (medical) Modified Rankin Scale Cadaver medicine Craniotomy medicine.diagnostic_test business.industry Endoscopy medicine.anatomical_structure Cavernous sinus Radiology business |
| Zdroj: | Journal of Neurosurgery. 132:884-894 |
| ISSN: | 1933-0693 0022-3085 |
| DOI: | 10.3171/2018.10.jns171898 |
| Popis: | OBJECTIVEThe evolution of microsurgical and endoscopic techniques has allowed the development of less invasive transcranial approaches. The authors describe a purely endoscopic transpterional port craniotomy to access lesions involving the cavernous sinus and the anterolateral skull base.METHODSThrough single- or dual-port incisions and with direct endoscopic visualization, the authors performed an endoscopic transpterional port approach (ETPA) using a 4-mm straight endoscope in 8 sides of 4 formalin-fixed cadaveric heads injected with colored latex. A main working port incision is made just below the superior temporal line and behind the hairline. An optional 0.5- to 1-cm second skin port incision is made on the lateral supraorbital region, allowing multiangle endoscopic visualization and maneuverability. A 1.5- to 2-cm craniotomy centered over the pterion is done through the main port, which allows an extradural exposure of the cavernous sinus region and extra/intradural exposure of the frontal and temporal cranial fossae. The authors present a pilot surgical series of 17 ETPA procedures and analyze the surgical indications and clinical outcomes retrospectively.RESULTSThe initial stage of this work on cadavers provided familiarity with the technique, standardized its steps, and showed its anatomical limits. The clinical ETPA was applied to gain access into the cavernous sinus, as well as for aneurysm clipping and meningioma resection. Overall, perioperative complications occurred in 1 patient (6%), there was no mortality, and at last follow-up all patients had a modified Rankin Scale score of 0 or 1.CONCLUSIONSThe ETPA provides a less invasive, focused, and direct route to the cavernous sinus, and to the frontal and temporal cranial fossae, and it is feasible in clinical practice for selected indications with good results. |
| Databáze: | OpenAIRE |
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