The Extended Lateral Supraorbital Approach and Extradural Anterior Clinoidectomy Through a Frontopterio-Orbital Window: Technical Note and Pilot Surgical Series

Autor: Sirajeddin Belkhair, Hugo Andrade-Barazarte, Rachel Tymianski, Juha Hernesniemi, Karl Lothard Schaller, Michael Tymianski, Mazda K Turel, Max Jägersberg, Ivan Radovanovic
Přispěvatelé: Department of Neurosciences, Clinicum, Neurokirurgian yksikkö, HUS Neurocenter
Rok vydání: 2017
Předmět:
Male
medicine.medical_treatment
Pilot Projects
3124 Neurology and psychiatry
Anterior clinoid process
Subarachnoid Hemorrhage/diagnostic imaging/surgery
0302 clinical medicine
80 and over
Craniotomy
Aged
80 and over
Astrocytoma/diagnostic imaging/surgery
Tumor
Brain Neoplasms
Anatomy
Middle Aged
ANATOMY
medicine.anatomical_structure
Anterior cranial fossa
Superior orbital fissure
030220 oncology & carcinogenesis
Cavernous sinus
CONSECUTIVE PATIENTS
Female
Extradural anterior clinoidectomy
Meningioma
Anterior/diagnostic imaging/surgery
Lateral supraorbital approach
Orbit (anatomy)
Adult
Craniotomy/methods
Meningioma/diagnostic imaging/surgery
Brain Neoplasms/diagnostic imaging/surgery
Astrocytoma
Cranial Fossa
Young Adult
03 medical and health sciences
medicine
Humans
ANEURYSMS
Aged
Retrospective Studies
Cranial Fossa
Anterior
Optic canal
business.industry
Intracranial Aneurysm/diagnostic imaging/surgery
3112 Neurosciences
Subarachnoid Hemorrhage
Intracranial aneurysm
3126 Surgery
anesthesiology
intensive care
radiology
ddc:616.8
Anterior choroidal artery
EXPERIENCE
Surgery
Neurology (clinical)
business
030217 neurology & neurosurgery
Zdroj: World Neurosurgery, Vol. 100 (2017) pp. 159-166
ISSN: 1878-8750
DOI: 10.1016/j.wneu.2016.12.087
Popis: Background Lateral approaches to treat anterior cranial fossa lesions have evolved since the first frontotemporal approach described by Dandy in 1918. We describe a less invasive approach to perform extradural anterior clinoidectomy through a lateral supraorbital (LSO) approach for anterior circulation aneurysms and anterolateral skull base lesions. Methods The extended LSO approach involves performing a standard lateral supraorbital craniotomy followed by drilling of the sphenoid wing and lateral wall of the orbit through the frontal bony opening of the LSO approach, without any temporal extension of the craniotomy. This creates a frontopterio-orbital window exposing the periorbita; superior, medial, and anterior aspect of the temporal dura mater; and superior orbital fissure. After unroofing the superior orbital fissure, the meningo-orbital fold is cut, and the temporal dura mater is peeled from the lateral wall of the cavernous sinus to expose the anterior clinoid process allowing a standard opening of the optic canal and anterior clinoidectomy. Results The extended LSO approach and extradural anterior clinoidectomy allowed access to 4 sphenoid wing/anterior clinoidal meningiomas, 5 anterior circulation aneurysms, 2 temporomesial lesions, and 1 orbital/cavernous sinus abscess. Postoperatively, 2 patients had transient hemiparesis, 2 patients had transient third nerve palsy, and 1 patient had minimal visual field deterioration. All patients had a modified Rankin Scale score ≤1 at 8-week follow-up. Conclusion The extended LSO approach opens a new route (frontopterio-orbital window) to perform extradural anterior clinoidectomy safely and increases surgical exposure, angles, and operability of a less invasive keyhole craniotomy (LSO approach) to treat anterior cranial fossa lesions.
Databáze: OpenAIRE
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