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Pterional approach

Shyamal C Bir, Tanmoy Maiti, Subhas Konar, Anil Nanda
OBJECTIVE: The pterional/frontotemporal orbitozygomatic (FTOZ) approaches are the two widely used procedures for resection of sphenoid wing meningiomas. However, a comparison of outcomes and complications of these two approaches has not been well described yet. Here, we investigated the outcomes, complications and predictors of favorable outcomes of these two approaches. METHODS: Data of ninety consecutive cases with sphenoid wing meningiomas between 1995 and 2015 was reviewed retrospectively...
October 19, 2016: World Neurosurgery
Ethan L Fulwood, Doug M Boyer, Richard F Kay
The pterion, on the lateral aspect of the cranium, is where the zygomatic, frontal, sphenoid, squamosal, and parietal bones approach and contact. The configuration of these bones distinguishes New and Old World anthropoids: most extant platyrrhines exhibit contact between the parietal and zygomatic bones, while all known catarrhines exhibit frontal-alisphenoid contact. However, it is thought that early stem-platyrrhines retained the apparently primitive catarrhine condition. Here we re-evaluate the condition of key fossil taxa using μCT (micro-computed tomography) imaging...
November 2016: Journal of Human Evolution
Jing Cheng, Qiang Shao, Zhiyong Pan, Jin You
OBJECTIVE: To investigate the relationship between the operative approach, clinical pathological factors, and curative effect of the surgical treatment in the patients with craniopharyngioma; to provide a theoretical basis for determining the prognosis and reducing the recurrence rate during the long-term postoperative follow-up in children. METHODS: This was a retrospective analysis of the clinical data of 92 children who underwent surgical treatment in our department from May 2011 to January 2005...
October 14, 2016: Journal of Craniofacial Surgery
Pritam Gurung, Yasushi Motoyama, Ichiro Nakagawa, Hun Soo Park, Yasuo Hironaka, Young Su Park, Hideyuki Ohnishi, Hiroyuki Nakase
BACKGROUND: Blood blister aneurysms (BBAs) of the internal carotid artery (ICA) are very challenging vascular lesions for neurosurgeons as they are very fragile and difficult to clip. They are commonly found at the dorsal wall of the ICA. Trapping is an alternative for these lesions, accompanied by vascular reconstruction. However, they are sometimes close to the posterior communicating artery (PcoA) and anterior choroidal artery (AchoA). CASE DESCRIPTION: A 30-year-old man presented with subarachnoid hemorrhage due to rupture of a BBA in the right distal ICA...
September 13, 2016: World Neurosurgery
Mohamad-Motaz Al Mahdi, Joachim K Krauss, Makoto Nakamura, Almuth Brandis, Bujung Hong
Ectopic recurrence of craniopharyngioma in the cerebellopontine angle after surgical resection of a suprasellar craniopharyngioma is rare. Thus, only 5 cases were reported with a delay ranging between 4 and 26 years after removal of the primary tumor. We report a unique case of ectopic recurrence of craniopharyngioma in the cerebellopontine angle, which occurred at only 4 months after surgical resection of the primary tumor. A 24-year-old man underwent resection of a suprasellar craniopharyngioma via a right pterional approach four months earlier...
March 28, 2016: Turkish Neurosurgery
Mustafa Güdük, Ulaş Yener, Halil İbrahim Sun, Mehmet Hacihanefioğlu, Koray Özduman, Mustafa Necmettin Pamir
AIM: Olfactory groove meningiomas make 4 to 13% of meningiomas. The first line treatment of meningiomas is surgery but the extent and types of approaches advised for olfactory groove meningiomas are diverse, and include from aggressive skull base approaches to standard or minimally invasive craniotomies and endoscopic approaches. We retrospectively reviewed our series of olfactory groove meningiomas which were operated microsurgically by standard pterional or unifrontal approaches. MATERIAL AND METHODS: Our series of 61 olfactory groove meningioma patients operated through pterional or unifrontal approaches between March 1987 and September 2015 is reviewed and the clinical data, radiological findings, surgical treatment and clinical outcomes of the patients are retrospectively analyzed...
May 25, 2016: Turkish Neurosurgery
Athansios Petridis, Suzin Jung
AIM: There is a number of different surgical approaches in MCA aneurysm surgery. Evolution from the classical pterional approach towards smaller modified approaches took places over the years. In the present report we describe a new modified approach in the treatment of MCA aneurysms, which is almost exclusively subfrontal. MATERIAL AND METHODS: Technical report. On three patients with MCA bifurcation aneurysms a modified approach was used. Craniotomy was subfrontal and suprapterional with minimal dissection of the temporal muscle and no drilling of the pterion...
February 16, 2016: Turkish Neurosurgery
Manisha Sharma, Manas Madan, Mridu Manjari, Harleen Kaur
Chondrosarcoma is a mesenchymal tumor composed of tumor cells producing cartilage. It is more common in older age and often affects the axial skeleton. We report a rare case of chondrosarcoma mimicking a sellar and suprasellar mass with parasellar extension. A 40 yr woman presented with decreasing visual acuity and headache. Magnetic resonance (MR) image revealed a cystic sellar and suprasellar mass with parasellar extension showing mild enhancing solid component. It favored the diagnosis of craniopharyngioma...
2016: Iranian Journal of Pathology
Zhe Wang, Hong-Mei Yan, Xiu-Rong Zhou, Jin-Kai Liu, Jian-Yong Chang, Yu-Ting Wang
Pilomyxoid astrocytoma (PMA) is a rare, low-grade glioma that is recognised as a variant of pilocytic astrocytoma. There have been few reports on this pathologic entity presenting with spontaneous haemorrhage. In this study, we report a rare case of PMA in the hypothalamic/chiasmatic region presenting with intratumoural and intraventricular haemorrhage. An external ventricular drain was urgently inserted. A ventriculo-peritoneal shunt (VP) was undergone 4weeks thereafter. The patient received fractionated Gamma Knife radiosurgery in another hospital 3weeks after the VP shunt...
November 2016: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
A Zoghlami, N Bon Mardion, F Callonnec, D Dehesdin, F Proust, J-P Marie
INTRODUCTION: Skull base meningoencephaloceles are rare congenital malformations. The two cases of transalar transsphenoidal malformation reported here differ from the classical transsphenoidal meningoencephalocele. CASE REPORTS: Case 1 was a three-and-a-half-year-old boy and case 2 was a 36-year-old man. Both cases presented with clinical features of recurrent meningitis. Surgical management of case 1 was performed via an intradural infratemporal fossa craniotomy with reoperation 2years later...
July 15, 2016: European Annals of Otorhinolaryngology, Head and Neck Diseases
Orlando Diaz, Leonardo Rangel-Castilla
Intracranial aneurysms are abnormal dilations of the intracranial vessels, in which all the layers of the vascular wall are affected by degenerative changes that lead to distension of the vessel. Intracranial aneurysms can be classified based on their anatomic location, size, and morphology. Subarachnoid hemorrhage is the most devastating clinical presentation. The goal of preventing hemorrhage or rehemorrhage can only be achieved by excluding the aneurysm from the cerebral circulation. Endovascular or surgical clipping can achieve this goal...
2016: Handbook of Clinical Neurology
Anil Nanda, Tanmoy K Maiti, Shyamal C Bir, Subhas K Konar, Bharat Guthikonda
OBJECTIVE: Olfactory groove meningiomas are often behaviorally silent. Numerous surgical approaches have been described in the literature for successful removal of these meningiomas. Lateral (pterional/ frontolateral) and anterior (bifrontal/ fronto-orbito-basal) approaches with their various modifications remain the two major corridors in resecting them. In this study, we discuss our experience in microsurgical treatment of these tumors at our institution and assess the extent of frontal lobe damage after the resection of tumor...
June 30, 2016: World Neurosurgery
G Chen, W W Zhai, Z Q Yu
OBJECTIVE: To investigate varying patterns of intracranial pressure(ICP)after giant meningioma resection and analyze the causes of the variation of ICP in different postoperative phases. METHODS: Clinical data, surgical approachs and the ICP monitoring data of 7 patients with giant meningioma in different positions who were admitted to the First Affiliated Hospital of Soochow University from October 2013 to July 2014 and received microsurgical resection via different approachs were analysed retrospectively...
June 28, 2016: Zhonghua Yi Xue za Zhi [Chinese medical journal]
Leonardo Rangel-Castilla, Jonathan J Russin, Robert F Spetzler
AIM: To present a review of the contemporary surgical management of skull base tumors. BACKGROUND: Over the last two decades, the treatment of skull base tumors has evolved from observation, to partial resection combined with other therapy modalities, to gross total resection and no adjuvant treatment with good surgical results and excellent clinical outcomes. MATERIALS AND METHODS: The literature review of current surgical strategies and management of skull base tumors was performed and complemented with the experience of Barrow Neurological Institute...
July 2016: Reports of Practical Oncology and Radiotherapy
Shou-Sen Wang, Lin Wei, Jun-Jie Jing, Shang-Ming Zhang
INTRODUCTION: The aim was to investigate the relationship between the tumor (clinicopathologic and radiological) characteristics and the morphological parameters of pituitary macroadenoma or giant adenoma patients using a three-dimensional (3D) reconstructed model. MATERIAL AND METHODS: Magnetic resoanance imaging (MRI) was performed preoperatively; tumor grade was determined by the Knosp-Steiner classification and tumor morphology by the SIPAP classification. Pituitary adenomas and adjacent structures were reconstructed three-dimensionally by volume rendering...
June 1, 2016: Archives of Medical Science: AMS
Ali Tayebi Meybodi, Dylan Griswold, Halima Tabani, Michael T Lawton, Pooneh Mokhtari, Andre Payman, Arnau Benet
BACKGROUND: The anterior temporal artery (ATA) is an appealing donor artery for intracranial-intracranial bypass procedures. However, its identification may be difficult. Current literature lacks useful landmarks to help identify the ATA at the surface of the sylvian fissure. The objective of this study was to define the topographic anatomy of the cortical segment of the ATA relative to constant landmarks exposed during the pterional approach. METHODS: The temporopolar artery (TPA), ATA, and middle temporal artery (MTA) were examined in 16 cadaveric specimens...
September 2016: World Neurosurgery
Hamid Borghei-Razavi, Shunsuke Shibao, Uta Schick
Optic pathway glioma (OPG) encompasses a spectrum of findings ranging from lesions confined to the optic nerve only, lesions affecting the optic chiasm and hypothalamus, and lesions with diffuse involvement of a large part of the optic pathway and neighboring structures. The majority of pediatric low-grade astrocytomas in the optic/chiasmatic region are typical pilocytic astrocytoma. The rest of them (10 %) may be other gliomas such as fibrillary pilomyxoid astrocytoma (grade 2 WHO). The postsurgical local recurrence rate of 55 to 76 % has been reported in some histological subtypes such as pilomyxoid astrocytoma (grade 2)...
May 26, 2016: Neurosurgical Review
Richard C Allen
PURPOSE OF REVIEW: Classical orbital approaches in skull base surgery have involved large incisions with extensive bone removal resulting in prolonged recovery with associated morbidity and mortality. The purpose of this review is to explore recent advances in skull base surgery that are applicable to the orbital surgeon. RECENT FINDINGS: Transnasal endoscopic surgery provides access to the medial 180 degrees of the orbit. Access to the lateral 180 degrees may be obtained using transmaxillary and transcranial techniques...
September 2016: Current Opinion in Ophthalmology
Jose Carlos Lynch, Mariangela Barbi Gonçalves, Celestino Esteves Pereira, Wladimir Melo, Gianni Ferraz Temponi
Objective To describe a unique operative strategy, instead the classical pterional approach, and to analyses it safety and effectiveness for removal of anterior cranial fossa meningiomas. Method We identify 38 patients with tuberculum sellae and olphactory groove meningiomas operated between 1986 and 2013. Medical charts, operative reports, imaging studies and clinical follow-up evaluations were reviewed and analyzed retrospectively. The pterional craniotomy is extended toward the frontal bone providing access through the subfrontal route, besides the usual anterolateral view provided by the classical pterional approach...
May 2016: Arquivos de Neuro-psiquiatria
Mario Carvi Y Nievas, Elefterios Archavlis
OBJECTIVE: To determine the effect of surgical technique on outcomes from ruptured middle cerebral artery aneurysms (RMCAA). METHODS: A retrospective review was performed of patients with RMCAA, who were treated at the authors' institutions. The study compares the clipping efficacy, the postoperative CT findings as well as the clinical outcome in 87 acute operated patients. Forty patients who underwent a surgical adapted technique to the preoperative radiological findings in the last 2 ½ years were included in Group 1, and 47 previously operated cases who underwent a standardized pterional approach with aneurysm preparation from proximal to distal were included in Group 2...
January 2016: Neurological Research
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