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Pterional approach

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https://www.readbyqxmd.com/read/29046469/-a-rare-case-of-ruptured-unruptured-miniature-aneurysms-originating-from-the-infundibular-dilatation-of-the-callosomarginal-artery-branching-from-the-infracallosal-a2-segment-of-the-azygos-anterior-cerebral-artery
#1
Shota Yoshimura, Chika Somagawa, Kei Satoh, Yutaka Fukuda, Takeshi Hiu, Tomonori Ono, Ryujiro Ushijima, Keisuke Toda, Keisuke Tsutsumi
We report the first case of two de novo miniature aneurysms(ruptured/unruptured)emerging from the infundibular dilatation(ID)of the callosomarginal artery, which branches from the infracallosal(A2)segment of the azygos anterior cerebral artery(AACA), in a 36-year-old woman. The patient had previously been diagnosed with a miniature, unruptured aneurysm, occurring in the A2 segment of the AACA, detected by CT angiography(CTA)at another hospital two years ago, and had been followed up with MR angiography(MRA)every 6 months...
October 2017: No Shinkei Geka. Neurological Surgery
https://www.readbyqxmd.com/read/29038082/supraorbital-approach-for-resection-of-clinoidal-meningioma
#2
Rimal H Dossani, Piyush Kalakoti, Bharat Guthikonda
Meningiomas of the clinoid region pose formidable surgical challenge. Pterional craniotomy is the traditional approach, and often associated with high-risk post-surgical morbidities. In the current presentation, we describe an elderly male with a clinoidal meningioma that underwent a minimally invasive supra-orbital craniotomy for tumor resection. Patient presentation, neuroimaging, and surgical techniques (patient position, incision, anatomical consideration, and surgical steps) are described meticulously...
October 13, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/28987838/contralateral-approach-to-middle-cerebral-artery-aneurysms-an-anatomical-clinical-analysis-to-improve-patient-selection
#3
Ali Tayebi Meybodi, Michael T Lawton, Roberto Rodriguez Rubio, Sonia Yousef, Arnau Benet
BACKGROUND: A contralateral approach to clip a middle cerebral artery (MCA) aneurysm in case of bilateral intracranial aneurysms reduces surgical time and cost. However, there is a lack of evidence for objective patient selection. In this study, we assessed the change in surgical freedom along the contralateral MCA to provide objective evidence for patient selection. METHODS: Sixteen cadaveric specimens were studied. Through a pterional approach, the surgical freedom was calculated moving distally along the contralateral MCA at 5-mm increments...
October 4, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/28980149/hemorrhagic-presentation-of-intracranial-pilocytic-astrocytomas-literature-review
#4
REVIEW
G Lakshmi Prasad, B N Nandeesh, Girish R Menon
Pilocytic astrocytomas (PAs) are seemingly innocuous and benign tumors. However, in recent times, many case series have documented high rates of hemorrhage in these neoplasms. We hereby provide a detailed analysis on hemorrhagic pilocytic astrocytomas (HPA) in adults and report one such case managed at our institute. In addition, salient differences between adult and pediatric hemorrhagic PA have been briefed. Hospital records were retrieved for our case. Literature review was conducted by searching online databases for the following keywords-pilocytic astrocytoma, hemorrhage, cranial, pediatric, and adults...
October 4, 2017: Neurosurgical Review
https://www.readbyqxmd.com/read/28967310/combined-interhemispheric-translamina-terminalis-and-pterional-approach-for-a-dorsum-sellae-meningioma
#5
Shinya Suematsu, Hideaki Ono, Tomohiro Inoue, Akira Tamura
This video demonstrates a surgical technique of resecting dorsum sellae meningioma using a combined interhemispheric translamina terminalis approach and pterional approach with clinoidectomy. The tumor, 5 cm in maximum diameter, originated from the dorsum sellae, compressed the third ventricle and the midbrain, and displaced the pituitary stalk ventrally. Feeding arteries of the tumor were bilateral meningohypophyseal trunks, mainly from the right side. The authors performed devascularization of the tumor via a right pterional approach following frontotemporal craniotomy, and debulking of the tumor via an interhemispheric translamina terminalis approach following bifrontal craniotomy...
October 2017: Neurosurgical Focus
https://www.readbyqxmd.com/read/28967305/orbitozygomatic-craniotomy-and-trans-sylvian-approach-for-resection-of-a-tuberculum-sella-meningioma-with-extension-to-the-posterior-fossa
#6
Georgios Klironomos, Amir R Dehdashti
Tuberculum sella meningiomas can be approached through lateral approaches including pterional/orbitozygomatic craniotomies, frontobasal craniotomy, or through expanded endoscopic transsphenoidal approaches. The authors present the case of a 60-year-old male who presented with bitemporal hemianopia and significant right-side visual acuity compromise due to a large tuberculum sella meningioma. The tumor had an important extension to the posterior fossa. A right orbitozygomatic trans-sylvian approach was deemed most suitable to tackle the posterior extension of the tumor...
October 2017: Neurosurgical Focus
https://www.readbyqxmd.com/read/28961901/parasellar-schwannomas-extradural-vs-extra-intradural-surgical-approach
#7
Giuseppe Mariniello, Oreste de Divitiis, Ferdinando Caranci, Flavia Dones, Francesco Maiuri
BACKGROUND: Schwannomas of the parasellar region may arise from the trigeminal, oculomotor, trochlear, and abducens nerves. OBJECTIVE: To define the tumor origin, location, and dural relationship (extradural vs extra-intradural vs cisternal) on preoperative magnetic resonance imaging (MRI), in order to plan the best surgical approach (purely extradural vs extra-intradural). METHODS: Twenty-four patients with parasellar schwannomas who underwent surgery were retrospectively analyzed...
August 22, 2017: Operative Neurosurgery (Hagerstown, Md.)
https://www.readbyqxmd.com/read/28954339/-concomitant-unruptured-intracranial-aneurysms-and-ischemic-cerebrovascular-diseases-a-surgical-experience-of-31-cases
#8
Y R Zheng, C Wu, H Zhang, Z Xue, H W Wang, Z H Sun
Objective: To summarize the clinic experience of preventing cerebral ischemic events during perioperative period in patients which concomitant unruptured intracranial aneurysms and ischemic cerebrovascular diseases. Methods: The clinical materials of 31 consecutive patients with concomitant unruptured intracranial aneurysms and ischemic cerebrovascular diseases from April 2010 to April 2014 were retrospectively reviewed.A total of 35 aneurysms were detected, and all of them were unruptured aneurysms.Among them, 17 cases were located on the ipsilateral side of artery stenosis or occlusion, and 18 cases were detected in the contralateral side...
September 19, 2017: Zhonghua Yi Xue za Zhi [Chinese medical journal]
https://www.readbyqxmd.com/read/28937325/revascularization-of-the-upper-posterior-circulation-with-the-anterior-temporal-artery-an-anatomical-feasibility-study
#9
Ali Tayebi Meybodi, Michael T Lawton, Dylan Griswold, Pooneh Mokhtari, Andre Payman, Halima Tabani, Sonia Yousef, Arnau Benet
OBJECTIVE In various disease processes, including unclippable aneurysms, a bypass to the upper posterior circulation (UPC) including the superior cerebellar artery (SCA) and posterior cerebral artery (PCA) may be needed. Various revascularization options exist, but the role of intracranial (IC) donors has not been scrutinized. The objective of this study was to evaluate the anatomical feasibility of utilizing the anterior temporal artery (ATA) for revascularization of the UPC. METHODS ATA-SCA and ATA-PCA bypasses were performed on 14 cadaver specimens...
September 22, 2017: Journal of Neurosurgery
https://www.readbyqxmd.com/read/28935549/mini-pterional-and-supraorbital-keyhole-craniotomies-for-ruptured-anterior-circulation-aneurysms-experience-at-a-single-center
#10
Hoanh Tra, Trong Huynh, Ba Nguyen
A keyhole craniotomy is a type of pterional craniotomy that involves a minimally invasive approach for the treatment of cerebral aneurysms. Currently, the mini-pterional keyhole craniotomy (MPKC) and supraorbital keyhole craniotomy (SOKC) procedures are frequently performed. We evaluated the feasibility and safety of SOKCs and MPKCs for the clipping of ruptured intracranial aneurysms in the anterior cerebral circulation as an alternative to the pterional approach in a consecutive series of 25 patients. The rate of intraoperative aneurysmal rupture was 8% (2/25), and all ruptures were safely controlled...
September 18, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/28927909/monolateral-pterional-keyhole-approaches-to-bilateral-cerebral-aneurysms-anatomy-and-clinical-application
#11
Liang-Hong Yu, Huang-Cheng Shang-Guan, Guo-Rong Chen, Shu-Fa Zheng, Yuan-Xiang Lin, Zhang-Ya Lin, Pei-Sen Yao, De-Zhi Kang
OBJECTIVE: To study the anatomy and clinical application of monolateral pterional keyhole approach for treating bilateral cerebral aneurysms. MATHERIAL AND METHODS: 12 alcohol-preserved cadaveric heads underwent right pterional keyhole approaches for management of simulative contralateral aneurysms. Length of the contralateral middle cerebral artery (MCA), distal internal carotid artery (DICA), anterior cerebral artery (ACA), and ophthalmic segment of internal carotid artery (OICA) was recorded...
September 16, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/28927217/surgical-technique-for-high-flow-internal-maxillary-artery-to-middle-cerebral-artery-bypass-using-a-superficial-temporal-artery-interposition-graft
#12
Xuequan Feng, Ali Tayebi Meybodi, Jordina Rincon-Torroella, Ivan H El-Sayed, Michael T Lawton, Arnau Benet
BACKGROUND: Extracranial-to-intracranial high-flow bypass often requires cranial, cervical, and graft site incisions. The internal maxillary artery (IMA) has been proposed as a donor to decrease invasiveness, but its length is insufficient for direct intracranial bypass. We report interposition of a superficial temporal artery (STA) graft for high-flow IMA to middle cerebral artery (MCA) bypass using a middle fossa approach. OBJECTIVE: To assess the feasibility of an IMA-STA graft-MCA bypass using a new middle fossa approach...
April 1, 2017: Operative Neurosurgery (Hagerstown, Md.)
https://www.readbyqxmd.com/read/28922882/microsurgical-anatomy-of-the-interfascial-vein-its-significance-in-the-interfascial-dissection-of-the-pterional-approach
#13
Alvaro Campero, Pablo Ajler, Martín Paíz, Ramiro López Elizalde
BACKGROUND: The pterional approach (PA), together with its variants, is still one of the most common methods used by surgeons to reach the anterior and middle cranial base. A highly important technical detail during a PA is the preservation of the frontotemporal branch of the facial nerve, which can be achieved through an interfascial dissection. OBJECTIVE: To describe the anatomy of the interfascial vein (IFV), highlighting its recognition as a significant anatomic reference to perform an interfascial dissection (IFD)...
October 1, 2017: Operative Neurosurgery (Hagerstown, Md.)
https://www.readbyqxmd.com/read/28904827/horizontal-distance-of-anterior-communicating-artery-aneurysm-neck-from-anterior-clinoid-process-is-critically-important-to-predict-postoperative-complication-in-clipping-via-pterional-approach
#14
Takashi Fujii, Naoki Otani, Satoru Takeuchi, Terushige Toyooka, Kojiro Wada, Kentaro Mori
BACKGROUND: The difficulty of clipping aneurysm of the anterior communicating artery (AcomA) depends on the size, direction, positional relationship with the parent artery, and height from the anterior frontal base. Cases of clipping unruptured AcomA aneurysm through pterional approach were analyzed to investigate the importance of the horizontal distance from the base of the anterior clinoid process. METHODS: Twenty-six consecutive unruptured AcomA aneurysms were treated by clipping through pterional approach in 10 males and 11 females aged 37-77 years (mean 61...
2017: Surgical Neurology International
https://www.readbyqxmd.com/read/28780846/-clinical-analysis-of-lateral-supraorbital-microsurgical-approach-for-ruptured-anterior-circulation-aneurysm
#15
Q H Meng, J J Xu, S C Wei, R Yu, J Jiang, J Wang, C C Qu
Objective: To explore the safety and efficiency of lateral supraorbital (LSO) approach for the ruptured anterior circulation aneurysm. Methods: The clinical data of 23 patients with grade Ⅰ-Ⅲ ruptured anterior circulation aneurysm via LSO at the Second Hospital of Shandong University from February 2016 to December 2016 were retrospectively analyzed. The clinical data included their clinical manifestations, radiological finding, microsurgical techniques and follow-up results. Results: All patients were diagnosed as anterior circulation aneurysm by preoperative CT angiography (CTA) or Digital Subtraction Angiography (DSA)...
August 1, 2017: Zhonghua Yi Xue za Zhi [Chinese medical journal]
https://www.readbyqxmd.com/read/28761525/the-minipterional-approach-for-ruptured-and-unruptured-anterior-circulation-aneurysms-our-initial-experience
#16
Kenan A Alkhalili, Jack R Hannallah, Gasser H Alshyal, Mohab M Nageeb, Khaled M Abdel Aziz
OBJECTIVE: To report our experience with the minipterional (MPT) craniotomy approach for anterior circulation aneurysms and to discuss the clinical outcomes as well as to evaluate the advantages of this unique approach. MATERIALS AND METHODS: Single-center retrospective review of 57 cases involving anterior circulation aneurysms both ruptured and unruptured aneurysms treated with the MPT. We analyzed the clinical and patient demographic data, aneurysm characteristics, surgical outcomes, and complications in these individuals...
July 2017: Asian Journal of Neurosurgery
https://www.readbyqxmd.com/read/28705701/piezosurgery-in-modified-pterional-orbital-decompression-surgery-in-graves-disease
#17
Juergen Grauvogel, Christian Scheiwe, Waseem Masalha, Nadja Jarc, Tanja Grauvogel, Andreas Beringer
OBJECTIVE: Piezosurgery uses microvibrations to selectively cut bone, preserving the adjacent soft tissue. The present study evaluated the use of piezosurgery for bone removal in orbital decompression surgery in Graves disease via a modified pterional approach. METHODS: A piezosurgical device (Piezosurgery medical) was used in 14 patients (20 orbits) with Graves disease who underwent orbital decompression surgery in additional to drills and rongeurs for bone removal of the lateral orbital wall and orbital roof...
October 2017: World Neurosurgery
https://www.readbyqxmd.com/read/28646464/early-retreatment-after-surgical-clipping-of-ruptured-intracranial-aneurysms
#18
Yoshiro Ito, Tetsuya Yamamoto, Go Ikeda, Wataro Tsuruta, Kazuya Uemura, Yoji Komatsu, Akira Matsumura
BACKGROUND: Although a rerupture after surgical clipping of ruptured intracranial aneurysms is rare, it is associated with high morbidity and mortality. The causes for retreatment and rupture after surgical clipping are not clearly defined. METHODS: From a prospectively maintained database of 244 patients who had undergone surgical clipping of ruptured intracranial aneurysms, we selected patients who experienced retreatment or rerupture within 30 days after surgical clipping...
June 23, 2017: Acta Neurochirurgica
https://www.readbyqxmd.com/read/28602922/sphenopterional-point-strategic-point-for-burr-role-placement-in-frontotemporal-craniotomies
#19
Baltazar Leão Reis, Roberto Leal Da Silveira, Sebastião Nataniel Silva Gusmão
BACKGROUND: Frontotemporal craniotomies are the most commonly performed neurosurgical approaches. We studied the external bony landmarks on the lateral surface of the skull to identify a "strategic" point where both the anterior and middle cranial fossae are exposed simultaneously during frontotemporal craniotomies through a single burr hole placed over the greater wing of the sphenoid bone (sphenopterional point). OBJECTIVE: This study aimed to anatomically define the sphenopterional point via craniometric measurements taken on the lateral surface of the human skull...
September 2017: World Neurosurgery
https://www.readbyqxmd.com/read/28576712/preserving-the-facial-nerve-during-orbitozygomatic-craniotomy-surgical-anatomy-assessment-and-stepwise-illustration
#20
Ali Tayebi Meybodi, Michael T Lawton, Sonia Yousef, J J González Sánchez, Arnau Benet
OBJECTIVE: Surgical safety and efficiency during an orbitozygomatic (OZ) osteotomy rely on thorough knowledge of the surgical anatomy of the facial nerve. Although the anatomy of the facial nerve and its relation to the pterional craniotomy are described, a thorough assessment of facial nerve preservation techniques during the OZ approach and its variations is lacking. We assessed the surgical anatomy of the facial nerve related to the OZ approach and provided a thorough stepwise description on how to preserve it...
September 2017: World Neurosurgery
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