Anatomic study, petroclival region, pterional approach, subtemporal approach, skull base oz. The subtemporal approach is one of the surgical routes used to reach the interpeduncular fossa. Keyhole supracerebellar transtentorial transcollateral sulcus approach to the lateral ventricle background and importance. The digital imaging and communications in medicine dicom files of 1. Basilar tip aneurysms are one of the most complex vascular lesions to. Resective epilepsy surgery, in appropriately selected patients, is the accepted treatment of choice for dre as supported by two randomized clinical trials. Short specialisation degrees 20192020 university of. Peschillo s, caporlingua a, cannizzaro d, resta m, burdi n, valvassori l, pero g, lanzino g.
This approach exposes the entire temporal lobe in order to offer the transylvian and late ral subfrontal views, from the pterional craniotomy, along with the subtemporal and temporopolar views to access the. The fully endoscopic subtemporal approach by hrayr k. Probabilistic tractography to predict the position of cranial. The subtemporal approach was used in 48 procedures, mainly for aneurysms of the basilar tip region when located below the level of the posterior clinoid process. For these patients, surgery offers the possibility of not just seizure freedom but significantly improved neurocognitive and behavioral outcomes.
The supraorbital modification combines a pterional craniotomy with a supralateral orbitotomy to access lesions in the anterior and middle cranial fossae. The subtemporal approach is indicated for basilar tip aneurysms located at the level of the floor of the sella turcica to 1 cm above the dorsum sellae. Nuances and advantages of the subtemporal approach. Our experience with fortyeight patients sumit sinha, amandeep kumar, bhawani s sharma department of neurosurgery, all india institute of medical sciences, new delhi, india. Schwannomas originating from the trochlear nerve are extremely rare. In this paper, we present our personal experience with the use of subtemporal approach. In the aneurysms that point anteriorly toward the basilar tip, one of the major disadvantages of the subtemporal approach seen is the lack of visibility of the contralateral p1. Subtemporal approach to basilar bifurcation aneurysms. The pterional approach can also be used with any of the combined supratentorial and infratentorial approaches to cre ate an exposure that extends from the region of the cavernous sinus to the lower brain stem.
Historically, the first form of subtemporal approach had been described for the treatment of trigeminal neuralgia early. The subtemporal approach is indicated for basilar tip aneurysms located at. It is one of the surgical routes used to reach the interpeduncular fossa, offers a good access to the medial temporal region the subtemporal approach avoids neocortical transgression and injury to the optic radiations. The infratranstentorial subtemporal approach itsta. The endoscopic endonasal transpterygoid approach is considered the best to access the midline structures such as the nasopharynx, eustachian tube, sella, and clivus. The surgical approach was selected based the location of the tumors, including subtemporal approach via the petrous bone, subtemporal preauricular approach to the middle cranial fossa, frontoorbitozygomatic approach and so on table 1. Subtemporal approach for distal basilar occlusion for giant aneurysm. It is in many ways similar to the subtemporal transtentorial approach, with the added advantage of drilling the anterior petrous ridge. Strengths and limitations of tractography methods to identify the optic radiation for epilepsy surgery. Subtemporal approach for distal basilar occlusion for. Anterior transpetrosal and subtemporal transtentorial. This book takes the reader stepbystep through routine temporal bone surgeries while maximizing the use of the cadaver tissue. Subtemporal transtentorial approach in mesencephalic and. Further details about the principles of montage design and the different preferences by members of this committee have been published am j eeg technol, 17.
The subtemporal approach is historically known as the standard approach for the treatment of tumoral, vascular and inflammatory lesions of the middle cranial. This is subtemporal approach by surgical neurology international on vimeo. The subtemporal approach is historically known as the standard approach for the treatment of tumoral, vascular and inflammatory lesions of the middle cranial fossa, the tentorium, the anterior and middle tentorial incisura, the upperthird of the clivus and the petroclival region. Technical nuances of subtemporal approach for the treatment of basilar tip aneurysm. Domain adaptation for largescale sentiment classification.
Patient positioning and incision configuration are illustrated. Zygomatic anterior subtemporal approach for lesions in the. Transtemporal approaches to posterior cranial fossa. Endoscopic approaches are more appropriate than conventional approaches if the goal is palliation. Skull base approaches to the basilar artery vanderbilt university. The competing approach for such problems was and still is the transsylvian approach to the interpeduncular region. Bifrontal basal interhemispheric approach for midline suprasellar tumors. A case of aneurysm of the posterior temporal artery. Original article endovascular management of ruptured. Subtemporal decompression definition of subtemporal. Orbitozygomatic approach is the other approach suggested by gerber to treat p 2 aneurysms, which minimizes retraction of the temporal lobe through cutting the zygomatic arch.
Conclusion the pterional approach is one of the most important and versatile approaches for exposure of a variety of intracranial fig 10. Technical nuances of subtemporal approach for the treatment of. Surgical access to spaceoccupying lesions such as tumors and vascular malformations located in the area of the tentorial notch, mediobasal temporal lobe, and paramidbrain is difficult. Original article clinical characteristics and causes of. Six patients were operated upon using the anterior transpetrosal approach. Lateral ventricle are the largest cavities out of set of four. This technique can help to distinguish tumors from the surrounding white matter when viewed under a specialized operating microscope filter, facilitating maximal tumor resection. The master has the aim to provide the theorical knowledge and the cultural elements of the skull base microsurgery and the clinical practise to manage the lesions of this area. Bifrontal basal interhemispheric approach for midline. We use two major modifications of the traditional orbitozygomatic craniotomy, including supraorbital and subtemporal variations.
Probabilistic tractography to predict the position of. Subtemporal decompression, although seldom used today for the management of hydrocephalus, pseudotumour cerebri, or premature closure of cranial sutures, is still used in many centres to alleviate intracranial hypertension caused by tumour, trauma, or severe intracranial haemorrhage. Keyhole supracerebellar transtentorial transcollateral. However, a significant disadvantage lies in the integrity of the lateral sinus via this approach. Lesions in this area are typically resected with supratentorial approaches demanding significant elevation of the temporal lobe or even partial lobectomy, or via a supracerebellar transtentorial approach. American clinical neurophysiology society guideline 3. In such cases a lateral exposure via a subtemporal approach is indicated. Strengths and limitations of tractography methods to. Short specialisation degrees 20192020 university of padova. Many operative approaches have been utilized for lesion resection, but the advantages of the anterior transpetrosal approach are numerous and include excellent exposure, minimal extradural retraction of the temporal lobe, and minimal cerebrospinal fluid leaks.
Subtemporal transtentorial petrosalapex approach for giant. Meningiomas of the lateral ventricles are commonly located in the atria. May 24, 2018 subtemporalretrosigmoid petrosal approach. In this paper, we propose a deep learning approach for the problem of domain adaptation of sentiment classi ers. We discuss issues related to positioning and lumbar drainage. Several attentions regarding head position, control of intracranial. The subtemporal approach is indicated for basilar tip aneurysms. Occasionally, aneurysms are located higher than the petrous edge and lower than the floor of the sella. Surgical access to such tumors is challenging because of their deep location and proximity to critical neurovascular structures, particularly if. Presigmoid approach to vertebrobasilar artery aneurysms. Both intraparenchymal papillary meningioma and papillary meningioma with cyst formation of brainstem have never been reported. An infratemporal fossa approach is a complex procedure that involves significant time, effort, and cost. Technical nuances of subtemporal approach for the treatment.
Approximately 2030% of children with recurrent seizures have drugresistant epilepsy dre. The subtemporal approach is a wellknown neurosurgical approach that is rarely described in children. One of them is the endoscopic endonasal transpterygoid approach to the infratemporal fossa. This approach uses a combination of the extended middle fossa approach with the addition of intradural resection of the tentorium to allow wider posterior fossa exposure. Multiple surgical approaches have been described to access the infratemporal fossa.
We described the subtemporal approach, which was used for distal basilar artery occlusion in a patient with a symptomatic giant unclippable aneurysm. In the aneurysms that point anteriorly toward the basilar tip, one of the major disadvantages of the subtemporal approach seen is. Intraparenchymal papillary meningioma of brainstem. The technique is described in detail including its nuances and potential pitfalls. It was used in 27 cases in the acute stage of sah and 21 times under scheduled conditions. Microanatomy research on subtemporal transtentorial petrosalapex approach was reported by the senior authors team in 2008. Manual of otologic surgery christoph arnoldner springer. Sep 09, 2019 details for a temporal craniotomy are discussed with pearls such as localizaiton of the vein of labbe. Temporalsubtemporal craniotomy the neurosurgical atlas, by. Keyhole subtemporal approaches and zygomatic arch osteotomy have been proposed in an effort to decrease the amount of temporal lobe retraction. This is subtemporal approach by surgical neurology international on vimeo, the home for high quality videos and the people who love them. Lateral ventricle are the largest cavities out of set of. Deep learning is based on algorithms for discovering intermediate representations built in a. The authors present an extremely rare case of patient with intraparenchymal papillary meningioma of brainstem.
When the aneurysm points upwards and posteriorly, the subtemporal approach has all the prerequisites in comparison to the transsilvien approach. Jun 08, 2018 an infratemporal fossa approach is a complex procedure that involves significant time, effort, and cost. Lateral ventricle are the largest cavities out of set of four interconnected cavities in the brain, where the cerebrospinal fluid csf is produced. The authors decided to use a right middle subtemporal approach, for the aneurysm existing at the posterior temporal artery branched from the pca in the ambient cistern. For aneurysms arisen at the origin of the sca, the subtemporal approach provides excellent visualization of the neck and fundus of the aneurysms. Combining a subtemporal with a retrosigmoid approach provides better access to the petroclival junction than either approach alone. In addition, a frontotemporal craniotomy is reported to provide a wide exposure of the anterior temporal base, thus allowing oblique access to the interpeduncular cistern with minimal brain retraction. Subtemporal decompression medical definition merriam. Diffusion tensor imaging dti tractography tg can visualize meyers loop ml, providing important information for the epilepsy surgery team, both for preoperative counseling and to reduce the frequency of visual field defects after. The subtemporal approach is historically known as the standard approach for the treatment of tumoral, vascular and inflammatory. In an effort to improve visual realism, the book provides highresolution photographs and anatomically accurate illustrations to allow the reader to better appreciate the.
We aim to describe the technical details of the transzygomatic approach to intracranial surgery. Pdf technical nuances of subtemporal approach for the. Keyhole supracerebellar transtentorial transcollateral sulcus. Because an increasing proportion of cerebral aneurysms, particularly those of the basilar artery, are treated by endovascular. Quantitative anatomic comparison of the extended pterional.
Surgical technique described for the treatment of these aneurysms include parent artery occlusion, trapping or body clipping, and wrapping 5. A 23yearold chinese male presented with a 4month history of progressive left upper limb and facial nerve palsy. The most frequent route was the translabyrinthine approach n 31 followed by the retrosigmoid approach n 10. The presigmoid approach also referred to as the posterior. Petrous apex approach while the subtemporal approach represents the surgical module milestone designed to reach the petrous apex, a novel ventral route, which is the superior eyelid transorbital endoscopic approach, has been proposed to access the skull base. The length of the surgery ranged from 4 to 16 hours, with an average of 9. Temporalsubtemporal craniotomy the neurosurgical atlas.
Barkas pterional approach and sylvian fissure dissection j. The authors describe the use of the subtemporal transtentorial and anterior petrosectomy approaches to pontine cavernomas in nine patients treated at their institution over a 20year period. The transzygomatic approach vanderbilt university medical. On each side of the cadaver head we performed the keyhole and the subtemporal approaches, giving us 4 pairs. Original article endovascular management of ruptured basilar. Objective to assess the feasibility, advantages, and disadvantages of subtemporal approach in.
Subtemporal approach offers good surgical corridor for the management of these. Details for a temporal craniotomy are discussed with pearls such as localizaiton of the vein of labbe. Microsurgical subtemporal approach to aneurysms on the p 2. Each lateral ventricle is a cshaped cavity that wraps around the thalamus and is situated deep within the cerebrum. The middle fossa approach for the removal of a trochlear. Even for fusiform aneurysm in superior atery, surgical is a alterative option. The main structures that help decide the approach to midbasilar middle fifth of the ba aneurysms are the free edge of the petrous. They are usually projecting laterally toward the approach side, and no perforators emanate from the ba segment between the pca and sca, making clipping simple and straightforward. This study describes clinicians experience and the surgical results of 24 patients who underwent a zygomatic anterior subtemporal approach.
The main struc tures that help decide the approach to midbasilar middle fifth of the ba aneurysms are the free edge. The promising new area of deep learning has emerged recently. Therefore, the area of interest in a subtemporal approach is actually above the plane of the lateral skull base and middle fossa floor. The subtemporal approach is historically known as the standard approach for the treatment of tumoral, vascular and inflammatory lesions of the middle cranial fossa, the tentorium, the anterior and. Pdf technical nuances of subtemporal approach for the treatment. Charles drake for the microneurosurgical clipping of aneurysms of the distal basilar artery. Endoscopic approach to the infratemporal fossa sciencedirect. Jan 12, 2012 both intraparenchymal papillary meningioma and papillary meningioma with cyst formation of brainstem have never been reported. Pediatric epilepsy is a debilitating condition that impacts millions of patients throughout the world. Five human cadaveric heads were dissected at the laboratory of surgical neuroanatomy of the university of. The surgical approach was selected based the location of the tumors, including subtemporal approach via the petrous bone, subtemporalpreauricular approach to the middle cranial fossa, frontoorbitozygomatic approach and so on table 1.