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Skull base approaches in neurosurgery.

Scholz M, Parvin R, Thissen J, Löhnert C, Harders A, Blaeser K - Head Neck Oncol (2010)

Bottom Line: It is very important for the neurosurgeon to choose the right approach in order to reach the lesion without harming the other intact structures.In the following text these approaches will be described.These approaches are:1) pterional approach2) frontolateral approach3) transsphenoidal approach4) suboccipital lateral approachThese approaches can be extended and combined with each other.In the following we want to enhance this philosophy.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Neurosurgery, Klinikum Duisburg, Academic Teaching Hospital of University Essen-Duisburg, Germany.

ABSTRACT
The skull base surgery is one of the most demanding surgeries. There are different structures that can be injured easily, by operating in the skull base. It is very important for the neurosurgeon to choose the right approach in order to reach the lesion without harming the other intact structures. Due to the pioneering work of Cushing, Hirsch, Yasargil, Krause, Dandy and other dedicated neurosurgeons, it is possible to address the tumor and other lesions in the anterior, the mid-line and the posterior cranial base. With the transsphenoidal, the frontolateral, the pterional and the lateral suboccipital approach nearly every region of the skull base is exposable.In the current state many different skull base approaches are described for various neurosurgical diseases during the last 20 years. The selection of an approach may differ from country to country, e.g., in the United States orbitozygomaticotomy for special lesions of the anterior skull base or petrosectomy for clivus meningiomas, are found more frequently than in Europe.The reason for writing the review was the question: Are there keyhole approaches with which someone can deal with a vast variety of lesions in the neurosurgical field?In my opinion the different surgical approaches mentioned above cover almost 95% of all skull base tumors and lesions. In the following text these approaches will be described.These approaches are:1) pterional approach2) frontolateral approach3) transsphenoidal approach4) suboccipital lateral approachThese approaches can be extended and combined with each other. In the following we want to enhance this philosophy.

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Computer animation of a left frontolateral approach from the frontal view. If the frontal sinus will be opened it has to be closed carefully with a galea flap.
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Figure 14: Computer animation of a left frontolateral approach from the frontal view. If the frontal sinus will be opened it has to be closed carefully with a galea flap.

Mentions: This approach allows different skin incisions, which depend on the patient's anatomy and physiognomy. The osteoplastic trepanation above the pterion and above the temporal muscle follows a curved skin incision or an eyebrow skin incision [13] (Figure 13, Figure 14). The trepanation of an approximately 3 × 4-cm frontolateral craniotomy allows the entry to the anterior fossa. It is essential to include radiological data of the patient in order to prepare a performance of a sophisticated approach such as the frontolateral approach. A common iatrogenic injury is the injury of superficial structures. The superciliary skin incision allows the surgeon to protect superficial structures like the frontal branches of the facial nerve and the superficial temporal artery. Perneczky led to the development of endoscopical approaches using the supraorbital "key-hole" approach [14]. Via endoscopic techniques it is possible to provide relatively great exposure, while offering less brain retraction.


Skull base approaches in neurosurgery.

Scholz M, Parvin R, Thissen J, Löhnert C, Harders A, Blaeser K - Head Neck Oncol (2010)

Computer animation of a left frontolateral approach from the frontal view. If the frontal sinus will be opened it has to be closed carefully with a galea flap.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2913918&req=5

Figure 14: Computer animation of a left frontolateral approach from the frontal view. If the frontal sinus will be opened it has to be closed carefully with a galea flap.
Mentions: This approach allows different skin incisions, which depend on the patient's anatomy and physiognomy. The osteoplastic trepanation above the pterion and above the temporal muscle follows a curved skin incision or an eyebrow skin incision [13] (Figure 13, Figure 14). The trepanation of an approximately 3 × 4-cm frontolateral craniotomy allows the entry to the anterior fossa. It is essential to include radiological data of the patient in order to prepare a performance of a sophisticated approach such as the frontolateral approach. A common iatrogenic injury is the injury of superficial structures. The superciliary skin incision allows the surgeon to protect superficial structures like the frontal branches of the facial nerve and the superficial temporal artery. Perneczky led to the development of endoscopical approaches using the supraorbital "key-hole" approach [14]. Via endoscopic techniques it is possible to provide relatively great exposure, while offering less brain retraction.

Bottom Line: It is very important for the neurosurgeon to choose the right approach in order to reach the lesion without harming the other intact structures.In the following text these approaches will be described.These approaches are:1) pterional approach2) frontolateral approach3) transsphenoidal approach4) suboccipital lateral approachThese approaches can be extended and combined with each other.In the following we want to enhance this philosophy.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Neurosurgery, Klinikum Duisburg, Academic Teaching Hospital of University Essen-Duisburg, Germany.

ABSTRACT
The skull base surgery is one of the most demanding surgeries. There are different structures that can be injured easily, by operating in the skull base. It is very important for the neurosurgeon to choose the right approach in order to reach the lesion without harming the other intact structures. Due to the pioneering work of Cushing, Hirsch, Yasargil, Krause, Dandy and other dedicated neurosurgeons, it is possible to address the tumor and other lesions in the anterior, the mid-line and the posterior cranial base. With the transsphenoidal, the frontolateral, the pterional and the lateral suboccipital approach nearly every region of the skull base is exposable.In the current state many different skull base approaches are described for various neurosurgical diseases during the last 20 years. The selection of an approach may differ from country to country, e.g., in the United States orbitozygomaticotomy for special lesions of the anterior skull base or petrosectomy for clivus meningiomas, are found more frequently than in Europe.The reason for writing the review was the question: Are there keyhole approaches with which someone can deal with a vast variety of lesions in the neurosurgical field?In my opinion the different surgical approaches mentioned above cover almost 95% of all skull base tumors and lesions. In the following text these approaches will be described.These approaches are:1) pterional approach2) frontolateral approach3) transsphenoidal approach4) suboccipital lateral approachThese approaches can be extended and combined with each other. In the following we want to enhance this philosophy.

Show MeSH
Related in: MedlinePlus