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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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Related in: MedlinePlus

The dura is exposed and opened.
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Figure 21: The dura is exposed and opened.

Mentions: The classic technique begins with the patient in supine position. An x-ray machine is positioned laterally to control each step of intervention. In microsurgery the surgeon stands at the tip of the head whereas in pure endoscopic pituitary surgery the neurosurgeon stands at the shoulder of the patient. We would like to concentrate on the microsurgical approach in our review article. After incising the septal mucosa (Figure 18) and revealing the anterior wall of the sphenoid sinus, the anterior wall of the sphenoid sinus will be removed with punch forceps (Figure 19, 20). We then excise the sinus mucosa. After opening the dura (Figure 21), the tumor must be indentified in order to extirpate it with a curette (Figure 22) by using lateral extensions. The transsphenoidal route is portrayed as the fundamental treatment of pituitary adenomas and other tumors in the sellar region [19,20].


Skull base approaches in neurosurgery.

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

The dura is exposed and opened.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 21: The dura is exposed and opened.
Mentions: The classic technique begins with the patient in supine position. An x-ray machine is positioned laterally to control each step of intervention. In microsurgery the surgeon stands at the tip of the head whereas in pure endoscopic pituitary surgery the neurosurgeon stands at the shoulder of the patient. We would like to concentrate on the microsurgical approach in our review article. After incising the septal mucosa (Figure 18) and revealing the anterior wall of the sphenoid sinus, the anterior wall of the sphenoid sinus will be removed with punch forceps (Figure 19, 20). We then excise the sinus mucosa. After opening the dura (Figure 21), the tumor must be indentified in order to extirpate it with a curette (Figure 22) by using lateral extensions. The transsphenoidal route is portrayed as the fundamental treatment of pituitary adenomas and other tumors in the sellar region [19,20].

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