scholarly journals The mini-pterional approach and the atrophy of the temporal muscle

2021 ◽  
Author(s):  
Leonardo C. Welling ◽  
Nicollas Nunes Rabelo ◽  
Eberval G. Figueiredo
Keyword(s):  
Pterional Approach ◽  
Temporal Muscle

scholarly journals Quantitative anatomical analysis and clinical experience with mini-pterional and mini-orbitozygomatic approaches for intracranial aneurysm surgery

2017 ◽  
Vol 127 (3) ◽  
pp. 646-659 ◽  
Author(s):  
Kaan Yagmurlu ◽  
Sam Safavi-Abbasi ◽  
Evgenii Belykh ◽  
M. Yashar S. Kalani ◽  
Peter Nakaji ◽  
...  
Keyword(s):  
Quantitative Analysis ◽  
Clinical Experience ◽  
Cerebral Artery ◽  
Angle Of Attack ◽  
Circle Of Willis ◽  
Superior Cerebellar Artery ◽  
Pterional Approach ◽  
Temporal Muscle ◽  
Distal Point ◽  
Significant Difference

OBJECTIVEThe aim of this investigation was to modify the mini-pterional and mini-orbitozygomatic (mini-OZ) approaches in order to reduce the amount of tissue traumatization caused and to compare the use of the 2 approaches in the removal of circle of Willis aneurysms based on the authors' clinical experience and quantitative analysis.METHODSThree formalin-fixed adult cadaveric heads injected with colored silicone were examined. Surgical freedom and angle of attack of the mini-pterional and mini-OZ approaches were measured at 9 anatomical points, and the measurements were compared. The authors also retrospectively reviewed the cases of 396 patients with ruptured and unruptured single aneurysms in the circle of Willis treated by microsurgical techniques at their institution between January 2006 and November 2014.RESULTSA significant difference in surgical freedom was found in favor of the mini-pterional approach for access to the ipsilateral internal carotid artery (ICA) and middle cerebral artery (MCA) bifurcations, the most distal point of the ipsilateral posterior cerebral artery (PCA), and the basilar artery (BA) tip. No statistically significant differences were found between the mini-pterional and mini-OZ approaches for access to the posterior clinoid process, the most distal point of the superior cerebellar artery (SCA), the anterior communicating artery (ACoA), the contralateral ICA bifurcation, and the most distal point of the contralateral MCA. A trend toward increasing surgical freedom was found for the mini-OZ approach to the ACoA and the contralateral ICA bifurcation. The lengths exposed through the mini-OZ approach were longer than those exposed by the mini-pterional approach for the ipsilateral PCA segment (11.5 ± 1.9 mm) between the BA and the most distal point of the P2 segment of the PCA, for the ipsilateral SCA (10.5 ± 1.1 mm) between the BA and the most distal point of the SCA, and for the contralateral anterior cerebral artery (ACA) (21 ± 6.1 mm) between the ICA bifurcation and the most distal point of the A2 segment of the ACA. The exposed length of the contralateral MCA (24.2 ± 8.6 mm) between the contralateral ICA bifurcation and the most distal point of the MCA segment was longer through the mini-pterional approach. The vertical angle of attack (anteroposterior direction) was significantly greater with the mini-pterional approach than with the mini-OZ approach, except in the ACoA and contralateral ICA bifurcation. The horizontal angle of attack (mediolateral direction) was similar with both approaches, except in the ACoA, contralateral ICA bifurcation, and contralateral MCA bifurcation, where the angle was significantly increased in the mini-OZ approach.CONCLUSIONSThe mini-pterional and mini-OZ approaches, as currently performed in select patients, provide less tissue traumatization (i.e., less temporal muscle manipulation, less brain parenchyma retraction) from the skin to the aneurysm than standard approaches. Anatomical quantitative analysis showed that the mini-OZ approach provides better exposure to the contralateral side for controlling the contralateral parent arteries and multiple aneurysms. The mini-pterional approach has greater surgical freedom (maneuverability) for ipsilateral circle of Willis aneurysms.

Evaluation of temporal muscle trophism in relation to the manipulation time and infiltration of 0.5% isobaric bupivacaine through a pterional approach

2019 ◽  
Vol 30 (5) ◽  
pp. 222-227
Author(s):  
Heberseleth Valdivia-Chiñas ◽  
María Elena Córdoba-Mosqueda ◽  
Erika Fabiola Cruz-Cruz ◽  
Diego Ochoa-Cacique ◽  
Óscar Medina-Carrillo ◽  
...  
Keyword(s):  
Pterional Approach ◽  
Temporal Muscle

Removal of Intracranial K-Wire through Combined Endoscopic and Pterional Approach

2020 ◽  
Author(s):  
Reginald Fong ◽  
Christoph Griessenauer ◽  
Andrew Conger
Keyword(s):  
Pterional Approach

A Less Invasive Pterional Approach to an Unruptured Cerebral Aneurysm

2006 ◽  
Vol 34 (6) ◽  
pp. 389-394 ◽  
Author(s):  
Kazuhiro YOKOYAMA ◽  
Hiroshi NOGUCHI ◽  
Yoshitomo UCHIYAMA ◽  
Hiroshi YOKOTA ◽  
Toshisuke SAKAKI
Keyword(s):  
Cerebral Aneurysm ◽  
Pterional Approach ◽  
Less Invasive ◽  
Unruptured Cerebral Aneurysm

Resection of Pontine Cavernoma Through the Anterior Transpetrosal Approach

2021 ◽  
Author(s):  
Paulo A S Kadri ◽  
Walid I B N Essayed ◽  
Ossama Al-Mefty
Keyword(s):  
Brain Stem ◽  
Neurological Deficits ◽  
Venous Angioma ◽  
Temporal Muscle ◽  
Anterior Transpetrosal Approach ◽  
Anatomical Basis ◽  
Direct Exposure ◽  
Brainstem Cavernoma ◽  
Radiation Induced ◽  
Available Technology

Abstract The pons is the most frequent local for brain stem cavernoma.1 Repeated hemorrhage of brainstem cavernoma is associated with significant and accumulative neurological deficits and thus requires treatment. According to the Swedish Karolinska’s group of radiosurgery, ”it could not be concluded whether GKRS affects the natural course of a CM. The incidence of radiation-induced complications was approximately seven times higher than that expected.”2 Thus, microsurgical removal has become the mainstay of treatment. In our experience, the following details assist in obtaining favorable outcomes and avoiding postoperative complications3,4: (a) the entry into the cavernoma based on thorough knowledge of the microanatomy; (b) the detailed study of the images and the presentation of the cavernoma on or near the brain stem surface; (c) the resection of the live cavernous hemangioma and not the mere removal of the multiple aged organized hematomas; (d) the preservation of the associated venous angioma; (e) the direct and shortest access to the lesion provided by a skull base approach; and (f) the use of the available technology, such as intraoperative neuromonitoring and neuroimaging. We present the case of a 54-yr-old male with recent deterioration in year 2001, past repetitive episodes of gait imbalance, and speech difficulty over a 7-yr period from known pontine cavernoma. The anterior petrosal approach provided superb and direct exposure to the entry at the lateral pons and the cavernoma was totally removed with preservation of the venous angioma. His preoperative neurological deficit rapidly recovered. Patient consented to the procedure and photography. Images at 3:15 from Kadri et al, The anatomical basis for surgical presercation of temporal muscle. J Neurosurg. 2004;100:517-522, used with permission from JNSPG. Image at 3:27 from Al-Mefty O, Operative Atlas of Meningiomas, © LWW, 1997, with permission.

scholarly journals High concurrent validity between digital and analogue algometers to measure pressure pain thresholds in healthy participants and people with migraine: a cross-sectional study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
René F. Castien ◽  
Michel W. Coppieters ◽  
Tom S. C. Durge ◽  
Gwendolyne G. M. Scholten-Peeters
Keyword(s):  
Concurrent Validity ◽  
Tibialis Anterior Muscle ◽  
Intraclass Correlation ◽  
Cephalic Region ◽  
Limits Of Agreement ◽  
Temporal Muscle ◽  
Pain Thresholds ◽  
Pressure Pain ◽  
Pressure Pain Thresholds ◽  
Healthy Participants

Abstract Background Pressure pain thresholds (PPTs) are commonly assessed to quantify mechanical sensitivity in various conditions, including migraine. Digital and analogue algometers are used, but the concurrent validity between these algometers is unknown. Therefore, we assessed the concurrent validity between a digital and analogue algometer to determine PPTs in healthy participants and people with migraine. Methods Twenty-six healthy participants and twenty-nine people with migraine participated in the study. PPTs were measured interictally and bilaterally at the cephalic region (temporal muscle, C1 paraspinal muscles, and trapezius muscle) and extra-cephalic region (extensor carpi radialis muscle and tibialis anterior muscle). PPTs were first determined with a digital algometer, followed by an analogue algometer. Intraclass correlation coefficients (ICC3.1) and limits of agreement were calculated to quantify concurrent validity. Results The concurrent validity between algometers in both groups was moderate to excellent (ICC3.1 ranged from 0.82 to 0.99, with 95%CI: 0.65 to 0.99). Although PPTs measured with the analogue algometer were higher at most locations in both groups (p < 0.05), the mean differences between both devices were less than 18.3 kPa. The variation in methods, such as a hand-held switch (digital algometer) versus verbal commands (analogue algometer) to indicate when the threshold was reached, may explain these differences in scores. The limits of agreement varied per location and between healthy participants and people with migraine. Conclusion The concurrent validity between the digital and analogue algometer is excellent in healthy participants and moderate in people with migraine. Both types of algometer are well-suited for research and clinical practice but are not exchangeable within a study or patient follow-up.

Complications Following Decompressive Craniectomy

2021 ◽  
Author(s):  
Jan Mraček ◽  
Jan Mork ◽  
Jiri Dostal ◽  
Radek Tupy ◽  
Jolana Mrackova ◽  
...  
Keyword(s):  
Risk Factors ◽  
Decompressive Craniectomy ◽  
Clinical Status ◽  
Fluid Collection ◽  
Epileptic Seizures ◽  
Middle Cerebral Artery Infarction ◽  
Temporal Muscle ◽  
Life Saving ◽  
Potential Risk Factors ◽  
The Impact

Abstract Background Decompressive craniectomy (DC) has become the definitive surgical procedure to manage a medically intractable rise in intracranial pressure. DC is a life-saving procedure resulting in lower mortality but also higher rates of severe disability. Although technically straightforward, DC is accompanied by many complications. It has been reported that complications are associated with worse outcome. We reviewed a series of patients who underwent DC at our department to establish the incidence and types of complications. Methods We retrospectively evaluated the incidence of complications after DC performed in 135 patients during the time period from January 2013 to December 2018. Postoperative complications were evaluated using clinical status and CT during 6 months of follow-up. In addition, the impact of potential risk factors on the incidence of complications and the impact of complications on outcome were assessed. Results DC was performed in 135 patients, 93 of these for trauma, 22 for subarachnoid hemorrhage, 13 for malignant middle cerebral artery infarction, and 7 for intracerebral hemorrhage. Primary DC was performed in 120 patients and secondary DC in 15 patients. At least 1 complication occurred in each of 100 patients (74%), of which 22 patients (22%) were treated surgically. The following complications were found: edema or hematoma of the temporal muscle (34 times), extracerebral hematoma (33 times), extra-axial fluid collection (31 times), hemorrhagic progression of contusions (19 times), hydrocephalus (12 times), intraoperative malignant brain edema (10 times), temporal muscle atrophy (7 times), significant intraoperative blood loss (6 times), epileptic seizures (5 times), and skin necrosis (4 times). Trauma (p = 0.0006), coagulopathy (p = 0.0099), and primary DC (p = 0.0252) were identified as risk factors for complications. There was no significant impact of complications on outcome. Conclusions The incidence of complications following DC is high. However, we did not confirm a significant impact of complications on outcome. We emphasize that some phenomena are so frequent that they can be considered a consequence of primary injury or natural sequelae of the DC rather than its direct complication.

Temporal muscle flap (TMF) as an alternative to the treatment in cleft palate patients: a case report

2019 ◽  
Vol 48 ◽  
pp. 22
Author(s):  
M.D. Pavelski ◽  
R.A. Conci ◽  
C. Heitz ◽  
E.A. Garbin-Junior ◽  
G.L. Griza ◽  
...  
Keyword(s):  
Case Report ◽  
Cleft Palate ◽  
Muscle Flap ◽  
Temporal Muscle
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