Anatomical Step-by-Step Dissection of Complex Skull Base Approaches for Trainees: Surgical Anatomy of the Posterior Petrosal Approach

2019 ◽  
Author(s):  
Christopher Graffeo ◽  
Maria Peris-Celda ◽  
Avital Perry ◽  
Lucas Carlstrom ◽  
Colin Driscoll ◽  
...  
Keyword(s):  
Skull Base ◽  
Surgical Anatomy

Anatomical Step-by-Step Dissection of Complex Skull Base Approaches for Trainees: Surgical Anatomy of the Endoscopic Endonasal Approach to the Orbit

2021 ◽  
Author(s):  
Laura Salgado-Lopez ◽  
Luciano C. Leonel ◽  
Michael Obrien ◽  
Adedamola Adepoju ◽  
Michael J. Link ◽  
...  
Keyword(s):  
Skull Base ◽  
Surgical Anatomy ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Endoscopic Endonasal

Level I to III craniofacial approaches based on Barrow classification for treatment of skull base meningiomas: surgical technique, microsurgical anatomy, and case illustrations

2011 ◽  
Vol 30 (5) ◽  
pp. E5 ◽  
Author(s):  
Emel Avcı ◽  
Erinç Aktüre ◽  
Hakan Seçkin ◽  
Kutluay Uluç ◽  
Andrew M. Bauer ◽  
...  
Keyword(s):  
Surgical Technique ◽  
Skull Base ◽  
Surgical Anatomy ◽  
Microsurgical Anatomy ◽  
Middle Point ◽  
The Mean ◽  
The Right ◽  
Skull Base Meningiomas ◽  
Supraorbital Foramen ◽  
Ethmoidal Foramen

Object Although craniofacial approaches to the midline skull base have been defined and surgical results have been published, clear descriptions of these complex approaches in a step-wise manner are lacking. The objective of this study is to demonstrate the surgical technique of craniofacial approaches based on Barrow classification (Levels I–III) and to study the microsurgical anatomy pertinent to these complex craniofacial approaches. Methods Ten adult cadaveric heads perfused with colored silicone and 24 dry human skulls were used to study the microsurgical anatomy and to demonstrate craniofacial approaches in a step-wise manner. In addition to cadaveric studies, case illustrations of anterior skull base meningiomas were presented to demonstrate the clinical application of the first 3 (Levels I–III) approaches. Results Cadaveric head dissection was performed in 10 heads using craniofacial approaches. Ethmoid and sphenoid sinuses, cribriform plate, orbit, planum sphenoidale, clivus, sellar, and parasellar regions were shown at Levels I, II, and III. In 24 human dry skulls (48 sides), a supraorbital notch (85.4%) was observed more frequently than the supraorbital foramen (14.6%). The mean distance between the supraorbital foramen notch to the midline was 21.9 mm on the right side and 21.8 mm on the left. By accepting the middle point of the nasofrontal suture as a landmark, the mean distances to the anterior ethmoidal foramen from the middle point of this suture were 32 mm on the right side and 34 mm on the left. The mean distance between the anterior and posterior ethmoidal foramina was 12.3 mm on both sides; the mean distance between the posterior ethmoidal foramen and distal opening of the optic canal was 7.1 mm on the right side and 7.3 mm on the left. Conclusions Barrow classification is a simple and stepwise system to better understand the surgical anatomy and refine the techniques in performing these complex craniofacial approaches. On the other hand, thorough anatomical knowledge of the midline skull base and variations of the neurovascular structures is crucial to perform successful craniofacial approaches.

Surgical nuances for the endoscopic endonasal transpterygoid approach to lateral sphenoid sinus encephaloceles

2012 ◽  
Vol 32 (6) ◽  
pp. E5 ◽  
Author(s):  
Richard F. Schmidt ◽  
Osamah J. Choudhry ◽  
Joseph Raviv ◽  
Soly Baredes ◽  
Roy R. Casiano ◽  
...  
Keyword(s):  
Skull Base ◽  
Sphenoid Sinus ◽  
Skull Base Surgery ◽  
Surgical Anatomy ◽  
Endoscopic Endonasal ◽  
Csf Rhinorrhea ◽  
Lateral Recess ◽  
Sternberg Canal ◽  
Deep Location ◽  
Repair Techniques

Lateral sphenoid encephaloceles of the Sternberg canal are rare entities and usually present with spontaneous CSF rhinorrhea. Traditionally, these were treated via transcranial approaches, which can be challenging given the deep location of these lesions. However, with advancements in endoscopic skull base surgery, including improved surgical exposures, angled endoscopes and instruments, and novel repair techniques, these encephaloceles can be resected and successfully repaired with purely endoscopic endonasal approaches. In this report, the authors review the endoscopic endonasal transpterygoid approach to the lateral recess of the sphenoid sinus for repair of temporal lobe encephaloceles, including an overview of the surgical anatomy from an endoscopic perspective, and describe the technical operative nuances and surgical pearls for these cases. The authors also present 4 new cases of lateral sphenoid recess encephaloceles that were successfully treated using this approach.

Surgical Anatomy of the Vertebral Artery at the Skull Base

1992 ◽  
Vol 102 (7) ◽  
pp. 829-831 ◽  
Author(s):  
Clarence T. Sasaki ◽  
Steven Sims ◽  
Paul Drago ◽  
Edward McNelis
Keyword(s):  
Vertebral Artery ◽  
Skull Base ◽  
Surgical Anatomy

scholarly journals Pediatric Skull Base Tumors

2021 ◽  
Author(s):  
Usman A. Khan ◽  
Jillian H. Plonsker ◽  
Robert C. Rennert ◽  
Michael L. Levy
Keyword(s):  
Quality Of Life ◽  
Skull Base ◽  
Neurofibromatosis Type ◽  
Surgical Anatomy ◽  
Surgical Approaches ◽  
Skull Base Tumors ◽  
Tumor Pathology ◽  
Neuro Imaging ◽  
Individualized Management

Management of pediatric skull base tumors requires a multi-disciplinary team that integrates advances in neuro-imaging, radiation, medical and surgical treatments, and allied therapies. Tumors of the skull base harbor complex genetic and molecular signatures that have major implications on prognosis and quality of life. Individualized management requires a strong inter-disciplinary alliance amongst practitioners, as well as a strong therapeutic alliance with the patient and family to navigate the complex decision-making process of treatments. In this chapter, we present our experience managing surgical lesions of the pediatric skull base. General considerations to tumor pathology genetics and radiobiology, diagnostic imaging, rehabilitation of cranial neuropathies and cognitive function, surgical anatomy and reconstructive options, and quality of life should be applied to each case. We also present location- and tumor-specific considerations in the anterior, middle, and posterior fossa skull base with a focus on surgical approaches and complication avoidance. Special consideration is given to syndromic tumors, particularly those from neurofibromatosis type 2 (NF-2). Tumors can exist in multiple cranial compartments and as such some redundancy in concepts is unavoidable. Nevertheless, each patient presents with a unique clinical picture and tumor behavior. Knowledge and proficiency in skull base approaches is a necessary tool in every pediatric neurosurgeon’s armamentarium.

Ossification of the pterygoalar and pterygospinous ligaments: a computed tomography analysis of infratemporal fossa anatomical variants relevant to percutaneous trigeminal rhizotomy

2020 ◽  
Vol 132 (6) ◽  
pp. 1942-1951
Author(s):  
Tomasz Matys ◽  
Tariq Ali ◽  
Fulvio Zaccagna ◽  
Damiano G. Barone ◽  
Ramez W. Kirollos ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Skull Base ◽  
Infratemporal Fossa ◽  
Maximum Intensity Projection ◽  
Contralateral Side ◽  
Surgical Anatomy ◽  
Ct Scans ◽  
Surgical Approaches ◽  
Cross Sectional ◽  
Radiological Anatomy

OBJECTIVEOssification of pterygoalar and pterygospinous ligaments traversing the superior aspect of the infratemporal fossa results in formation of osseous bars that can obstruct percutaneous needle access to the trigeminal ganglion through the foramen ovale (FO), interfere with lateral mandibular nerve block, and impede transzygomatic surgical approaches. Presence of these ligaments has been studied on dry skulls, but description of their radiological anatomy is scarce, in particular on cross-sectional imaging. The aim of this study was to describe visualization of pterygoalar and pterygospinous bars on computed tomography (CT) and to review their prevalence and clinical significance.METHODSThe authors retrospectively reviewed 200 helical sinonasal CT scans by analyzing 0.75- to 1.0-mm axial images, maximum intensity projection (MIP) reconstructions, and volume rendered (VR) images, including views along the anticipated axis of the needle in percutaneous Hartel and submandibular approaches to the FO.RESULTSOssified pterygoalar and pterygospinous ligaments were readily identifiable on CT scans. An ossified pterygoalar ligament was demonstrated in 10 patients, including 1 individual with bilateral complete ossification (0.5%), 4 patients with unilateral complete ossification (2.0%), and 5 with incomplete unilateral ossification (2.5%). Nearly all patients with pterygoalar bars were male (90%, p < 0.01). An ossified pterygospinous ligament was seen in 35 patients, including 2 individuals with bilateral complete (1.0%), 8 with unilateral complete (4%), 8 with bilateral incomplete (4.0%), 12 with bilateral incomplete (6.0%) ossification, and 5 (2.5%) with mixed ossification (complete on one side and incomplete on the contralateral side). All pterygoalar bars interfered with a hypothetical needle access to the FO using the Hartel approach but not the submandibular approach. In contrast, 54% of complete and 24% of incomplete pterygospinous bars impeded the submandibular approach to the FO, without affecting the Hartel approach.CONCLUSIONSThis study provides the first detailed description of cross-sectional radiological and applied surgical anatomy of pterygoalar and pterygospinous bars. Our data are clinically useful during skull base imaging to predict potential obstacles to percutaneous cannulation of the FO and assist in the choice of approach, as these two variants differentially impede the Hartel and submandibular access routes. Our results can also be useful in planning surgical approaches to the skull base through the infratemporal fossa.

Sign in / Sign up

Export Citation Format

Share Document