scholarly journals Morphometry relevant to Anterior Petrosectomy with special reference to Kawase’s Triangle

2017 ◽  
Vol 06 (04) ◽  
pp. 280-285
Author(s):  
Abu Ubaida Siddiqui ◽  
Bikash Chandra Satapathy ◽  
Sukhjeet Singh Gill
Keyword(s):  
Holistic Approach ◽  
Middle Cranial Fossa ◽  
Petrous Apex ◽  
Morphometric Study ◽  
Physiological Status ◽  
Anatomical Landmarks ◽  
Safe Procedure ◽  
Methodical Approach ◽  
Anterior Petrosectomy ◽  
The Individual

Abstract Background and aims :The petrous apex and the middle cranial fossa is a commonly explored area in neurosurgeries and hence require a holistic approach which should include the possibility of anatomical variants and morphometric dissimilarities. Material and Methods:This morphometric study was undertaken on 91 dry adult skulls [182 petrosal apices] to analyze a number of parameters relevant to Anterior Petrosectomy [AP] via the Kawase’s Triangle [KT]. The anatomical landmarks most pertinent to Anterior Petrosectomy [Kawase's approach] were defined, recorded and validated. The findings of the study were compared with earlier workers who have employed other means of investigation viz. dry bones/CT scans or cadaveric studies . Results : The parameters undertaken for the study presented with variable values and moresoever for the surface area of the KT. This can be very logically attributed to the variant anatomy amongst races and also to the physiological status of the individual Conclusions : AP has evolved as a preferred method for approaching petroclival region and thus requires an in depth understanding. The present analysis throws significant light on certain parameters that would be helpful in making anterior petrosectomy safer. Surgeries of the skull base demand for high end precision and proficiency and thus our findings provide enhanced alertness for a better and safe procedure. A methodical approach to the area with the background knowledge of these parameters shall culminate in desired neurosurgical outcomes.

scholarly journals Anterior Petrosal Approach for the Resection of a Petrous Apex Meningioma with Tentorial Infiltration

2019 ◽  
Vol 80 (S 03) ◽  
pp. S304-S304
Author(s):  
Diego Mendez-Rosito
Keyword(s):  
Trigeminal Neuralgia ◽  
Free Edge ◽  
Gross Total Resection ◽  
Petrous Apex ◽  
Anatomical Landmarks ◽  
Middle Fossa ◽  
Total Resection ◽  
Middle Fossa Approach ◽  
Anterior Petrosectomy ◽  
Surgical Corridor

Objective The anterior petrosal approach is an extension of the middle fossa approach, characterized by drilling of the posteromedial triangle of the middle fossa. Drilling the Kawase's rhomboid creates a surgical corridor to the posterior fossa after splitting the tentorium. We present a case of a petrous apex meningioma invading the tentorium and causing trigeminal neuralgia. Results The patient was positioned in a Mayfield with the head rotated. A frontotemporal incision was done. A basal craniotomy was done to allow epidural dissection. The anatomical landmarks were identified. The surgical video is analyzed together with cadaveric dissections to highlight landmarks when doing an anterior petrosectomy. The tentorium was identified and the infiltrated region was coagulated and removed. The tentorium was sharply sectioned until the free edge of the tentorium was opened. The tumor in the petrous apex was identified and removed. The trigeminal nerve was decompressed and a gross total resection was achieved with resolution of the symptoms. Conclusion The anterior petrosal approach is a useful corridor to remove tumors in the petrous apex that infiltrate the tentorium. A thorough knowledge of the anatomical landmarks is crucial to identify and delineate the limits of the Kawase's rhomboid. After evaluating different surgical corridors, the anterior petrosal approach allows a gross total resection including the removal of the infiltrated tentorium and a resolution of the symptoms.The link to the video can be found at: https://youtu.be/p4KPUnM_bww.

scholarly journals MORPHOMETRIC CHARACTERISTICS OF THE LONGITUDINAL PARAMETERS OF THE MIDDLE CRANIAL FOSSA OF ADULTS DEPENDING ON EXTREME TYPE OF SKULLS STRUCTURE

10.23856/4333 ◽  
2021 ◽  
Vol 43 (6) ◽  
pp. 256-262
Author(s):  
Iryna Chekanova
Keyword(s):  
Short Form ◽  
Middle Cranial Fossa ◽  
Anatomical Landmarks ◽  
Detailed Understanding ◽  
Extreme Type ◽  
Complex Anatomy ◽  
Cranial Fossa ◽  
Human Skulls ◽  
The Individual ◽  
Base Of The Skull

Surgical accesses through the middle cranial fossa (MCF) and their variations require the surgeons a detailed understanding of a complex anatomy of this site of the inner base of the skull (IBS) and an individual anatomical variability of the anatomical landmarks often used in their medical practice. The aim of this study is to establish individual anatomical variability of the longitudinal dimensions of MCF of mature age human. The research was carried out by studying 50 craniotomograms and 50 bone preparations of mature age human skulls with their further subdivision to extreme types of skulls groups. The examinations of the main longitudinal parameters were done for detailed MCF craniometry, namely: MCF lateral cranial length, MCF general length, MCF medial areas length. It was determined that all longitudinal dimensions increase from brachicephales to dolichocephales. This is due to the fact that for brachicrans (round-headedness) short form of the skull is inherent, for dolichocrans (narrow-headedness) – long and for mesocrans (moderate-headedness) average head size is inherent. According to the received data, MCF longitudinal parameters of mature age human regardless of the extreme types of the skull structure have the tendency to increase from medial sections of the investigated area to lateral. The results of this study substantially complete the existing information about the individual anatomical variability of MCF of mature age human and also make it possible to deeply use this data in practical medicine and for further research in morphology and in craniology in details.

Middle Cranial Fossa Approach: Anatomical Study on Skull Base Triangles as a Landmark for a Safe Anterior Petrosectomy

2019 ◽  
Author(s):  
Pasquale Anania ◽  
Rosa Mirapeix-Lucas ◽  
Gianluigi Zona ◽  
Alessandro Prior ◽  
Carlos Asencio Cortes ◽  
...  
Keyword(s):  
Anatomical Study ◽  
Middle Cranial Fossa ◽  
Gasserian Ganglion ◽  
Anatomical Landmarks ◽  
Basal Turn ◽  
Caucasian Race ◽  
Iatrogenic Damage ◽  
Anterior Petrosectomy ◽  
Cranial Fossa ◽  
Hearing Damage

Abstract Objective The Kawase approach provides access to the petroclival and posterior cavernous sinus regions, cerebellopontine angle, and upper basilar artery territory. Nevertheless, it remains one of the most challenging approach for neurosurgeons, due to the considerable related morbidity and mortality. The goal of this study was to evaluate the relationship between anatomical landmarks and their possible variations, and to measure the extension of the Kawase space, to define the reliability of these landmarks while performing an anterior petrosectomy. Design Using eight cadaveric specimens (15 sides), an anatomical dissections and extradural exposure of the Kawase area were performed. Settings A two-step analysis of the distances between the mandibular branch of the trigeminal nerve (V3) and the structures at risk of iatrogenic damage was performed. Main outcome measures We measured the distance between V3 and the basal turn of the cochlea, and between V3 and the internal acoustic canal (IAC), analyzing the limits of bone resection without causing hearing damage. Results We analyzed eight cadaveric (15 sides) formalin-fixed heads injected with colored silicone: four males and four females of Caucasian race (mean age: 73.83 years). We found a mean distance of 10.46 ± 1.13 mm between the great superficial petrous nerve (GSPN) intersection with V3 and the basal turn of the cochlea, and of 11.92 ± 1.71 mm between the origin point of V3 from the Gasserian ganglion and the fundus of the IAC. Conclusion The knowledge of the safe distance between the most applicable anatomic landmarks and the hearing structures is a practical and useful method to perform this approach reducing related comorbidity.

Custom-tailored transdural anterior transpetrosal approach to ventral pons and retroclival regions

2006 ◽  
Vol 104 (1) ◽  
pp. 38-46 ◽  
Author(s):  
Hans-Jakob Steiger ◽  
Daniel Hänggi ◽  
Walter Stummer ◽  
Peter A. Winkler
Keyword(s):  
Carotid Artery ◽  
Cranial Nerves ◽  
Extent Of Resection ◽  
Venous Congestion ◽  
Petrous Apex ◽  
Anterior Transpetrosal Approach ◽  
Target Field ◽  
Custom Made ◽  
Anterior Petrosectomy ◽  
Spinal Catheter

Object The extradural anterior petrosectomy approach to the pons and midbasilar artery (mid-BA) has the main disadvantage that the extent of resection of the petrous apex cannot be as minimal as desired given that the surgical target field is not visible during bone removal. Unnecessary or excessive drilling poses the risk of injury to the internal carotid artery, vestibulocochlear organ, and seventh and eighth cranial nerves. The use of a custom-tailored transdural anterior transpetrosal approach can potentially avoid these pitfalls. Methods A technique for a transdural anterior petrosectomy was developed in the operating theater and anatomy laboratory. Following a subtemporal craniotomy and basal opening of the dura mater, the vein of Labbé is first identified and protected. Cerebrospinal fluid ([CSF] 50–100 ml) is drained via a spinal catheter. The tent is incised behind the entrance of the trochlear nerve toward the superior petrosal sinus (SPS), which is coagulated and divided. The dura is stripped from the petrous pyramid. Drilling starts at the petrous ridge and proceeds laterally and ventrally. The trigeminal nerve is unroofed. The internal acoustic meatus is identified and drilling is continued laterally as needed. The bone of the Kawase triangle toward the clivus can be removed down to the inferior petrosal sinus if necessary. Anterior exposure can be extended to the carotid artery if required. It is only exceptionally necessary to follow the greater superior petrosal nerve toward the geniculate ganglion and to expose the length of the internal acoustic canal. The modified transdural anterior petrosectomy exposure has been used in nine patients—two with a mid-BA aneurysm, two with a dural arteriovenous fistula, one with a pontine glioma, three with a pontine cavernoma, and one with a pontine abscess. In one patient with a mid-BA aneurysm, subcutaneous CSF collection occurred during the postoperative period. No CSF fistula or approach-related cranial nerve deficit developed in any of these patients. There was no retraction injury or venous congestion of the temporal lobe nor any venous congestion due to the obliteration of the SPS or the petrosal vein. Conclusions The custom-made transdural anterior petrosectomy appears to be a feasible alternative to the formal extradural approach.

scholarly journals SoK: Privacy on Mobile Devices – It’s Complicated

2016 ◽  
Vol 2016 (3) ◽  
pp. 96-116 ◽  
Author(s):  
Chad Spensky ◽  
Jeffrey Stewart ◽  
Arkady Yerukhimovich ◽  
Richard Shay ◽  
Ari Trachtenberg ◽  
...  
Keyword(s):  
Mobile Devices ◽  
Personal Space ◽  
Holistic Approach ◽  
Research Directions ◽  
Private Data ◽  
Technology Gaps ◽  
Complex Ecosystem ◽  
The Individual ◽  
Typical User ◽  
Do So

AbstractModern mobile devices place a wide variety of sensors and services within the personal space of their users. As a result, these devices are capable of transparently monitoring many sensitive aspects of these users’ lives (e.g., location, health, or correspondences). Users typically trade access to this data for convenient applications and features, in many cases without a full appreciation of the nature and extent of the information that they are exposing to a variety of third parties. Nevertheless, studies show that users remain concerned about their privacy and vendors have similarly been increasing their utilization of privacy-preserving technologies in these devices. Still, despite significant efforts, these technologies continue to fail in fundamental ways, leaving users’ private data exposed.In this work, we survey the numerous components of mobile devices, giving particular attention to those that collect, process, or protect users’ private data. Whereas the individual components have been generally well studied and understood, examining the entire mobile device ecosystem provides significant insights into its overwhelming complexity. The numerous components of this complex ecosystem are frequently built and controlled by different parties with varying interests and incentives. Moreover, most of these parties are unknown to the typical user. The technologies that are employed to protect the users’ privacy typically only do so within a small slice of this ecosystem, abstracting away the greater complexity of the system. Our analysis suggests that this abstracted complexity is the major cause of many privacy-related vulnerabilities, and that a fundamentally new, holistic, approach to privacy is needed going forward. We thus highlight various existing technology gaps and propose several promising research directions for addressing and reducing this complexity.

The Most Important Therapy Outcomes for School-Aged Children Who Stutter: An Exploratory Study

2018 ◽  
Vol 27 (3S) ◽  
pp. 1152-1163 ◽  
Author(s):  
Katie Cooke ◽  
Sharon K. Millard
Keyword(s):  
Holistic Approach ◽  
Young Person ◽  
Successful Therapy ◽  
Therapy Outcomes ◽  
Language Therapy ◽  
Holistic View ◽  
School Aged Children ◽  
Delphi Approach ◽  
The Individual ◽  
Integrated Or

Purpose The aim of this article was to identify what school-aged children who stutter consider to be the most important outcomes from therapy. Method A Delphi approach was employed for the study. Eighteen participants aged 9–13 years completed a survey, generating 90 statements that would constitute successful therapy outcomes. After categorization and reduction, 79 statements were sent to participants in a second survey to seek consensus on their importance. Fifteen participants aged 8–14 years completed this second survey. Statements with the highest median ratings and smallest standard deviations were retained. Results Twenty-one statements were retained after analysis. These reflected hopes for affective and behavioral change in the young person and in other people after therapy. Important outcomes included, but are not limited to, increased fluency, greater independence, increased confidence at school, others knowing how to support the individual, and communication situations feeling easier. Conclusions Participants identified a range of outcomes that were important to achieve as a result of speech and language therapy. The findings suggest a need for a more holistic view of what is meant by successful therapy, incorporating improvements in the ability to communicate and participate in daily situations. The findings suggest that an integrated or holistic approach to intervention would be required to achieve these goals and should include significant others from the child's environment. The important statements identified in this study could be used to inform the content of therapy and to evaluate change over time. Supplemental Material https://doi.org/10.23641/asha.7144205

A qualitative exploration of young people and prison officers’ experiences of empathy within a young offenders’ institution

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Emily Anne Tarrant ◽  
Alison Torn
Keyword(s):  
Young People ◽  
Subjective Experience ◽  
Holistic Approach ◽  
Structured Interviews ◽  
Institutional Investment ◽  
Content Type ◽  
The Individual ◽  
Relationship Factors ◽  
The Impact ◽  
The Relationship

Purpose This study aims to explore the ways in which young people and prison staff (Prison Officers) within a youth custodial establishment experience empathy. Previous research tends to view empathy as a stable trait and one which people can develop through individual-centred therapy. There has been little consideration of the impact of relationship factors and context in relation to empathy experience and expression. The current study aims to address this by exploring the role of the custodial context in shaping empathy, including the potential impact of relationships, environmental factors and culture. Design/methodology/approach A qualitative approach was used to enable breadth and depth in the exploration of this area. Individual, semi-structured interviews were carried out with a purposive sample of three young people and three Prison Officers. Data was analysed using inductive thematic analysis informed by the guidelines of Braun and Clarke (2006) and King and Horrocks (2010). Findings Constructed themes included “constructions of empathy”, “recipe for empathy”, “institutional investment”, “the value of empathy” and “doing empathy”. Together, they provide detailed insight into the interplay of personal and wider contextual factors influencing the experience of empathy in a custodial setting. The findings suggest that the way in which young people and staff experience empathy in the custodial environment is unique. The findings suggest that empathy takes place within the context of relationships and is influenced by the nature of those relationships, along with the wider social context within which it occurs. Practical implications The findings of the current study support a move away from understanding empathy as an individual personality trait and instead viewing it as a dynamic experience that is changeable based upon the relationship and the context within which it occurs. The findings suggest that interventions aiming to develop empathy should look beyond the level of the individual and the relationship and focus upon developing environments that are supportive of empathy. Originality/value This study provides unique insights into the subjective experience of empathy in a custodial setting, presenting as one of the first to take a more holistic approach to understand this phenomenon.

Microsurgical Resection of a Petroclival Epidermoid Cyst Using an Anterior Petrosectomy Approach: 2-Dimensional Operative Video

2021 ◽  
Author(s):  
Kunal V Vakharia ◽  
Ryan M Naylor ◽  
Ashley M Nassiri ◽  
Colin L W Driscoll ◽  
Michael J Link
Keyword(s):  
Epidermoid Cyst ◽  
Cranial Nerves ◽  
Residual Tumor ◽  
Middle Meningeal Artery ◽  
Neural Tube Closure ◽  
Petrous Apex ◽  
Meckel’S Cave ◽  
Postoperative Mri ◽  
Meckel's Cave ◽  
Anterior Petrosectomy

Abstract Epidermoid cysts are rare, benign lesions that result from inclusion of ectodermal elements during neural tube closure.1 Cysts are composed of desquamated epithelial cells and restrict diffusion on magnetic resonance imaging (MRI).2,3 Symptoms are attributable to anatomic location.4,5 In this video, we illustrate the surgical treatment of an epidermoid cyst located in the right cerebellopontine angle, petrous apex, and Meckel's cave. The patient, a 33-yr-old female with right-sided V1 trigeminal hypoesthesia, underwent surveillance imaging for 2 yr. However, she developed progressive V1 and V2 trigeminal hypoesthesia and imaging revealed enlargement of the lesion. Therefore, surgical resection was pursued. The patient consented to the procedure. The patient underwent a right middle fossa craniotomy and anterior petrosectomy. After identifying the greater superficial petrosal nerve and cutting the middle meningeal artery as it exited foramen spinosum, Kawase's triangle was drilled, and the dura over Meckel's cave and the subtemporal dura were opened. The lesion was resected, taking care to preserve the trigeminal nerve and the basilar artery. A retrosigmoid craniotomy was then fashioned. The cyst and its capsule were dissected off the brainstem and cranial nerves utilizing natural corridors between the trigeminal and vestibulocochlear nerves as well as between the facial and lower cranial nerves. Gross total resection was confirmed on postoperative MRI, and she was discharged home on postoperative day 5. Three months after surgery, she underwent formal pinprick testing, which revealed 95% loss of sensation in V1, 20% loss in V2, and normal sensation in V3. Three-month postoperative MRI showed no residual tumor.

Health Promotion in the Workplace – The Merging of the Paradigms

2005 ◽  
Vol 44 (02) ◽  
pp. 278-284 ◽  
Author(s):  
A. Yassi
Keyword(s):  
Health Promotion ◽  
Occupational Health ◽  
Healthy Lifestyle ◽  
Workplace Health Promotion ◽  
Health And Safety ◽  
Holistic Approach ◽  
Occupational Health And Safety ◽  
Healthcare Sector ◽  
Workplace Health ◽  
The Individual

Summary Purpose: To synthesize the lessons from both occupational health and health promotion, to improve workplace health. Approach: This article briefly outlines the evolution in defining and understanding health promotion as well as current thinking in occupational health and safety.It also discusses an approach taken in the healthcare sector in British Columbia, Canada, where evidence-based practices and collaboration became the cornerstones to bringing about change and achieve impressive cost-beneficial results in healthcare workforce health. Conclusion: Traditionally, workplace health promotion and occupational health and safety have been two solitudes. Workplace health promotion is rooted in ‘wellness’ and healthy lifestyle choices, while occupational health is heavily dictated by workplace health and safety requirements and legislation. Recently however, there has been increasing recognition of the need for a more holistic approach that focusses on workplace culture, addressing both primary and secondary prevention [1], as well as interventions aimed both at the individual as well as the organisation [2].

scholarly journals The approaches to developing the distributed information-control systems of organizational type

2018 ◽  
Vol 18 ◽  
pp. 01005
Author(s):  
Victor L. Lyaskovsky ◽  
Igor B. Bresler ◽  
Mihail A. Alasheev
Keyword(s):  
Initial Data ◽  
Control Systems ◽  
Information Control ◽  
Methodological Framework ◽  
Distributed Information ◽  
Organizational Type ◽  
Methodical Approach ◽  
The Individual

The article contains the results of research aimed at developing a scientific and methodological framework for justifying solutions for the development of distributed information-control systems of an organizational type. The structuring of the initial data is made, a formalized statement of the problem of justifying solutions for the development of distributed information-control systems of the organizational type is proposed. To solve this problem, a scientific-methodical approach is proposed, which includes methods for assessing the effectiveness of the solution and the individual indicators.

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