Retrosigmoid Craniectomy with a Layered Soft Tissue Dissection and Hydroxyapatite Reconstruction: Technical Note, Surgical Video, Regional Anatomy, and Outcomes

2021 ◽  
Author(s):  
Stephen T. Magill ◽  
Young M. Lee ◽  
Roberto R. Rubio ◽  
Minh P. Nguyen ◽  
Carl B. Heilman ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Skin Incision ◽  
Technical Note ◽  
Retrosigmoid Approach ◽  
Regional Anatomy ◽  
Surgical Video ◽  
Soft Tissue Dissection ◽  
Tissue Dissection ◽  
Tissue Flap ◽  
Over The Top

Abstract Background There are many reported modifications to the retrosigmoid approach including variations in skin incisions, soft tissue dissection, bone removal/replacement, and closure. Objective The aim of this study was to report the technical nuances developed by two senior skull base surgeons for retrosigmoid craniectomy with reconstruction and provide anatomic dissections, surgical video, and outcomes. Methods The regional soft tissue and bony anatomy as well as the steps for our retrosigmoid craniectomy were recorded with photographs, anatomic dissections, and video. Records from 2017 to 2019 were reviewed to determine the incidence of complications after the authors began using the described approach. Results Dissections of the relevant soft tissue, vascular, and bony structures were performed. Key surgical steps are (1) a retroauricular C-shaped skin incision, (2) developing a skin and subgaleal tissue flap of equal thickness above the fascia over the temporalis and sub-occipital muscles, (3) creation of subperiosteal soft tissue planes over the top of the mastoid and along the superior nuchal line to expose the suboccipital region, (4) closure of the craniectomy defect with in-lay titanium mesh and overlay hydroxyapatite cranioplasty, and (5) reapproximation of the soft tissue edges during closure. Complications in 40 cases were pseudomeningocele requiring shunt (n = 3, 7.5%), wound infection (n = 1, 2.5%), and aseptic meningitis (n = 1, 2.5%). There were no incisional cerebrospinal fluid leaks. Conclusions The relevant regional anatomy and a revised technique for retrosigmoid craniectomy with reconstruction have been presented with acceptable results. Readers can consider this technique when using the retrosigmoid approach for pathology in the cerebellopontine angle.

scholarly journals Craniotomy Revisited: Techniques for Improved Access and Reconstruction

2000 ◽  
Vol 27 (1) ◽  
pp. 44-48 ◽  
Author(s):  
Michael D. Cusimano ◽  
Agustinus S. Suhardja
Keyword(s):  
Soft Tissue ◽  
Operating Time ◽  
Additional Cost ◽  
Bone Flap ◽  
Temporalis Muscle ◽  
Native Bone ◽  
Soft Tissue Dissection ◽  
Tissue Dissection ◽  
Orbital Rim ◽  
Additional Operating Time

ABSTRACT:Objective:To describe simple modifications of the technique of opening and closure of the craniotomy to improve basal exposure and reconstruction.Methods:The modifications involve: a) additional soft-tissue dissection which is carried downward to the base of the ear and to the orbital rim, exposing the orbital rim and malar eminence without removing the bone; b) cutting the bone flap so that ‘bridges’ of bone remain that help to stabilize the flap when it is returned to the cranium at the end of the operation; c) the wedging of bone chips between the bone flap and native cranium at the time the bone is being reaffixed so as to provide firm stability by diminishing movement of the bone flap; d) the use of bone dust and bone chips mixed with the patient's blood to seal and bridge the gap between the bone flap and the native bone; e) reattachment of the temporalis muscle with the bone flap sutures. An ‘inlay’ technique of duraplasty is also described.Results and Conclusion:These simple modifications of craniotomy provide better basal exposure and reconstruction with little additional operating time at no additional cost.

Video-Assisted Thoracoscopic Dissection Of The Brachial Plexus:Cadaveric Study And Illustrative Case

2006 ◽  
Vol 58 (suppl_4) ◽  
pp. ONS-287-ONS-291 ◽  
Author(s):  
Chad J. Morgan ◽  
Jefferson Lyons ◽  
Benjamin C. Ling ◽  
P. Colby Maher ◽  
Robert J. Bohinski ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Brachial Plexus ◽  
Thoracoscopic Surgery ◽  
Surgical Approaches ◽  
Illustrative Case ◽  
Lower Trunk ◽  
Video Assisted ◽  
First Rib ◽  
Soft Tissue Dissection ◽  
Tissue Dissection

Abstract Objective: Standard surgical approaches to the brachial plexus require an open operative technique with extensive soft tissue dissection. A transthoracic endoscopic approach using video-assisted thoracoscopic surgery (VATS) was studied as an alternative direct operative corridor to the proximal inferior brachial plexus. Methods: VATS was used in cadaveric dissections to study the anatomic details of the brachial plexus at the thoracic apex. After placement of standard thoracoscopic ports, the thoracic apex was systematically dissected. The limitations of the VATS approach were defined before and after removal of the first rib. The technique was applied in a 22-year-old man with neurofibromatosis who presented with a large neurofibroma of the left T1 nerve root. Results: The cadaveric study demonstrated that VATS allowed for a direct cephalad approach to the inferior brachial plexus. The C8 and T1 nerve roots as well as the lower trunk of the brachial plexus were safely identified and dissected. Removal of the first rib provided exposure of the entire lower trunk and proximal divisions. After the fundamental steps to the dissection were identified, the patient underwent a successful gross total resection of a left T1 neurofibroma with VATS. Conclusion: VATS provided an alternative surgical corridor to the proximal inferior brachial plexus and obviated the need for the extensive soft tissue dissection associated with the anterior supraclavicular and posterior subscapular approaches.

scholarly journals Energized soft tissue dissection in surgery simulation

2016 ◽  
Vol 27 (3-4) ◽  
pp. 280-289 ◽  
Author(s):  
Kun Qian ◽  
Tao Jiang ◽  
Meili Wang ◽  
Xiaosong Yang ◽  
Jianjun Zhang
Keyword(s):  
Soft Tissue ◽  
Surgery Simulation ◽  
Soft Tissue Dissection ◽  
Tissue Dissection

scholarly journals Functional outcome following external fixator (JESS) application for proximal humeral fractures

2016 ◽  
Vol 2 (4) ◽  
pp. 303
Author(s):  
Om P. Gupta ◽  
Arun Vashisht ◽  
Avinash Rastogi ◽  
Naman Gupta ◽  
Utkarsh Shahi ◽  
...  
Keyword(s):  
Soft Tissue ◽  
External Fixator ◽  
Scoring System ◽  
Young Patients ◽  
High Energy ◽  
Proximal Humeral Fractures ◽  
Humeral Fractures ◽  
Average Score ◽  
Soft Tissue Dissection ◽  
Tissue Dissection

<p class="abstract"><strong>Background:</strong> Proximal humeral fractures account for 5% of all fractures. Observed frequently in older osteoporotic patients but found in young patients with high-energy trauma.About 80% of these fractures are undisplaced or minimally displaced. Non-operative method requiring immobilization of shoulder often leads to a stiff shoulder, whereas surgical procedures such as plating need excessive soft tissue dissection. It was overcome in this study by less soft tissue dissection by use of external fixator application and early mobilization.</p><p class="abstract"><strong>Methods:</strong> Total of 18 patients mean age 40.5 years, predominantly male (16/18) treated with external fixator - JESS (Joshi’s external immobilization system) for Neer’s two, three and four part proximal humeral fractures. Vehicular accidents were the most common mode of injury followed by fall. There were 8 cases each of Neer's two and three part fractures. Shoulder mobilization started within a week as postoperativelyas pain allowed. Patients followed up at 3, 6, 12 and 18 weeks for pain, function, range of motion and anatomy with check X-ray. After radiological union at 8-10 weeks JESS was removed. Cases were evaluated for functional result by constant scoring system.<strong></strong></p><p class="abstract"><strong>Results:</strong> Average score on constant scoring system was 72 after a mean follow-up of 6 months. All fractures united in mean duration of 9.33 weeks. The complications included shoulder stiffness in one case and pin tract infection in two cases.</p><strong>Conclusions:</strong> Early shoulder mobilization a prerequisite for good results can be achieved without compromising fracture union. Less soft tissue dissection required and significant cost effective.

The Blood Supply of the Tendon with a Paratenon

HAND ◽  
1983 ◽  
Vol os-15 (1) ◽  
pp. 9-14 ◽  
Author(s):  
M. Naito ◽  
K. Ogata
Keyword(s):  
Blood Flow ◽  
Soft Tissue ◽  
Achilles Tendon ◽  
Blood Supply ◽  
Flow Rate ◽  
Vascular System ◽  
Blood Flow Rate ◽  
Soft Tissue Dissection ◽  
Tissue Dissection ◽  
Before And After

The blood supply to the central third of the Achilles tendon was studied in adult rabbits using the hydrogen washout technique before and after soft tissue dissection including paratenon. The soft tissue dissection caused a decrease of the blood flow rate in the Achilles tendon by approximately 35 per cent. These results may indicate that the central third of the tendon with a paratenon receives its blood supply from the extrinsic vascular system by approximately 35 per cent and from the intrinsic vascular system by approximately 65 per cent.

Application of Subcutaneous Talc After Soft Tissue Dissection in A Rat Model Is Not Associated With Systemic or Pulmonary Side Effects

2012 ◽  
Vol 172 (2) ◽  
pp. 339
Author(s):  
D.A. Klima ◽  
P.D. Colavita ◽  
E.H. Lipford ◽  
A.L. Walters ◽  
A.E. Lincourt ◽  
...  
Keyword(s):  
Side Effects ◽  
Soft Tissue ◽  
Rat Model ◽  
Soft Tissue Dissection ◽  
Tissue Dissection

Retrosigmoid craniotomy for cerebellopontine angle/petroclival epidermoid cyst

2014 ◽  
Vol 36 (v1supplement) ◽  
pp. 1
Author(s):  
Shaan M. Raza ◽  
Franco DeMonte
Keyword(s):  
Soft Tissue ◽  
Epidermoid Cyst ◽  
Cerebellopontine Angle ◽  
Cranial Nerves ◽  
Total Resection ◽  
Vertebrobasilar System ◽  
System A ◽  
Soft Tissue Dissection ◽  
Tissue Dissection ◽  
Key Steps

This video describes the surgical management of an epidermoid cyst within the cerebellopontine angle and petroclival region with involvement of cranial nerves V through XI and the vertebrobasilar system. A retrosigmoid craniotomy was performed for gross total resection of the lesion. The key steps of the procedure are discussed, including: positioning, soft tissue dissection, craniotomy, microsurgical dissection/resection, closure. Additionally, surgical nuances with regards to the safe maximal resection of such lesions are detailed.The video can be found here: http://youtu.be/VEROVO5cYdU.

scholarly journals Use of an aiming drill guide and ankle arthroscopy for reduction of depressed articular surface in posterior malleolar fractures

2021 ◽  
Vol 29 (3) ◽  
pp. 230949902110558
Author(s):  
Hyo-Jin Lee ◽  
Sung Jae Kim ◽  
Young Uk Park ◽  
Jintak Hyun ◽  
Hyong Nyun Kim
Keyword(s):  
Soft Tissue ◽  
Articular Surface ◽  
Ankle Arthroscopy ◽  
Direct Visualization ◽  
Novel Technique ◽  
Drill Guide ◽  
Posterior Malleolus ◽  
Soft Tissue Dissection ◽  
Tissue Dissection ◽  
The Mean

Purpose We describe a novel technique that uses an aiming drill guide and ankle arthroscopy for direct visualization and reduction of the depressed articular surface located between the posterior tibia and the fractured posterior malleolus. This technique requires less soft tissue dissection to visualize and reduce the depressed articular surface. Methods Between June 2014 and May 2019, 126 patients were surgically treated for trimalleolar fractures. Among them, 11 had depressed articular fragment between the posterior tibia and the fractured posterior malleolus reduced using our novel technique. The study included six men and five women, with a mean age of 46.5 (range: 23–62) years. Results In eight (73%) cases, the articular surface was reduced, with the articular surface step-off being less than 2 mm, as noted on postoperative computed tomography (CT). Syndesmosis congruity within an anterior-to-posterior difference of less than 2 mm was confirmed in nine (82%) cases via postoperative CT. The mean 100-mm visual analog scale (VAS) and the mean Olerud-Molander ankle score at the final follow-up were 16.6 ± 14.5 and 87.7 ± 7.5, respectively. Conclusions The depressed articular fragment located between the posterior tibia and the fractured posterior malleolus can be treated using an aiming drill guide and ankle arthroscopy. Ankle arthroscopy is used for direct visualization of the depressed articular surface, and the aiming drill guide can guide the bone plunger precisely to the depressed articular surface for reduction. This technique requires less soft tissue dissection than conventional techniques to visualize and reduce the depressed articular surface.

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