Supraorbital-Pterional Approach to Skull Base Lesions

Abstract A surgical approach to the skull base is described. It allows excellent exposure of the cranial base with minimal brain retraction. Deep lesions can be handled via subfrontal, transsylvian, or subtemporal routes during the same operation. This approach is most suitable for large lesions in the suprasellar, parasellar, and retrosellar areas and for those that extend into the cavernous sinus, along the tentorial notch, or into the orbit. After the single bone flap is replaced, there is little or no functional, anatomical, or cosmetic deficit. Our experience in 16 cases and suggestion for the use of this approach are presented.

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Supraorbital-pterional approach to skull base lesions

Neurosurgery ◽

10.1097/00006123-198710000-00006 ◽

1987 ◽

Vol 21 (4) ◽

pp. 474???7 ◽

Cited By ~ 25

Author(s):

O Al-Mefty

Keyword(s):

Skull Base ◽

Pterional Approach ◽

Skull Base Lesions

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Classification of Facial Translocation Approach to the Skull Base

Otolaryngology ◽

10.1177/019459989511200412 ◽

1995 ◽

Vol 112 (4) ◽

pp. 579-585 ◽

Cited By ~ 1

Author(s):

Ivo P. Janecka

Keyword(s):

Skull Base ◽

Outcome Measures ◽

Surgical Approach ◽

Cranial Base ◽

Skull Base Tumor ◽

Complementary Relationship ◽

Retrospective Assessment

OBJECTIVE: To categorize a surgical approach to the skull base. DESIGN: Retrospective assessment of an evolving concept pertaining to the facial translocation procedure. SETTING: Schematic/conceptual. MAIN OUTCOME MEASURES: To allow favorable surgical reach of the essential anatomy at the cranial base with the potential for functional and esthetic reconstruction. INTERVENTION: Systematic craniofacial disassembly. RESULTS: The facial translocation technique of modular craniofacial disassembly of facial units permits a satisfactory match between, a skull base tumor and a selected surgical approach. Individual units have a complementary relationship to one another, allowing an expansion of the surgical approach as needed.

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Respective Indications for Orbital Rim, Zygomatic Arch and Orbito-Zygomatic Osteotomies in the Surgical Approach to Central Skull Base Lesions. Critical, Retrospective Review in 146 Cases

Acta Neurochirurgica ◽

10.1007/s007010170001 ◽

2001 ◽

Vol 143 (10) ◽

pp. 967-975 ◽

Cited By ~ 26

Author(s):

M. Sindou ◽

E. Emery ◽

G. Acevedo ◽

U. Ben-David

Keyword(s):

Skull Base ◽

Surgical Approach ◽

Retrospective Review ◽

Zygomatic Arch ◽

Skull Base Lesions ◽

Orbital Rim

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Expanded endoscopic endonasal transcribriform approach for resection of anterior skull base olfactory schwannoma

Neurosurgical FOCUS ◽

10.3171/2012.v3.focus11300 ◽

2012 ◽

Vol 32 (Suppl1) ◽

pp. E3 ◽

Cited By ~ 6

Author(s):

James K. Liu ◽

Jean Anderson Eloy

Keyword(s):

Skull Base ◽

Skull Base Surgery ◽

Tumor Resection ◽

Cranial Base ◽

Anterior Skull Base ◽

Endoscopic Endonasal ◽

Olfactory Groove ◽

Anterior Cranial Base ◽

Ventral Skull Base ◽

Brain Retraction

Anterior skull base (ASB) schwannomas are extremely rare and can often mimic other pathologies involving the ASB such as olfactory groove meningiomas, hemangiopericytomas, esthesioneuroblastomas, and other malignant ASB tumors. The mainstay of treatment for these lesions is gross-total resection. Traditionally, resection for tumors in this location is performed through a bifrontal transbasal approach that can involve some degree of brain retraction or manipulation for tumor exposure. With the recent advances in endoscopic skull base surgery, various ASB tumors can be resected successfully using an expanded endoscopic endonasal transcribriform approach through a “keyhole craniectomy” in the ventral skull base. This approach represents the most direct route to the anterior cranial base without any brain retraction. Tumor involving the paranasal sinuses, medial orbits, and cribriform plate can be readily resected. In this video atlas report, the authors demonstrate their step-by-step techniques for resection of an ASB olfactory schwannoma using a purely endoscopic endonasal transcribriform approach. They describe and illustrate the operative nuances and surgical pearls to safely and efficiently perform the approach, tumor resection, and multilayered reconstruction of the cranial base defect. The video can be found here: http://youtu.be/NLtOGfKWC6U.

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Cranio-orbital approach for the paraclinoidal and anterior communicating aneurysms

Arquivos de Neuro-Psiquiatria ◽

10.1590/s0004-282x1995000400007 ◽

1995 ◽

Vol 53 (3b) ◽

pp. 592-597 ◽

Cited By ~ 6

Author(s):

Jorge Marcondes de Souza ◽

Flávio F. Rodrigues ◽

Marcelo R. da Silva ◽

Ricardo Maron ◽

Leonardo Martins ◽

...

Keyword(s):

Carotid Artery ◽

Skull Base ◽

Cavernous Sinus ◽

Posterior Communicating Artery ◽

Skull Base Tumors ◽

Bone Removal ◽

Brain Retraction

Aneurysms arising at the proximal intracranial carotid artery (between cavernous sinus and posterior communicating artery) and at the anterior communicating complex may present with technical difficulties regarding appropriate access without excessive brain retraction. In a series of 15 patients the authors show the use of the cranio-orbital approach, formerly designed in the access of skull base tumors, for these subgroups of aneurysms. They discuss the advantages of a basal avenue in minimizing brain retraction, better anatomical orientation, obviation of tissue ressection and easier extra-dural bone removal. It was not identified any complication due to the described approach.

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