Zygomaticotemporal Approach to the Basis Cranii and Basilar Artery

Neurosurgery ◽  
1988 ◽  
Vol 23 (1) ◽  
pp. 20-22 ◽  
Author(s):  
Glenn Neil-Dwyer ◽  
Michael Sharr ◽  
Richard Haskell ◽  
David Currie ◽  
Massoud Hosseini
Keyword(s):  
Temporal Lobe ◽  
Basilar Artery ◽  
Masseter Muscle ◽  
Anterior Approach ◽  
Zygomatic Bone ◽  
Interpeduncular Cistern ◽  
Suprasellar Region ◽  
Brain Retraction

ABSTRACT When using the zygomaticotemporal approach, one removes the whole of the zygomatic bone with its attachment to the masseter muscle, allowing a lower and more anterior approach to the interpeduncular cistern along the inferomedial surface of the temporal lobe. Minimal brain retraction is required to give an excellent view of the bifurcation of the basilar artery and of the suprasellar region. (Neurosurgery 23:20-22, 1988)

Malignant astrocytoma following radiotherapy of a craniopharyngioma

1978 ◽  
Vol 48 (4) ◽  
pp. 622-627 ◽  
Author(s):  
Richard L. Sogg ◽  
Sarah S. Donaldson ◽  
Craig H. Yorke
Keyword(s):  
Experimental Evidence ◽  
Temporal Lobe ◽  
Malignant Astrocytoma ◽  
Content Type ◽  
Suprasellar Region ◽  
The Right ◽  
Fine Print

✓ A 9-year-old schoolgirl received 6007 rads to the suprasellar region for craniopharyngioma. Five years later, a malignant astrocytoma developed in the right temporal lobe. We cite clinical and experimental evidence to support our suspicion that the glioma may have been induced by radiation.

Zygomatic Temporopolar Approach for Basilar Artery Aneurysms

Neurosurgery ◽  
1989 ◽  
Vol 25 (5) ◽  
pp. 793-797 ◽  
Author(s):  
Yoshiaki Shiokawa ◽  
Isamu Saito ◽  
Nobuhiko Aoki ◽  
Hiroshi Mizutani
Keyword(s):  
Facial Nerve ◽  
Temporal Lobe ◽  
Basilar Artery ◽  
Operative Procedure ◽  
Zygomatic Arch ◽  
Nerve Injuries ◽  
Operating Field ◽  
Facial Nerve Injuries

Abstract For surgery of upper basilar artery aneurysms, we have modified the temporopolar approach proposed by Sano by detaching the zygomatic arch to obtain a wide, shallow operating field. This approach seems to be suitable for anteriorly protruding, high-positioned, or large aneurysms of the upper basilar artery. We have used this zygomatic temporopolar approach in 4 patients with such aneurysms and obtained satisfactory results. In this paper, we detail the operative procedure and emphasize certain technical points to minimize temporal lobe retraction and to prevent oculomotor and facial nerve injuries.

Modified orbitozygomatic craniotomy for craniopharyngioma resection in children

2009 ◽  
Vol 4 (4) ◽  
pp. 345-352 ◽  
Author(s):  
Kiarash J. Golshani ◽  
Kirk Lalwani ◽  
Johnny B. Delashaw ◽  
Nathan R. Selden
Keyword(s):  
Sella Turcica ◽  
Residual Tumor ◽  
Optic Chiasm ◽  
Neurological Deficits ◽  
Endocrine Dysfunction ◽  
Prepontine Cistern ◽  
Institutional Review ◽  
Suprasellar Region ◽  
Transsphenoidal Operation ◽  
Brain Retraction

Object In this study, the authors evaluated the efficacy and safety of modified orbitozygomatic craniotomy for resection of craniopharyngioma in children. Methods A prospective, institutional review board–approved database was retrospectively reviewed for pediatric patients undergoing craniopharyngioma resection performed by a single surgeon. Results Ten patients underwent craniopharyngioma resection surgery between July 2000 and January 2006 (4 girls and 6 boys, ages 1.5–17 years). Nine patients presented to the authors' institution, and 1 patient was referred after surgery and radiation therapy were administered elsewhere. Nine patients presented with visual field deficits (2 with unilateral or bilateral light perception only) and 5 with endocrine dysfunction. Eight patients had large tumors that significantly displaced the optic chiasm and hypothalamus. All patients underwent a modified frontotemporal orbitozygomatic osteotomy in a single piece. The lamina terminalis was opened in 4 patients with third ventricular extension. One patient required a staged transsphenoidal operation to remove residual tumor in the sella turcica, and 1 patient underwent a contralateral subtemporal approach to resect a daughter lesion in the prepontine cistern. Complete radiographic resection was achieved in all patients. Follow-up averaged 55 months (range 12–95 months). Vision was improved in 8 patients and remained stable in 2. All patients had postoperative endocrine dysfunction. One patient experienced transient cranial nerve IV palsy and 1 suffered a small caudate stroke 5 months after surgery without sequelae. Two patients experienced polyphagia and weight gain without other symptoms of hypothalamic dysfunction. There were no other new neurological deficits. Conclusions Modified orbitozygomatic craniotomy provides excellent exposure of the suprasellar region with minimal brain retraction, allowing complete resection of craniopharyngiomas with good visual and neurological results.

Extradural temporopolar approach to lesions of the upper basilar artery and infrachiasmatic region

1994 ◽  
Vol 81 (2) ◽  
pp. 230-235 ◽  
Author(s):  
J. Diaz Day ◽  
Steven L. Giannotta ◽  
Takanori Fukushima
Keyword(s):  
Basilar Artery ◽  
Cranial Nerve ◽  
Pathological Process ◽  
Total Resection ◽  
Anterior Clinoid Process ◽  
Content Type ◽  
Surgical Access ◽  
Complete Obliteration ◽  
Brain Retraction ◽  
Fine Print

✓ Surgical access to the parasellar, infrachiasmatic, and posterior clinoid regions has traditionally been accomplished through an intradural pterional or subtemporal approach. However, for large or complex lesions in these locations, such traditional trajectories may not afford sufficient exposure for complete obliteration of the pathological process. The authors describe an anterolateral transcavernous approach to this region that includes the following components: 1) extradural removal of the sphenoid wing and exposure of the superior orbital fissure and foramen rotundum; 2) removal of the anterior clinoid process via the anterolateral route; 3) decompression of the optic canal; 4) extradural retraction of the temporal tip; 5) transcavernous mobilization of the carotid artery and third cranial nerve; and 6) removal of the posterior clinoid process. This method results in enhanced exposure with minimal brain retraction and preservation of the temporal tip bridging veins. This approach has been used in 22 patients: 10 with basilar top aneurysms, eight with craniopharyngiomas, one with a tuberculum sellae meningioma, and two with trigeminal neuromas; the last patient had a carotidcavernous fistula and a concomitant pituitary adenoma. Complete clip ligation was performed for all 10 basilar artery aneurysms, and gross total resection was achieved with preservation of the pituitary stalk in all tumor cases. Microscopic total resection was not possible in two cases of craniopharyngioma due to hypothalamic invasion. Two patients suffered transient postoperative hemiparesis, and one patient has persisting weakness; however, no patient followed for more than 6 months suffered any persistent cranial nerve morbidity. It is concluded that this procedure can serve as an alternative to either the transsylvian or subtemporal approaches when cranial base pathologies are large or complex.

Endoscopic Transorbital Approach to Mesial Temporal Lobe for Intra-Axial Lesions: Cadaveric Study and Case Series (SevEN-008)

2021 ◽  
Author(s):  
Hun Ho Park ◽  
Tae Hoon Roh ◽  
Seonah Choi ◽  
Jihwan Yoo ◽  
Woo Hyun Kim ◽  
...  
Keyword(s):  
Temporal Lobe ◽  
Case Series ◽  
Invasive Technique ◽  
Low Grade ◽  
Orbital Roof ◽  
Endoscopic Transorbital ◽  
Temporal Horn ◽  
Skull Base Lesions ◽  
Mesial Temporal Lobe ◽  
Brain Retraction

Abstract BACKGROUND Endoscopic transorbital approach (ETOA) has been proposed as a minimally invasive technique for the treatment of skull base lesions located around mesial temporal lobe (MTL), mostly extra-axial pathology. OBJECTIVE To explore the feasibility of ETOA in accessing intraparenchymal MTL with cadaveric specimens and describe our initial clinical experience of ETOA for intra-axial lesions in MTL. METHODS Anatomic dissections were performed in 4 adult cadaveric heads using a 0° endoscope. First, a stepwise anatomical investigation of ETOA to intraparenchymal MTL was explored. Then, ETOA was applied clinically for 7 patients with intra-axial lesions in MTL, predominantly high-grade gliomas (HGGs) and low-grade gliomas (LGGs). RESULTS The extradural stage of ETOA entailed a superior eyelid incision followed by orbital retraction, drilling of orbital roof, greater and lesser wing of sphenoid bone, and cutting of the meningo-orbital band. For the intradural stage, the brain tissue medial to the occipito-temporal gyrus was aspirated until the temporal horn was opened. The structures of MTL could be aspirated selectively in a subpial manner without injury to the neurovascular structures of the ambient and sylvian cisterns, and the lateral neocortex. After cadaveric validation, ETOA was successfully performed for 4 patients with HGGs and 3 patients with LGGs. Gross total resection was achieved in 6 patients (85.7%) without significant surgical morbidities including visual field deficits. CONCLUSION ETOA provides a logical line of access for intra-axial lesions in MTL. The safe and natural surgical trajectory of ETOA can spare brain retraction, neurovascular injury, and disruption of the lateral neocortex.

Zygomatic approach for lesions in the interpeduncular cistern

1985 ◽  
Vol 62 (3) ◽  
pp. 340-343 ◽  
Author(s):  
Kazuhiko Fujitsu ◽  
Takeo Kuwabara
Keyword(s):  
Technical Problem ◽  
Optic Tract ◽  
Contralateral Side ◽  
Zygomatic Arch ◽  
Content Type ◽  
Interpeduncular Cistern ◽  
Frontal Process ◽  
Brain Retraction ◽  
New Surgical Technique ◽  
Fine Print

✓ Lesions in the interpeduncular cistern include basilar tip aneurysms, craniopharyngiomas, and chordomas. The surgical approach to these lesions presents a special technical problem, particularly when they are located high in the interpeduncular fossa. For the purpose of minimizing brain retraction and achieving excellent exposure within the interpeduncular cistern, the authors have developed a new surgical technique which involves detachment of the zygomatic arch. The patient is placed in the supine position with the head rotated 45° to the contralateral side and tilted down 30° so that the surgeon can see into the interpeduncular cistern obliquely from below. The zygomatic arch of the temporal bone as well as a portion of the lateral orbital rim (the posterior ridge of the frontal process of the zygomatic bone) is removed to expose the anterior temporal base. With posterior retraction of the temporal lobe, the arachnoid membranes covering the Sylvian stem are opened in a retrograde fashion until the tentorial edge is sufficiently exposed. The posterior communicating artery and the optic tract are elevated to enter the interpeduncular cistern, after which the oculomotor nerve is dissected free of its surrounding arachnoid membranes and displaced posteroinferiorly. Two patients with basilar tip aneurysms were operated on with this zygomatic approach, and a subtemporal modification of the zygomatic approach was used to treat a craniopharyngioma and a chordoma in two other patients. The procedure is described and a short description of its clinical use is given.

scholarly journals Skull Base Chondrosarcoma Presenting with Hemorrhage

2009 ◽  
Vol 36 (6) ◽  
pp. 774-775 ◽  
Author(s):  
Gary L. Gallia ◽  
Zev A. Binder ◽  
Jacob Schwarz ◽  
John L. Moriarity ◽  
Jon D. Weingart
Keyword(s):  
Temporal Lobe ◽  
Intraventricular Hemorrhage ◽  
Histopathological Examination ◽  
Acute Onset ◽  
Low Grade ◽  
Blurred Vision ◽  
Proton Beam Radiotherapy ◽  
Suprasellar Region ◽  
Third Cranial Nerve Palsy ◽  
The Right

A 34-year-old white man with a six month history of a feeling of déjà vu presented with an acute onset of headache and blurred vision associated with nausea and vomiting. Neurological examination was significant for a right third cranial nerve palsy. Computerized tomography (CT) demonstrated a 2.0 cm rim calcified right paracavernous mass with intratumoral hemorrhage and an adjacent 2.6 cm by 2.0 cm right temporal lobe hematoma. Intraventricular hemorrhage (IVH) was present in both lateral ventricles, right more than left (Figure 1). Diagnostic cerebral angiography demonstrated no evidence of aneurysm. Brain magnetic resonance (MR) imaging revealed a 2 cm mass in the right paracavernous region extending into the suprasellar region with heterogeneous signal intensity on T1- and T2-weighted images and heterogeneous enhancement after gadolinium administration. Adjacent to the lesion was a right temporal lobe hematoma; intraventricular hemorrhage was also observed in the right lateral ventricle (Figure 2). The patient underwent a right pterional craniotomy for gross total resection of the tumour. Histopathological examination of the tumour demonstrated a low grade hyaline chondrosarcoma. The patient subsequently underwent proton beam radiotherapy and is currently 82 months out from surgery with no evidence of recurrence.

scholarly journals The extradural temporopolar approach: a review of indications and operative technique

2008 ◽  
Vol 25 (6) ◽  
pp. E3 ◽  
Author(s):  
Gabriel Zada ◽  
J. Diaz Day ◽  
Steven L. Giannotta
Keyword(s):  
Cavernous Sinus ◽  
Basilar Artery ◽  
Operative Technique ◽  
Cranial Nerves ◽  
Artery Aneurysm ◽  
Lateral Wall ◽  
Superior Cerebellar Artery ◽  
Trigeminal Schwannoma ◽  
Cerebellar Artery ◽  
Brain Retraction

Object The extradural temporopolar approach is used for enhanced exposure of the cavernous sinus and petroclival regions in the treatment of complex lesions not amenable to sole treatment via radiosurgical or endovascular methods. The authors' objective was to review the indications, surgical experience, and operative technique in a series of patients who underwent surgery with this approach. Methods The authors conducted a retrospective review to identify patients who underwent a temporopolar approach from 1992 to 2008. An orbitozygomatic craniotomy was frequently used, followed by extradural retraction of the temporal lobe. A sequential progression of bone removal at the anterior and middle skull base, followed by opening the layers of the lateral wall of the cavernous sinus was next performed to safely retract the brain and widen the exposure to the cavernous sinus, interpeduncular fossa, and upper petroclival regions. Results Sixty-six patients were identified and included in the study. The mean patient age was 49 years. The main indications for surgery were as follows: meningioma (25 patients, 38%), basilar artery aneurysm (11 patients, 17%), trigeminal schwannoma (7 patients, 11%), chordoma (5 patients, 7%), hemangioma (3 patients, 5%), pituitary adenoma (3 patients, 5%), superior cerebellar artery aneurysm (3 patients, 5%), and other lesions (9 patients, 14%). Complications included hemiparesis in 4 patients (6%), infarcts in 4 patients (6%), transient aphasia in 1 patient (1.5%), and cranial nerve paresis in 20 patients (30%). Conclusions The extradural temporopolar approach offers a relatively safe and wide exposure of the sphenocavernous and petroclival regions. Mobilization of the cranial nerves and internal carotid artery allow gentle brain retraction and maximal preservation of venous outflow. This is an advantageous approach to large tumors in these regions and for complex upper basilar artery or superior cerebellar artery aneurysms.

scholarly journals Tuberculomas in the Cavernous Sinus, Temporal Lobe and Basal Subarachnoid Spaces

2012 ◽  
Vol 13 (1) ◽  
pp. 75-76
Author(s):  
Md Raziul Haque ◽  
Forhad Hossain Chowdhury ◽  
Md Shafiqul Islam ◽  
Khandkar Ali Kawsar ◽  
AFM Momtazul Haque
Keyword(s):  
Temporal Lobe ◽  
Cavernous Sinus ◽  
Rare Case ◽  
Histopathological Study ◽  
Left Temporal Lobe ◽  
Prepontine Cistern ◽  
Radiological Features ◽  
Interpeduncular Cistern ◽  
Neoplastic Lesions ◽  
Subarachnoid Spaces

Tuberculoma is not an uncommon lesion in intracranial space specially in developing world but tuberculoma in the cavernous sinus is very rare, and only less than ten cases have been reported in the literature, till today. Preoperative neuro-radiological features of such lesions may mimic neoplastic lesions of skull base and brain and post operative histopathological study brings the ultimate diagnosis. Here we report a rare case of cavernous sinus tuberculoma where tuberculomas were also in temporal lobe and Basal subarachnoid spaces (Right cavernous sinus, left temporal lobe, right sylvian fissure, basal cistern, interpeduncular cistern and prepontine cistern).   DOI: http://dx.doi.org/10.3329/jom.v13i1.10056  JOM 2012; 13(1): 75-76   Tuberculoma is not an uncommon lesion in intracranial space specially in developing world but tuberculoma in the cavernous sinus is very rare, and only less than ten cases have been reported in the literature, till today. Preoperative neuro-radiological features of such lesions may mimic neoplastic lesions of skull base and brain and post operative histopathological study brings the ultimate diagnosis. Here we report a rare case of cavernous sinus tuberculoma where tuberculomas were also in temporal lobe and Basal subarachnoid spaces (Right cavernous sinus, left temporal lobe, right sylvian fissure, basal cistern, interpeduncular cistern and prepontine cistern). DOI: http://dx.doi.org/10.3329/jom.v13i1.10056 JOM 2012; 13(1): 75-76

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