Microsurgical Approaches to the Medial Temporal Region: An Anatomical Study

2006 ◽  
Vol 59 (suppl_4) ◽  
pp. ONS-279-ONS-308 ◽  
Author(s):  
Alvaro Campero ◽  
Gustavo Tro´ccoli ◽  
Carolina Martins ◽  
Juan C. Fernandez-Miranda ◽  
Alexandre Yasuda ◽  
...  
Keyword(s):  
Anatomical Study ◽  
Middle Part ◽  
Surgical Anatomy ◽  
Surgical Approaches ◽  
Temporal Region ◽  
Anterior Portion ◽  
Posterior Portion ◽  
Medial Surface ◽  
Posterior Group ◽  
Quadrigeminal Plate

Abstract OBJECTIVE: To describe the surgical anatomy of the anterior, middle, and posterior portions of the medial temporal region and to present an anatomic-based classification of the approaches to this area. METHODS: Twenty formalin-fixed, adult cadaveric specimens were studied. Ten brains provided measurements to compare different surgical strategies. Approaches were demonstrated using 10 silicon-injected cadaveric heads. Surgical cases were used to illustrate the results by the different approaches. Transverse lines at the level of the inferior choroidal point and quadrigeminal plate were used to divide the medial temporal region into anterior, middle, and posterior portions. Surgical approaches to the medial temporal region were classified into four groups: superior, lateral, basal, and medial, based on the surface of the lobe through which the approach was directed. The approaches through the medial group were subdivided further into an anterior approach, the transsylvian transcisternal approach, and two posterior approaches, the occipital interhemispheric and supracerebellar transtentorial approaches. @@RESULTS:@@ The anterior portion of the medial temporal region can be reached through the superior, lateral, and basal surfaces of the lobe and the anterior variant of the approach through the medial surface. The posterior group of approaches directed through the medial surface are useful for lesions located in the posterior portion. The middle part of the medial temporal region is the most challenging area to expose, where the approach must be tailored according to the nature of the lesion and its extension to other medial temporal areas. CONCLUSION: Each approach to medial temporal lesions has technical or functional drawbacks that should be considered when selecting a surgical treatment for a given patient. Dividing the medial temporal region into smaller areas allows for a more precise analysis, not only of the expected anatomic relationships, but also of the possible choices for the safe resection of the lesion. The systematization used here also provides the basis for selection of a combination of approaches.

Microsurgical Anatomy of the Supracerebellar Transtentorial Approach to the Posterior Mediobasal Temporal Region: Technical Considerations With a Case Illustration

2008 ◽  
Vol 62 (suppl_1) ◽  
pp. ONS1-ONS8 ◽  
Author(s):  
Roham Moftakhar ◽  
Yusuf Izci ◽  
Mustafa K. Basşkaya
Keyword(s):  
Temporal Lobe ◽  
Vascular Anatomy ◽  
Surgical Anatomy ◽  
Parahippocampal Gyrus ◽  
Temporal Region ◽  
Microsurgical Anatomy ◽  
Posterior Portion ◽  
Surgical Access ◽  
Formidable Challenge ◽  
Left Posterior

Abstract Objective: Surgical access to the posterior portion of the mediobasal temporal lobe presents a formidable challenge to neurosurgeons, and much controversy still exists regarding the selection of the surgical approach to this region. The supracerebellar transtentorial (SCTT) approach to the posterior mediobasal temporal region can be used as an alternative to the subtemporal or transtemporal approaches. The aim of this study was to demonstrate the surgical anatomy of the SCTT approach and review the gyral, sulcal, and vascular anatomy of the posterior mediobasal temporal lobe. The use of this approach in the resection of a ganglioglioma located in the left posterior parahippocam-pal gyrus is illustrated. Methods: The SCTT approach to the posterior parahippocampal gyrus was performed on three silicone-injected cadaveric heads. The gyral, sulcal, and arterial anatomy of the posterior mediobasal temporal lobe was studied in six formalin-fixed injected hemispheres. Results: The SCTT approach provided a direct path to the posterior mediobasal temporal lobe and exposed the posterior parahippocampal gyrus as well as the adjacent gyri in all of the cadaveric specimens. Through this approach, gross total resection of the ganglioglioma was possible in our patient. Conclusion: The SCTT approach provided a viable surgical route to the posterior mediobasal temporal lobe in the cadaveric studies. This approach provides an advantage over the subtemporal and transtemporal routes in that there is less temporal lobe retraction.

scholarly journals Endoscopic transorbital route to the cavernous sinus through the meningo-orbital band: a descriptive anatomical study

2017 ◽  
Vol 127 (3) ◽  
pp. 622-629 ◽  
Author(s):  
Iacopo Dallan ◽  
Alberto Di Somma ◽  
Alberto Prats-Galino ◽  
Domenico Solari ◽  
Isam Alobid ◽  
...  
Keyword(s):  
Cavernous Sinus ◽  
Sagittal Plane ◽  
Anatomical Study ◽  
Lateral Wall ◽  
Petrous Bone ◽  
Surgical Approaches ◽  
Anterior Portion ◽  
Advantages And Disadvantages ◽  
Endoscopic Transorbital ◽  
Starting Point

OBJECTIVEExposure of the cavernous sinus is technically challenging. The most common surgical approaches use well-known variations of the standard frontotemporal craniotomy. In this paper the authors describe a novel ventral route that enters the lateral wall of the cavernous sinus through an interdural corridor that includes the removal of the greater sphenoid wing via a purely endoscopic transorbital pathway.METHODSFive human cadaveric heads (10 sides) were dissected at the Laboratory of Surgical NeuroAnatomy of the University of Barcelona. To expose the lateral wall of the cavernous sinus, a superior eyelid endoscopic transorbital approach was performed and the anterior portion of the greater sphenoid wing was removed. The meningo-orbital band was exposed as the key starting point for revealing the cavernous sinus and its contents in a minimally invasive interdural fashion.RESULTSThis endoscopic transorbital approach, with partial removal of the greater sphenoid wing followed by a “natural” ventral interdural dissection of the meningo-orbital band, allowed exposure of the entire lateral wall of the cavernous sinus up to the plexiform portion of the trigeminal root and the petrous bone posteriorly and the foramen spinosum, with the middle meningeal artery, laterally.CONCLUSIONSThe purely endoscopic transorbital approach through the meningo-orbital band provides a direct view of the cavernous sinus through a simple and rapid means of access. Indeed, this interdural pathway lies in the same sagittal plane as the lateral wall of the cavernous sinus. Advantages include a favorable angle of attack, minimal brain retraction, and the possibility for dissection through the interdural space without entering the neurovascular compartment of the cavernous sinus. Surgical series are needed to demonstrate any clinical advantages and disadvantages of this novel route.

Cavernomas and Arteriovenous Malformations in the Mesial Temporal Region: Microsurgical Anatomy and Approaches

2016 ◽  
Vol 13 (1) ◽  
pp. 113-123 ◽  
Author(s):  
Alvaro Campero ◽  
Pablo Ajler ◽  
Carlos Rica ◽  
Albert Rhoton
Keyword(s):  
Arteriovenous Malformations ◽  
Temporal Lobectomy ◽  
Temporal Region ◽  
Microsurgical Anatomy ◽  
Anterior Portion ◽  
Anterior Temporal Lobectomy ◽  
Posterior Portion ◽  
Transinsular Approach ◽  
Posterior Sector ◽  
Formalin Fixed

Abstract BACKGROUND: The mesial temporal region (MTR) is located deep in the temporal lobe and it is surrounded by important vascular and nervous structures that should be preserved during surgery. OBJECTIVE: To describe microsurgical anatomy and approaches to the MTR in relation to cavernomas and arteriovenous malformations (AVMs). METHODS: Five formalin-fixed and red silicone-embedded heads of adult cadavers were used for this study. Between January 2003 and June 2014, 7 patients with cavernomas and 6 patients with AVMs in the MTR underwent surgery. RESULTS: The MTR of the cadavers was divided into 3 areas: anterior, middle, and posterior. Of the 7 patients with MTR cavernomas, 4 were located anteriorly, 2 were located medially, and 1 was located posteriorly. Of the 6 patients with MTR AVMs, 3 were located in the anterior sector, 2 in the middle sector, and 1 in the posterior sector. For the anterior portion of the MTR, a transsylvian-transinsular approach was used; for the middle portion of the MTR, a transtemporal approach was used (anterior temporal lobectomy); and for the posterior portion of the MTR, a supracerebellar-transtentorial approach was used. CONCLUSION: Dividing the MTR into 3 regions allows us to adapt the approach to lesion location. Thus, the anterior sector can be approached via the sylvian fissure, the middle sector can be approached transtemporally, and the posterior sector can be approached via the supracerebellar approach.

New Perspectives on the Surgical Anatomy and Nomenclature of the Temporal Region

2013 ◽  
Vol 132 (3) ◽  
pp. 461e-463e ◽  
Author(s):  
Justin X. O’Brien ◽  
Mark W. Ashton ◽  
Warren M. Rozen ◽  
Richard Ross ◽  
Bryan C. Mendelson
Keyword(s):  
Surgical Anatomy ◽  
Temporal Region

scholarly journals The epitrigeminal approach to the brainstem

2018 ◽  
Vol 128 (5) ◽  
pp. 1512-1521 ◽  
Author(s):  
Georgios Andrea Zenonos ◽  
David Fernandes-Cabral ◽  
Maximiliano Nunez ◽  
Stefan Lieber ◽  
Juan Carlos Fernandez-Miranda ◽  
...  
Keyword(s):  
Cavernous Malformation ◽  
Anatomical Study ◽  
Normal Subjects ◽  
Surgical Approaches ◽  
Illustrative Case ◽  
Fiber Tractography ◽  
High Definition ◽  
Entry Zone ◽  
Corticospinal Tracts ◽  
Direct Distance

OBJECTIVESurgical approaches to the ventrolateral pons pose a significant challenge. In this report, the authors describe a safe entry zone to the brainstem located just above the trigeminal entry zone which they refer to as the “epitrigeminal entry zone.”METHODSThe approach is presented in the context of an illustrative case of a cavernous malformation and is compared with the other commonly described approaches to the ventrolateral pons. The anatomical nuances were analyzed in detail with the aid of surgical images and video, anatomical dissections, and high-definition fiber tractography (HDFT). In addition, using the HDFT maps obtained in 77 normal subjects (154 sides), the authors performed a detailed anatomical study of the surgically relevant distances between the trigeminal entry zone and the corticospinal tracts.RESULTSThe patient treated with this approach had a complete resection of his cavernous malformation, and improvement of his symptoms. With regard to the HDFT anatomical study, the average direct distance of the corticospinal tracts from the trigeminal entry zone was 12.6 mm (range 8.7–17 mm). The average vertical distance was 3.6 mm (range −2.3 to 8.7 mm). The mean distances did not differ significantly from side to side, or across any of the groups studied (right-handed, left-handed, and ambidextrous).CONCLUSIONSThe epitrigeminal entry zone to the brainstem appears to be safe and effective for treating intrinsic ventrolateral pontine pathological entities. A possible advantage of this approach is increased versatility in the rostrocaudal axis, providing access both above and below the trigeminal nerve. Familiarity with the subtemporal transtentorial approach, and the reliable surgical landmark of the trigeminal entry zone, should make this a straightforward approach.

Computed Tomogram Findings of Mucous Recirculation between the Natural and Accessory Ostia of the Maxillary Sinus

2002 ◽  
Vol 16 (5) ◽  
pp. 265-268 ◽  
Author(s):  
Seung-Kyu Chung ◽  
Do Yeon Cho ◽  
Hun Jong Dhong
Keyword(s):  
Maxillary Sinus ◽  
Ring Structure ◽  
Endoscopic Examination ◽  
Mucous Secretion ◽  
Middle Portion ◽  
Anterior Portion ◽  
Posterior Portion

Background The phenomenon of recirculation involves the circulation of mucous secretion between the natural ostium and other openings and is observed mainly after surgery when the surgical opening is not connected. Methods Seven patients with a mucous stream transporting into an accessory ostium, as found during endoscopic examination, were entered into study. The coronal computed tomogram findings of the mucous recirculation were analyzed at three levels: anterior, middle, and posterior portion of it. Results The anterior portion was visualized at the level of the natural ostium in five patients. The middle portion inside the maxillary sinus was visible in six cases. The posterior portion was visualized at the level of the accessory ostium in five patients. Among the axial scans, mucous rings were visible in two patients. Conclusions The primary mucous recirculation between the natural and accessory openings is shown as a ring structure in coronal computed tomogram scans.

Left Pan-Hippocampal Low Grade Glioma—2-Stage Transsylvian Transventricular and Paramedian Supracerebellar Transtentorial Approaches: 2-Dimensional Operative Video

2018 ◽  
Vol 16 (3) ◽  
pp. E82-E82
Author(s):  
Juan C Fernandez-Miranda
Keyword(s):  
Tumor Resection ◽  
Spatial Relationship ◽  
Low Grade Glioma ◽  
Parahippocampal Gyrus ◽  
Surgical Approaches ◽  
Low Grade ◽  
Fiber Tractography ◽  
High Definition ◽  
Posterior Portion ◽  
Fiber Tracts

Abstract The surgical goal for low-grade gliomas (LGGs) is to maximize resection while minimizing morbidity. Pan-hippocampal LGGs extend from the hippocampal head to the hippocampal tail, and involve the parahippocampal gyrus and uncus. Given their anteroposterior extension, they cannot be completely removed with 1 single approach, requiring a 2-stage front-to-back operation.  In this video, we present the case of a 52-yr-old man with new onset of generalized seizures and a dominant-side, nonenhancing, pan-hippocampal infiltrative lesion compatible with a low-grade glioma. Preoperative high-definition fiber tractography (HDFT) showed the spatial relationship of the tumor with surrounding fiber tracts, such as the arcuate, inferior fronto-occipital, and middle longitudinal fascicles, and optic radiations.  Surgical resection was planned in 2 separate stages. The first stage consisted of a transsylvian transinferior insular sulcus approach to the extra- and intraventricular aspects of the uncohippocampal region. The entire anterior and middle portions of the tumor were successfully removed with minimal morbidity, including transient naming difficulties and permanent superior quadrantanopia. Postoperative HDFT showed preservation of all fiber tracts, except for a portion of Meyer's loop and the inferior-most aspect of the inferior fronto-occipital fascicle. The second stage was completed 8 wk later and consisted of a paramedian supracerebellar-transtentorial approach on sitting position. The posterior portion of the tumor was entirely removed to achieve a complete macroscopic tumor resection. The final diagnosis was IDH1-positive LGG.  Pan-hippocampal tumors remain a surgical challenge but accurate knowledge of surgical neuroanatomy and surgical approaches facilitates their safe and effective treatment.  The patient signed an informed consent including the use of photographic and video material for educational or academic purposes.

scholarly journals Repair of the Malpositioned Lower Lid

2017 ◽  
Vol 33 (06) ◽  
pp. 598-605 ◽  
Author(s):  
David Chan ◽  
Mofiyinfolu Sokoya ◽  
Yadranko Ducic
Keyword(s):  
Surgical Outcomes ◽  
Lower Eyelid ◽  
Surgical Anatomy ◽  
Surgical Approaches ◽  
Eyelid Surgery ◽  
Management Techniques

AbstractComplications from surgical approaches to the orbit can be associated with debilitating morbidity and negative surgical outcomes. The surgeon must be familiar with the different factors that predispose a patient to these complications and be facile with techniques to avoid them. In this article, the authors discuss the surgical anatomy of the lower eyelid, as well as various complications that result from eyelid surgery, including lower lid retraction, ectropion, entropion, canthal malposition, and midface descent. They also discuss various management techniques that are employed in addressing these complications.

Endoscopic Endonasal Approaches to the Clivus with No Violation of the Nasopharynx: Surgical Anatomy and Clinical Illustration

2021 ◽  
Author(s):  
Carlos D. Pinheiro-Neto ◽  
Laura Salgado-Lopez ◽  
Luciano C.P.C. Leonel ◽  
Serdar O. Aydin ◽  
Maria Peris-Celda
Keyword(s):  
Posterior Fossa ◽  
Cerebrospinal Fluid Leak ◽  
Craniovertebral Junction ◽  
Foramen Magnum ◽  
Surgical Anatomy ◽  
Csf Leak ◽  
Surgical Approaches ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Endoscopic Endonasal

Abstract Background Despite the use of vascularized intranasal flaps, endoscopic endonasal posterior fossa defects remain surgically challenging with high rates of postoperative cerebrospinal fluid leak. Objective The aim of the study is to describe a novel surgical technique that allows complete drilling of the clivus and exposure of the craniovertebral junction with preservation of the nasopharynx. Methods Two formalin-fixed latex-injected anatomical specimens were used to confirm feasibility of the technique. Two surgical approaches were used: sole endoscopic endonasal approach and transnasion approach. The sole endonasal approach was used in a patient with a petroclival meningioma. Results In both anatomical dissections, the inferior clivectomy with exposure of the foramen magnum was achieved with a sole endoscopic endonasal approach. The addition of the transnasion approach helped to complete drilling of the inferior border of the foramen magnum and exposure of the arch of C1. Conclusion This study shows the anatomical feasibility of total clivectomy and exposure of the craniovertebral junction with preservation of the nasopharynx. A more favorable anatomical posterior fossa defect for the reconstruction is achieved with this technique. Further clinical studies are needed to assess if this change would impact the postoperative CSF leak rate.

Memoirs: The Chondrocranium of Calotes versicolor (Daud.) with a Desription of the Osteocranium of a just-hatched Young

1946 ◽  
Vol s2-87 (347) ◽  
pp. 237-297
Author(s):  
L. S. RAMASWAMI
Keyword(s):  
Ventral Side ◽  
Otic Capsule ◽  
Anterior Portion ◽  
Posterior Portion ◽  
Early Stages ◽  
Median Part ◽  
Dorsal Portion ◽  
Calotes Versicolor ◽  
Anterior Semicircular Canal ◽  
Atlas And Axis

1. In the earliest stage of Calotes studied, the basal plate is confluent with the pleurocentrum of the atlas and axis vertebrae. Later, a joint appears between the hypocentral condyle and the first vertebra. This shows that, at least temporarily, the elements of the anterior sclerotomic half in this region are in continuity with the posterior in front as happens in the vertebral region. The occipito-atlantic joint is, therefore, intravertebral and intersegmental as in other Lacertilia. 2. The anterior semicircular canal is completely separated for a short distance from the remaining otic capsule. The gap is filled with connective tissue. 3. The intervestibular septum shows a lateral foramen which transmits nothing and the utricular connexion between the anterior and posterior chambers passes posteriorly to the median part of the septum and, therefore, a medial orifice is not formed. 4. The preoptic roots, the orbital cartilages, and metoptic pila are paired in early stages; the orbital cartilage connects the preoptic root, pila metoptica and pila antotica dorsally. Later the two preoptic roots merge to form a median preoptic pillar, the orbital cartilages anteriorly unite to form the planum supraseptale, while posteriorly also the orbital cartilages (taenia medialis) unite at the region of the hypophysial foramen. This posterior united portion is met by a median vertical pillar (formed by the fusion of cartilago hypochiasmatica, subiculum infundibuli, and pilae metopticae) arising from the trabecula communis. The single septal fenestra is divided into an anterior larger and a posterior optic by the formation of median interorbital pillar from the ventral interorbital septum which meets the posterior portion of the planum supraseptale. The ventral portion of the interorbital septum is never noticed to be paired; the taenia marginalis is absent. However, short projections from the posterodorsal margin of the planum and from the anterodorsal face of the otic capsule represent the reminiscence of marginalis connexion. A supratrabecular bar is absent. 5. In the nasal capsule, a concha nasalis is absent; therefore, the lateral nasal glands are unenclosed in a cartilaginous capsule. The anterior portion of the paranasal cartilage unites with the dorsal portion of the lamina transversalis anterior, and the latter gives rise to an ectochoanal cartilage, but a paraseptal cartilage is absent. On the ventral side, from the free median margin of the lamina orbitonasalis, there arises a short projection which represents the posterior portion of the paraseptal cartilage. 6. The pterygoquadrate shows a free streptostylic quadrate, a processus ascendens which ossifies into the epipterygoid, a processus pterygoideus only in early stages, a basipterygoid articulation by a free meniscus cartilage, and an otic articulation with the crista parotica and processus paroticus by the quadrate. 7. The columella auris shows a ligamentary processus dorsalis connexion with the processus paroticus, a cartilaginous processus internus which articulates with the quadrate, a processus ccessorius anterior which is connected with the quadrate by a ligament, and a ligamentary connexion between the pars superior of the insertion plate and processus paroticus. The processus accessorius posterior-ceratohyal connexion was not noticed. There is also a muscle (a part of M. stylohyoid) spanning the pars superior and crista parotica. The pars superior-paroticus ligamentary connexion, with the chorda tympani running laterally to it, is homologized with the laterohyal of Sphenodon and the crocodile. 8. The hyoid apparatus shows a processus. lingualis and cornuhyale (paired hypo- and ceratohyals) arising from a median basihyal and two pairs of ceratobranchials. 9. In the osteocranium, the oto-occipital of each side is formed by the fusion of opisthotic and exoccipital, while the supraoccipital is formed by an ossification in the tectum and its fusion with the two epiotics formed in the sinus region of the otic capsule. The basioccipital and the composite ‘sphenoid’ are not united. The pleurosphenoid ossifies in the pila antotica. The epipterygoid is connected at its dorsal end with the parietal by a ligament, and ventromedially it is free from the meniscus cartilage. The frontals and parietals are paired in the stage examined, and in the adult the parietals of each side fuse, as also the frontals.

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