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.

Isolated Trigeminal Nerve Sarcoid Granuloma Mimicking Trigeminal Schwannoma: Case Report

Neurosurgery ◽  
2003 ◽  
Vol 52 (3) ◽  
pp. 700-705 ◽  
Author(s):  
Alfredo Quinones-Hinojosa ◽  
Edward F. Chang ◽  
Saad A. Khan ◽  
Michael W. McDermott
Keyword(s):  
Cavernous Sinus ◽  
Trigeminal Nerve ◽  
Facial Pain ◽  
Frozen Section ◽  
Cranial Nerves ◽  
Lateral Wall ◽  
Neurophysiological Monitoring ◽  
Pathology Report ◽  
Trigeminal Schwannoma ◽  
Sarcoid Granuloma

Abstract OBJECTIVE AND IMPORTANCE Sarcoidosis most commonly presents as a systemic disorder. Infrequently, sarcoidosis can manifest itself in the central nervous system, with granulomas involving the leptomeninges and presenting with facial nerve weakness. Sarcoid of the trigeminal nerve is exceedingly rare and can mimic trigeminal schwannoma. We review the literature on sarcoid granulomas of the trigeminal nerve and compare their radiological features with the more common schwannoma. CLINICAL PRESENTATION A 33-year-old woman presented with a history of left-sided facial pain and numbness for 11 months, which was presumed to be trigeminal neuralgia. A trial of carbamazepine had been unsuccessful in relieving the facial pain. Her neurological examination revealed decreased facial sensation in the V1–V2 distribution. Preoperative magnetic resonance imaging demonstrated a contrast-enhancing mass centered in the left cavernous sinus with extension along the cisternal portion of the left trigeminal nerve. INTERVENTION The patient underwent a left frontotemporal orbitozygomatic craniotomy with intraoperative neurophysiological monitoring of Cranial Nerves III, V, and VI and image guidance for subtotal microsurgical resection of what appeared, grossly and on frozen section, to be a neurofibroma. The final pathology report, however, revealed a sarcoid granuloma of the trigeminal nerve. CONCLUSION The differential diagnosis of contrast-enhancing lesions in the lateral wall of the cavernous sinus should include inflammatory conditions such as sarcoidosis. We recommend that surgery for biopsy or decompression be used only for those patients in whom a diagnosis cannot be confirmed with noninvasive testing. If surgery is performed, intraoperative frozen pathology is very useful in guiding the extent of resection.

scholarly journals Surgical Approach to the Cavernous Sinus for a Trigeminal Schwannoma Resection: Technical Note and Case Report

2016 ◽  
Vol 2016 ◽  
pp. 1-5
Author(s):  
Riccardo Caruso ◽  
Alessandro Pesce ◽  
Venceslao Wierzbicki ◽  
Luigi Marrocco ◽  
Emanuele Piccione
Keyword(s):  
Cavernous Sinus ◽  
Surgical Approach ◽  
Rare Case ◽  
Postoperative Morbidity ◽  
Internal Carotid ◽  
Cranial Nerves ◽  
Lateral Wall ◽  
Technical Note ◽  
Trigeminal Schwannoma ◽  
Rare Lesion

We report a rare case of schwannoma of the lateral wall of the cavernous sinus, an exceedingly rare lesion affecting this anatomical district, and discuss salient aspects of the surgical approach to the cavernous sinus, which are traditionally considered technically challenging due to the high risk of postoperative morbidity and mortality related to the presence of the cranial nerves and internal carotid artery.

scholarly journals Anatomical variations of the superior cerebellar artery: A cadaveric study at the University Teaching Hospitals, Lusaka, Zambia

2020 ◽  
Vol 9 (2) ◽  
pp. 1789-1796
Author(s):  
Mickey Banda ◽  
Caswell Hachabizwa ◽  
Joseph Hainza ◽  
Sikhanyiso Mutemwa ◽  
Krikor Erzingastian
Keyword(s):  
Cerebral Artery ◽  
Basilar Artery ◽  
Posterior Cerebral Artery ◽  
Cranial Nerves ◽  
Anatomical Variations ◽  
University Teaching ◽  
Superior Cerebellar Artery ◽  
Common Trunk ◽  
Outer Diameter ◽  
Cerebellar Artery

The superior cerebellar artery usually arises from the terminal end of the basilar artery. It may also originate from the posterior cerebral artery and or from a common trunk with the posterior cerebral artery. The anatomical variations of superior cerebellar artery show ethnic differences, but there are few reports on African populations in particular none from Zambia. Variations of the superior cerebellar artery might cause compression symptoms of cranial nerves III, IV and V. Furthermore, the presence of such variations has been considered to be a factor in the aetiology of  aneurysms and thrombus formation leading to cerebellar infarcts. The objectives of the study were to explore anatomical variations on the origin of the superior cerebellar artery; to measure the outer diameter at its origin and the length of superior cerebellar artery to its first bifurcation; to establish the presence of duplication , triplication , hypoplasia , agenesis , fenestration and any other anomalies that were detectable. This was a descriptive cross-sectional study in which 46 post-mortem human cadaveric brains were systematically sampled. A total of 113 superior cerebellar arteries were identified in 42 male and four female cadavers of age ranging between 18 and 65 years (mean 34.05±9.237mm). Superior cerebellar artery arose from the basilar artery as a single vessel in 49.5%, the common trunk arose in 6.2% and posterior cerebral artery origin was seen in 5.7%. Overall duplication of the superior cerebellar artery was seen in 35.5% and triplication in 5.3%. Nineteen (16.8%) of the superior cerebellar arteries were hypoplastic (less than 1mm) and ninety-four (83.2%) were normal. The diameter of the superior cerebellar artery at its origin ranged 0.25mm to 2.48mm (mean 1.42±0.54mm). The length of the superior cerebellar artery to its first bifurcation ranged from 3.77mm to 33.53mm (mean 21.92±7.40mm). Statistically, gender had no significant association of superior cerebellar artery variations (p>0.05). This knowledge will improvediagnosis and management of patients with vascular disorders of the posterior circulation. The newly identified patterns could be a contribution to the SCA classification system. Key words: Superior cerebellar artery, duplication, triplication and hypoplasia

scholarly journals Extreme Lateral Supracerebellar Infratentorial Approach to the Lateral Midbrain

2018 ◽  
Vol 79 (S 05) ◽  
pp. S415-S417
Author(s):  
M. Kalani ◽  
William Couldwell
Keyword(s):  
Cranial Nerves ◽  
Sudden Onset ◽  
Superior Cerebellar Artery ◽  
Entry Zone ◽  
Cerebellar Artery ◽  
Sensory Disturbances ◽  
History Of ◽  
Supracerebellar Infratentorial Approach ◽  
The Right ◽  
Piecemeal Resection

This video illustrates the case of a 52-year-old man with a history of multiple bleeds from a lateral midbrain cerebral cavernous malformation, who presented with sudden-onset headache, gait instability, and left-sided motor and sensory disturbances. This lesion was eccentric to the right side and was located in the dorsolateral brainstem. Therefore, the lesion was approached via a right-sided extreme lateral supracerebellar infratentorial (exSCIT) craniotomy with monitoring of the cranial nerves. This video demonstrates the utility of the exSCIT for resection of dorsolateral brainstem lesions and how this approach gives the surgeon ready access to the supracerebellar space, and cerebellopontine angle cistern. The lateral mesencephalic safe entry zone can be accessed from this approach; it is identified by the intersection of branches of the superior cerebellar artery and the fourth cranial nerve with the vein of the lateral mesencephalic sulcus. The technique of piecemeal resection of the lesion from the brainstem is presented. Careful patient selection and respect for normal anatomy are of paramount importance in obtaining excellent outcomes in operations within or adjacent to the brainstem.The link to the video can be found at: https://youtu.be/aIw-O2Ryleg.

Clinicoradiological Review: Symptomatic Superior Cerebellar Artery Aneurysm Imitating Cerebellopontine Angle Tumor

Neurosurgery ◽  
2005 ◽  
Vol 56 (4) ◽  
pp. 836-840 ◽  
Author(s):  
Ricardo J. Komotar ◽  
E Sander Connolly ◽  
Alexander Khandji ◽  
George P. Teitelbaum ◽  
Sean D. Lavine
Keyword(s):  
Cerebellopontine Angle ◽  
Artery Aneurysm ◽  
Superior Cerebellar Artery ◽  
Cerebellopontine Angle Tumor ◽  
Cerebellar Artery

Superior Cerebellar Artery Aneurysm

2016 ◽  
Author(s):  
Jonathan Russin ◽  
Yashar Kalani ◽  
Aaron Cohen-Gadol
Keyword(s):  
Artery Aneurysm ◽  
Superior Cerebellar Artery ◽  
Cerebellar Artery

scholarly journals Retrosigmoid Approach for Trapping and Removal of a Distal Dissecting Superior Cerebellar Artery Aneurysm in a Child

2018 ◽  
Vol 80 (S 03) ◽  
pp. S335-S338 ◽  
Author(s):  
Javier Ros de San Pedro
Keyword(s):  
Artery Aneurysm ◽  
Vascular Lesion ◽  
Retrosigmoid Approach ◽  
Vascular Lesions ◽  
Superior Cerebellar Artery ◽  
Anterior Inferior Cerebellar Artery ◽  
Unsteady Gait ◽  
Cerebellar Artery ◽  
Preoperative Magnetic Resonance ◽  
Magnetic Resonance Imaging Mri

Objectives To demonstrate the feasibility of the retrosigmoid craniotomy for surgical management of vascular lesions located in the cerebellopontine angle (CPA). Method A previously healthy 2-year-old boy presented a sudden episode of torticollis to the left while sleeping. This episode was selflimited but it occurred two more times in a 6-day span. Torticollis worsened in the upright position, caused unsteady gait and refusal to walk from the child. The preoperative magnetic resonance imaging (MRI) showed the presence of a round, heterogenous vascular lesion in the left CPA. The lesion clearly enhanced after contrast administration. The preoperative angiography demonstrated the absence of left anterior inferior cerebellar artery anterior inferior cerebellar artery (AICA), being the left superior cerebellar artery (SCA) the supplier of the left lateral cerebellum. A blurred blush on the distal left SCA was compatible with a fusiform aneurysm. A standard retrosigmoid approach was planned for trapping and removal of the aneurysm. Results Through a left retrosigmoid craniotomy the aneurysm was approached, along with the different neurovascular structures of the CPA. The aneurysm leaned on the VII, VIII nerves complex and the superior petrosal vein, while tightly attached to the lateral cerebellum. Both proximal and distal SCA segments to the aneurysm were dissected, clipped, and divided for a complete trapping. Finally, the aneurysm was completely detached and removed in a whole piece. The patient fully recovered after surgery with no relapse of his symptoms. Conclusion The retrosigmoid craniotomy is a versatile approach that permits wide exposure of all CPA structures and adequate removal of distal aneurysms located in those cerebellar arteries supplying the lateral cerebellum.The link to the video can be found at: https://youtu.be/oEVfy4goFYM.

scholarly journals Microsurgical resection of ambient cistern arteriovenous malformation

2016 ◽  
Vol 40 (videosuppl1) ◽  
pp. 1
Author(s):  
Omar Choudhri ◽  
Michael T. Lawton
Keyword(s):  
Arteriovenous Malformations ◽  
Posterior Cerebral Artery ◽  
Cranial Nerves ◽  
Superior Cerebellar Artery ◽  
Technical Aspects ◽  
The Third ◽  
Cerebellar Artery ◽  
Basal Vein Of Rosenthal ◽  
Microsurgical Resection ◽  
Ambient Cistern

The middle tentorial incisural space, located lateral to the midbrain and medial to the temporal lobe, contains the ambient cistern through which courses the third, fourth, and fifth cranial nerves, posterior cerebral artery (PCA), superior cerebellar artery, and the choroidal arteries. Arteriovenous malformations (AVMs) in this compartment are supplied by the thalamogeniculate and posterior temporal branches of the PCA, and drain into tributaries of the basal vein of Rosenthal. We present a case of an AVM in this middle tentorial incisural space that persisted after embolization and radiosurgery, and was microsurgically resected through a subtemporal approach. This case demonstrates the anatomy of the middle incisural space and technical aspects in microsurgical resection of these rare AVMs.The video can be found here: https://youtu.be/V-dIWh8ys3E.

Sign in / Sign up

Export Citation Format

Share Document