Comparative anatomical analysis between lateral supraorbital and minipterional approaches.

Surgical neurology international Pub Date : 2024-08-30 eCollection Date: 2024-01-01 DOI:10.25259/SNI_550_2024
Ricardo Marques Lopes de Araujo, Dan Zimelewicz Oberman, Leonardo Christiaan Welling, Bipin Chaurasia, Alexander I Evins, Antonio Bernardo, Gustavo Rassier Isolan, Jose Paulo Dourado, Nicollas Nunes Rabelo, Eberval G Figueiredo
{"title":"Comparative anatomical analysis between lateral supraorbital and minipterional approaches.","authors":"Ricardo Marques Lopes de Araujo, Dan Zimelewicz Oberman, Leonardo Christiaan Welling, Bipin Chaurasia, Alexander I Evins, Antonio Bernardo, Gustavo Rassier Isolan, Jose Paulo Dourado, Nicollas Nunes Rabelo, Eberval G Figueiredo","doi":"10.25259/SNI_550_2024","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>The pterional craniotomy, described by Yasargil and Fox in 1975, constitutes the most traditional and important surgical access in vascular neurosurgery. Minimally invasive alternatives include the minipterional (MP) and lateral supraorbital (LSO) craniotomies, which avoid complications such as injury to the frontal branch of the facial nerve, temporal muscle dysfunction, depression of the craniotomy site, frontal sinus opening, and cosmetically unacceptable outcomes. We evaluated and compared the exposures provided by MP and LSO craniotomies through quantitative measurements of the surgical exposure area around the circle of Willis and parasellar regions, as well as angular and linear exposures of the internal carotid artery (ICA) bifurcation, middle cerebral artery (MCA), midpoint of the anterior communicating artery, and tip of the basilar artery (BA).</p><p><strong>Methods: </strong>Seven fresh cadavers were dissected at the São Paulo Medical Examiner's Office, SP, and three at the skull base laboratory of Weill Cornell Medical College, New York, USA. The craniotomies were performed sequentially, initially with the LSO craniotomy followed by the MP. After the craniotomy, the surgical exposure area, craniotomy area, and angular exposures in the horizontal and vertical axes were determined.</p><p><strong>Results: </strong>The MP craniotomy provided better angular exposure for the ipsilateral MCA, while the LSO craniotomy and BA provided better vertical axis exposures. The LSO craniotomy provided better angular exposure in the vertical axis for the midpoint of the anterior communicating artery and contralateral ICA bifurcation. Regarding surgical exposure and craniotomy area, there were no statistically significant differences.</p><p><strong>Conclusion: </strong>The MP craniotomy offers a significantly larger surgical exposure compared to the LSO craniotomy, with specific advantages regarding angular exposure to important neurovascular structures. This study provides important quantitative data to guide the choice between these minimally invasive access techniques in vascular neurosurgery.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11380893/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Surgical neurology international","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.25259/SNI_550_2024","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/1/1 0:00:00","PubModel":"eCollection","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0

Abstract

Background: The pterional craniotomy, described by Yasargil and Fox in 1975, constitutes the most traditional and important surgical access in vascular neurosurgery. Minimally invasive alternatives include the minipterional (MP) and lateral supraorbital (LSO) craniotomies, which avoid complications such as injury to the frontal branch of the facial nerve, temporal muscle dysfunction, depression of the craniotomy site, frontal sinus opening, and cosmetically unacceptable outcomes. We evaluated and compared the exposures provided by MP and LSO craniotomies through quantitative measurements of the surgical exposure area around the circle of Willis and parasellar regions, as well as angular and linear exposures of the internal carotid artery (ICA) bifurcation, middle cerebral artery (MCA), midpoint of the anterior communicating artery, and tip of the basilar artery (BA).

Methods: Seven fresh cadavers were dissected at the São Paulo Medical Examiner's Office, SP, and three at the skull base laboratory of Weill Cornell Medical College, New York, USA. The craniotomies were performed sequentially, initially with the LSO craniotomy followed by the MP. After the craniotomy, the surgical exposure area, craniotomy area, and angular exposures in the horizontal and vertical axes were determined.

Results: The MP craniotomy provided better angular exposure for the ipsilateral MCA, while the LSO craniotomy and BA provided better vertical axis exposures. The LSO craniotomy provided better angular exposure in the vertical axis for the midpoint of the anterior communicating artery and contralateral ICA bifurcation. Regarding surgical exposure and craniotomy area, there were no statistically significant differences.

Conclusion: The MP craniotomy offers a significantly larger surgical exposure compared to the LSO craniotomy, with specific advantages regarding angular exposure to important neurovascular structures. This study provides important quantitative data to guide the choice between these minimally invasive access techniques in vascular neurosurgery.

眶上外侧入路和小翼入路的解剖学对比分析。
背景:翼部开颅术由 Yasargil 和 Fox 于 1975 年描述,是血管神经外科最传统、最重要的手术入路。微创手术的替代方法包括蝶骨小切口(MP)和眶上外侧(LSO)开颅术,可避免面神经额支损伤、颞肌功能障碍、开颅部位凹陷、额窦开放等并发症,以及外观上无法接受的结果。我们通过定量测量 Willis 圈和髌旁区域周围的手术暴露面积,以及颈内动脉 (ICA) 分叉、大脑中动脉 (MCA)、前交通动脉中点和基底动脉 (BA) 尖端的角度和线性暴露面积,评估并比较了 MP 和 LSO 开颅术提供的暴露面积:七具新鲜尸体在巴西圣保罗法医办公室解剖,三具在美国纽约威尔康奈尔医学院颅底实验室解剖。开颅手术按顺序进行,首先进行 LSO 开颅手术,然后进行 MP 开颅手术。开颅手术后,确定手术暴露面积、开颅面积以及水平轴和垂直轴的角度暴露:结果:MP开颅术为同侧MCA提供了更好的角度暴露,而LSO开颅术和BA提供了更好的垂直轴暴露。LSO开颅手术能更好地暴露前交通动脉中点和对侧ICA分叉的垂直轴角度。在手术暴露和开颅面积方面,差异无统计学意义:结论:与 LSO 开颅术相比,MP 开颅术的手术暴露面积明显更大,在重要神经血管结构的角度暴露方面更具优势。这项研究提供了重要的定量数据,为血管神经外科选择这些微创入路技术提供了指导。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
自引率
0.00%
发文量
0
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信