91 research outputs found
Endoscopic Endonasal Approach to Cavernous Sinus and Middle Cranial Fossa
No full textCavernous sinus surgery has evolved in the last decades moving toward less invasive approaches to reduce postoperative morbidities. Endoscopic endonasal techniques have been a revolution in skull base surgery providing a natural and direct line of sight to deep-seated skull base lesions such as the cavernous sinus, complementing the standard transcranial approaches. In this chapter, endoscopic anatomy, patient selection and contraindications, and surgical technique among clinical cases are provided
Anatomy of the inferior orbital fissure: Implications for endoscopic cranial base surgery
No full textConsidering many approaches to the skull base confront the inferior orbital fissure (IOF) or sphenomaxillary fissure, the authors examine this anatomy as an important endoscopic surgical landmark. In morphometric analyses of 50 adult human dry skulls from both sexes, we divided the length of the IOF into three segments (anterolateral, middle, posteromedial). Hemotoxylin- and eosin-stained sections were analyzed. Dissections were performed using transnasal endoscopy in four formalin-fixed cadaveric cranial specimens (eight sides); three endoscopic approaches to the IOF were performed.IOF length ranged from 25 to 35 mm (mean 29 mm). Length/width of the individual anterolateral, middle, and posteromedial segments averaged 6.46/5, 4.95/3.2, and 17.6/ 2.4 mm, respectively. Smooth muscle within the IOF had a consistent elationship with several important anatomical landmarks. The maxillary introstomy,total ethmoidectomy approach allowed access to the posteromedial segment of the fissure. The endoscopic modified, medial maxillectomy approach allowed access to the middle and posterior-medial segment. The Caldwell-Luc approach allowed complete exposure of the IOF. The IOF serves as an important anatomic landmark during endonasal endoscopic approaches to the skull base and orbit. Each of the three segments provides a characteristic endoscopic corridor, unique to the orbit and different fossas surrounding the fissure.Fil: de Battista, Juan Carlos. University of Cincinnati; Estados Unidos. Universidad Nacional de Córdoba. Facultad de Medicina. Instituto de Anatomia Normal; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Zimmer, Lee A.. University of Cincinnati; Estados UnidosFil: Theodosopoulos, Philip V.. University of Cincinnati; Estados UnidosFil: Froelich, Sebastien C.. University of Cincinnati; Estados UnidosFil: Keller, Jeffrey T.. University of Cincinnati; Estados Unidos. Mayfield Clinic; Estados Unido
Lariboisiere Hospital pre-operative surgical checklist to improve safety during transpetrosal approaches
No full textBackground: Transpetrosal approaches are technically complex and require a complete understanding of surgical and radiological anatomy. A careful evaluation of pre-operative magnetic resonance imaging and computed tomography scan is mandatory, because anatomical or pathological variations are common and may increase the risk of complications related with the approach.
Methods: Pre-operative characteristics of venous and petrous bone anatomy were analysed and correlated with intraoperative findings, using injected magnetic resonance imaging and thin-slices computed tomography scan. These data regularly checked before each transpetrosal approach were progressively included in the presented checklist.
Results: Transpetrosal approaches have been used in 101 patients. Items included in the checklist were petrous bone pneumatization, angle between petrous apex and clivus, dehiscence of petrous carotid artery, dehiscence of geniculate ganglion, distance between superior semicircular canal and middle fossa floor, distance between cochlea and middle fossa floor, sigmoid sinus dominance, transverse sigmoid sinus junction depth to the outer cortical bone, jugular bulb height (high or low), location of the vein of Labbé, characteristics of superior petrosal vein complex.
Conclusion: The presented checklist provides a systematic scheme of consultation of characteristic of venous and petrous bone anatomy for transpetrosal approaches. In our experience, the use of this checklist reduces the risk of complications related with approach, by minimizing the neglect of crucial information
The Rostral Mucosa: The Door to Open and Close for Targeted Endoscopic Endonasal Approaches to the Clivus
No full textBackground: Extended endoscopic endonasal approaches (EEAs) have progressively widened the armamentarium of skull base surgeons. In order to reduce approach-related morbidity of EEAs and closure techniques, the development of alternative strategies that minimize the resection of normal tissue and alleviate the use of naso-septal flap (NSF) is needed. We report on a novel targeted approach to the clivus, with incision and closure of the mucosa of the rostrum, as the initial and final step of the approach.
Objective: To present an alternative minimally invasive approach and reconstruction technique for selected clival chordomas.
Methods: Three cases of clival chordomas illustrating this technique are provided, together with an operative video.
Results: The mucosa of the rostrum is incised and elevated from the underlying bone, as first step of surgery. Following tumor resection with angled scope and instruments, the mucosa of the sphenoid sinus (SS) is removed and the tumor cavity and SS are filled with abdominal fat. The mucosal incision of the rostrum is then sutured. A hangman knot is prepared outside the nasal cavity and tightened after the first stitch and a running suture is performed.
Conclusion: We propose, in this preliminary report, a new targeted approach and reconstruction strategy, applying to EEAs the classic concept of skin incision and closure for transcranial approaches. With further development in the instrumentations and visualization tools, this technique may become a valuable minimally invasive endonasal approach for selected lesions
Muller's Muscle, No Longer Vestigial in Endoscopic Surgery
No full textBackground
As a thin filmy covering overlaying the inferior orbital fissure (IOF), Muller's muscle was considered a vestigial structure in humans, and for this reason, its anatomical significance was neglected. Because of increasing interest in endonasal approaches to the skull base that encompasses this region, we re-examined this structure's role as an anatomical landmark from an endoscopic perspective.
Methods
In 10 cadaveric specimens, microanatomical dissections were performed (n = 5); endoscopic dissections were performed (n = 5) via approaches of the middle turbinate or inferior turbinate, and via the Caldwell-Luc approach through the maxillary sinus. Histological examinations were performed in 20 human fetuses (Embryology Institute, Universidad Complutense de Madrid, Madrid, Spain).
Results
In cadaveric dissections, Muller's muscle was demonstrated in all specimens, serving as a bridge-like structure that spanned the entire IOF and separated the orbit from the temporal, infratemporal, and pterygopalatine fossas. Depending on which endoscopic corridor was used, a different aspect of the IOF and Muller's muscle was identified. In our endoscopic and microscopic observations, Muller's muscle was extensive, not only spanning the IOF but also extending posteriorly to reach the superior orbital fissure (SOF) and anterior confluence of the cavernous sinus. Histological analysis identified many anastomotic connections between the ophthalmic venous system and pterygoid plexus that may explain how infection or tumor spreads between these regions.
Conclusions
Muller's muscle serves as an anatomical landmark in the IOF and facilitates anatomical orientation in this region for endoscopic skull base approaches. Its recognition during endoscopic approaches allows for a better three-dimensional understanding of this anterior cranial base region.Depto. de Anatomía y EmbriologíaFac. de MedicinaTRUEpu
Combined hormonal influence of cyproterone acetate and nomegestrol acetate on meningioma: a case report
No full textExtreme Lateral Supracerebellar Infratentorial Approach: Surgical Anatomy and Review of the Literature
No full textObjective: The extreme lateral supracerebellar infratentorial (ELSI) approach has the potential to access several distinct anatomical regions that are otherwise difficult to reach. We have illustrated the surgical anatomy through cadaveric dissections and provided an extensive review of the literature to highlight the versatility of this approach, its limits, and comparisons with alternative approaches.
Methods: The surgical anatomy of the ELSI has been described using 1 adult-injected cadaveric head. Formalized noninjected brain specimens were also dissected to describe the brain parenchymal anatomy of the region. An extensive review of the literature was performed according to each targeted anatomical region. Illustrative cases are also presented.
Results: The ELSI approach allows for wide exposure of the middle and posterolateral incisural spaces with direct access to centrally located intra-axial structures such as the splenium, pulvinar, brainstem, and mesial temporal lobe. In addition, for skull base extra-axial tumors such as petroclival meningiomas, the ELSI approach represents a rapid and adequate method of access without the use of extensive skull base approaches.
Conclusions: The ELSI approach represents one of the most versatile approaches with respect to its ability to address several anatomical regions centered at the posterior and middle incisural spaces. For intra-axial pathologies, the approach allows for access to the central core of the brain with several advantages compared with alternate approaches that frequently involve significant brain retraction and cortical incisions. In specific cases of skull base lesions, the ELSI approach is an elegant alternative to traditionally used skull base approaches, thereby avoiding approach-related morbidity
Some Problems of Ethnotechnology among “Montagnards Paléonigritiques” in Northern Togo
No full textPeople classified as "montagnards paleonigritiques" inhabit
the central area of the Atakora mountains : the Tamberma, the
Kabre, the Naudemba, the Lamba, and others.
J.-C. Froelich describes their cultural features, as follows:
intensive agriculture, segmental organization, iron smelting,
habitation, nakedness, and others. His definition of "montagnards"
and "paleonigritiques" is not clear. But the existence
of a third cultural zone of the mountain dwellers between the
Guinea forest culture and the Sudan savannah culture can be
accepted.
As mentioned by J.-C. Froelich, there are common cultural
traits which exist among the people in the Atakora mountains,
the Jos Plateau, the Mandara mountains, and the Nuba Hills.
Although a common genealogical origin of these peoples cannot
be proved, the origin of the African negro culture can be approached
by examining the cultural features of the "montagnards
paleonigritiques" from the perspective of technology. In this
paper the author proposes an approach toward an analysis of the
core of African negro culture, based on field research in Northern
Togo from 1978 to 1979.departmental bulletin pape
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