Immediate results of microsurgical clipping of posterior. Minisupraorbital mso approach also known as supraorbital keyhole approach and pterional pt approach have been compared in a number of studies focusing on the treatment of aneurysms 57, craniopharyngiomas 810, and meningiomas 11, and they have been described in terms of their variants and advantages, 1517. Furthermore, the incision length in the lso approach group was 8. The role of pterional keyhole approach in the microsurgical clipping. Anatomical configuration of the sylvian fissure and its. Difference between file processing system and database approach. Full text get a printable copy pdf file of the complete article 1. Clinically, a good outcome was obtained in both cases. Classic pterional approach showing temporal muscle retraction and wide bone exposure. The pterional approach can also be used with any of the combined supratentorial and infratentorial approaches to cre ate an exposure that extends from the region of the cavernous sinus to the lower brain stem. Ever since the classical pterional surgical approach was introduced by yasagil, it has been adopted worldwide for the clipping of intracerebral aneurysms19.
The selected approaches were interhemispheric approach 16,17, pterional approach 18,19, middle cranial fossa approach, and retromastoid suboccipital approach. The arcuate scalp incision is centered on the sphenoid ridge, beginning about 1 cm above the zygomatic arch and ending at the midpupillary line. A 74yearold chinese man presented with a onemonth history of recurrent headaches, vomiting and left limb atony. The subtemporal modifica tion unites a pterional craniotomy with mobilization of the zygomatic arch to expose the temporal fossa up to the tento rial edge. Convert pdf to powerpoint convert your pdfs to powerpoint. Original article clinical analysis of the simultaneous. The present study was performed to determine the postoperative outcomes of patients following frontotemporal depression reconstruction using a highdensity. Minipterional craniotomy for treatment of unruptured.
The operation time of the lso approach group was 205. The keyhole approach is especially applicable for small. Pterional approach versus unilateral frontal approach on. Whereas the product approach focuses on writing tasks in which the learner imitates, copies and transforms teacher supplied models, the process approach focuses on the steps involved in creating a piece of work. Cosmetic reconstruction of frontotemporal depression using. Tuberculum sellae meningioma is one of the most challenging surgeries among neurosurgeons. The pdf is now an open standard, maintained by the international organization for standardization iso. The mini pterional approach was first described by figueiredo et al. Although the pterional approach is commonly used for microsurgical clipping of intracranial aneurysms of anterior circulation, the incision and temporalis muscle dissection impact postoperative recovery and cosmetic outcomes.
Using the translamina terminalis route via a pterional. Difference between file processing system and database approach is that in the past, many organizations exclusively used file processing systems to store and manage data. Sublabial transsphenoidal approach and resection of pituitary tumors. Abstractbackgroundwe evaluated adverse ischemic events as early surgical results of microsurgical clipping of 44 and 34 posterior communicating artery pcoma aneurysms through the pterional transsylvian and pretemporal transclinoidal approach, respectively, between january 2007 and october 2010. Pdf immersive surgical anatomy of the pterional approach. The specifics of this approach will be discussed and associated orbital complications will be detailed. Effect of clipping anterior communicating artery aneurysms via pterional approach contralateral to supply of dominant blood. Although the pterional approach is commonly used for microsurgical clipping of intracranial aneurysms of anterior. Conversion from pdf to ppt works on all computers the operating system you use doesnt matter. Smith department of neurosurgery provide educational operative videos online covering surgical techniques for neurological and nervoussystem conditions. Thirtyfour of the 48 cases were treated with pterional subolfactory approach and 14 were treated conventionally.
Drawing depicting the position of the patients head and the incision line for the orbitozygomatic skull base approach. Recommend for intel xeon processor processors e51600 e52600. Anatomic and surgical basis of the sphenoid ridge keyhole. Craniotomy, pterional approach, surgery, sylvian fissure.
It is located on the side of the skull, just behind the temple. This approach enables, specifically, the exposure of the entire frontoparietal operculum4,5, the opening of the entire sylvian fissure6,7 and all anterior cisterns of. The pterional approach pa is a versatile anterolateral neurosurgical technique that enables access to reach different structures contained in the cranial fossae. Unruptured supraclinoid internal carotid artery aneurysm. We have read with great attention the article by yagmurlu and colleagues 9 yagmurlu k, safaviabbasi s, belykh e, et al. The data were compared with a historical control group who underwent a pterional approach between january 2003 and december 2006. All books are in clear copy here, and all files are secure so dont worry about it. Surgical aspects of the pterional approach, and in particular the left pterional approach as well as other craniofacial approaches in severe penetrating skull base injuries are discussed. The terminology of the approach comes from the pterion. Although the pterional approach is a common route for suprasellar lesions, when the craniopharyngioma extends behind the chiasma into the third ventricle, access is even more difficult, and the lamina terminalis may offer a good working window.
Get stepbystep, expert guidance on fundamental procedures in neurosurgery both in print and on video. The extended pterional approach allows excellent results. First we selected the triangles and related surgical approaches. If the inline pdf is not rendering correctly, you can download the pdf file here. File based approach 1 traditional file based systems file based system predecessor to the dbms a collection of application programs that perform services for the endusers such as the production of reports. A singlecenter comparative analysis with standard pterional approach as regard to safety and efficacy of aneurysm clipping and the advantages of reconstruction.
The classical pterional approach is attractive and widely used for many reasons, including smaller size craniotomy yet still allowing a wide frontobasal exposure and rapid access to basal cisterns and the circle of willis, without requiring extensive brain retraction. The pterion is located in the temporal fossa, approximately 2. Operative nuances vanderbilt university medical center. The approach limits unnecessary frontal and temporal lobes exposure. Efficacy and safety of the pterional keyhole approach for. Because of the development of health medical examination techniques, surgery of. Volumetric model of the skull, with annotations of major ectocranial landmarks. No surgical complications directly resulting from the eac were observed.
Yet, there is a fascinating historical background over the last 100 years, that forms the basis of the presentday pterional approach. After conversion, you can see that there are following files listed in output folder. The optimum balance between craniotomy size, temporalis muscle dissection, and microsurgical exposure are the key concepts behind the mpt approach. A malignant fibrous histiocytoma occurring on the scalp near a primary operation site is extremely rare. Drilling of the marginal tubercle to enhance exposure via. The pdf reference also defines ways that third parties can define their own encryption systems for pdf. Jun 01, 2016 in the pdf file, clinical approaches were marked at the bookmark window. Advantages of using database approach vs traditional. Patient positioning for success approach pterional, frontal, temporal and parietal approaches. For sellar tumor especially with large suprasellar or parasellar extension, this keyhole approach can be used instead of the endonasal transsphenoidal approach. Access to these lesions was gained by a lateral pterional approach with osteoclastic or osteoplastic removal of the lateral bony wallroof of the orbit, and by entering adnexal contents following elevation of the lateral rectus muscle.
Total removal of meningiomas of the anterior cranial fossa was obtained in 86. Advantages of using database approach vs traditional file processing what is a file processing system. Core techniques in operative neurosurgery, 2nd edition, provides the tools needed to hone existing surgical skills and learn new techniques, helping you minimize risk and achieve optimal outcomes for every procedure. Pterional approach to the orbits for decompression or tumor removal.
Background severe penetrating head injuries caused by pointed objects account for about 0. In the 1960s parkinson 3, 4 championed a route that exposed the cavernous sinus with less retraction of the brain then earlier approaches. Core techniques in operative neurosurgery 2nd edition pdf. Full text get a printable copy pdf file of the complete article 948k, or click on a page image below to browse page by page. Original article effect of clipping anterior communicating. It is essential for neurosurgical practice to dominate and be familiarized with its multilayer anatomy.
Careful patient selection and sufficient opening of the sylvian fissure are the key points for good outcomes and the prevention of intraoperative complications. In a typical file processing system, each department or area within an organization has its own set of files. This approach allowed for complete tumor removal in all patients. You can change the default program for pdf files to open it in a program thats more suitable and featurerich, such as acrobat reader dc or acrobat dc. Historically, the term is derived from the greek root pteron and refers to the wings that were attached to the head of hermes, the messenger of the greek gods 1.
We present our experience with the surgical treatment of olfactory groove meningiomas using a pterional approach. The pterion is the region where the frontal, parietal, temporal, and sphenoid bones join together. The pterional approach to aneurysms of the circle of willis is one of the most common approaches in vascular neurosurgery. The pterional approach has undergone numerous modifications to improve access to the sellar region and the anterior cranial fossa.
This article will detail the successful use of this singlestage approach to intra or extradural lesions that originate in the infratemporal fossa. Although the counseling approaches included are used in some of the best known and most respected treatment programs in this. Working area and angle of attack in three cranial base. Favorable surgical results can be obtained with pterional craniotomy and eac for the clipping of paraclinoid aneurysms. Pterional approach versus unilateral frontal approach on tuberculum. The pterional approach allows the surgeon to address the circle of willis and also pathological changes in the cavernous sinus area. Methodspatients undergoing pcoma aneurysm clipping were divided into two groups. While the pterional craniotomy is one of the most versatile approaches in neurosurgery, it can lead to temporal hollowing1 porous may allow extensive vascular and soft tissue ingrowth, in addition to bone ingrowth at the implantbone interface.
Download file pdf atlas of neurosurgical anatomy the pterional perspectivethe operations seen in this atlas for the main part involve aneurysms and some tumors. Retrochiasmatic craniopharyngiomas involving the anterior third ventricle are challenging to access. Thank you for using the download pdf file feature, to. Pterional approach for surgical treatment of olfactory. This allows a wide exposure of the frontoorbital region on the side of the approach. However, it can result in temporal hollowing, which causes significant craniomaxillofacial asymmetry and esthetic deformity. Efficacy and safety of the pterional keyhole approach for the. Dec 14, 2006 surgical aspects of the pterional approach, and in particular the left pterional approach as well as other craniofacial approaches in severe penetrating skull base injuries are discussed. If your pdf is in a presentation format, the conversion should be no problem. A file processing system is a method for storing and organizing computer files and the data they contain to make it easy to find and access them. The difference between the contralateral native cranium thickness and implant thickness ranges from 0. The pterional approach is the standard surgical treatment for aneurysms. The pterional approach and extradural anterior clinoidectomy.
The pterional approach pa is performed around the pterion, which represents the intersection of the frontal, temporal, parietal, and sphenoid bones. The pterional approach and extradural anterior clinoidectomy to clip paraclinoid aneurysms. However, this approach requires a wide incision of the temporalis muscle, which can lead to the cosmetic problem of temporalis atrophy. Microsoft edge is the default program for opening pdf files on windows 10. Immersive surgical anatomy of the pterional approach. The approach combines the advantages of both the classical pterional and subtemporal approaches providing unhindered exposure of the anterior portion of the tentorial incisura in dealing with. Junction of the frontal, parietal, temporal, and sphenoid bones d. On average, this means 810 millimeters of augmentation. He had undergone a successful clipping operation through the pterional approach for an anterior communicating aneurysm five years previously. Original article the role of pterional keyhole approach in. Successful clipping of carotidophthalmic aneurysms through a contralateral pterional approach. Directed toward neurosurgeons, neuroscientists, and anatomists, the book is intended to serve as an atlas of anatomy as well as a guide to clinical neurosurgery. Designed and popularized by yasargil in the 1970s, this approach consists of approaching the brain and the anterior skull base through their lateral aspect by removing the frontal and temporal bones and the greater wing of the sphenoid.
Pdf documents can contain links and buttons, form fields, audio, video, and business logic. Which of the following is an artery that comprises the circle of willis. In the superciliary group, a total of 71 aneurysms were successfully clipped without a residual sac in 70 patients with a mean age of 57 years range, 3775 years. Note that the scalp incision crosses to the opposite midpupillary line. Increments in bony removal open a wider angle in which to work more than they increase the actual amount of working area. Filebased approach 6 traditional filebased systems limitations of filebased approach. We offer a pdf version of some documents on the aafp website so you can print a formatted copy. The primary goal of product writing is an errorfree coherent text. Approach to internal medicine amazon s3 pdf book manual. Optical character recognition converts nonselectable text from scanned documents into editable office files. Pdf the pterional approach pa is a versatile anterolateral neurosurgical technique that enables access to reach different structures. The tumor was totally resected using a left pterional approach. The implant design is adjusted to provide the additional volume needed to prevent pth.
Associate pdf files to always open in reader or acrobat on. This approach provides the advantages of previous techniques, such as preserving the frontal brain and superior sagittal sinus, early devascularization of the. Pterional craniotomy is a useful approach for the treatment of a variety of intracranial pathologies. The pterional approach has been used in neurosurgery primarily for the treatment of a wide variety of neurosurgical disorders 26, 10, 11, 16. Tuberculum sellae meningioma three burr holes are made, the first is located at maccarthy keyhole, the second is located at the temporal base above the posterior part of the zygoma, and the last is located beneath the. Special article what is the better minimally invasive surgery. Pterional subolfactory approach is a procedure including dissection of olfactory tract and resection of the gyrus rectus inferior and medial to the olfactory tract. Ten triangles around cavernous sinus for surgical approach. Download approach to internal medicine amazon s3 book pdf free download link or read online here in pdf. Conclusion the pterional approach is one of the most important and versatile approaches for exposure of a variety of intracranial fig 10. They can be signed electronically, and you can easily view pdf files on windows or mac os using the free acrobat reader dc software. The bleeding points were cauterized with a bipolar coagulator to avoid a bulky skin flap. Pdf pterional trephination approach to tumors of the.
This approach provides the opportunity to treat lesions located in the anterior, middle, and upper parts of the posterior fossae and can be used alone or in combination with other approaches to make possible the management of extensive and complex. Read online approach to internal medicine amazon s3 book pdf free download link book now. Process approach to teaching writing applied in different. Atlas of neurosurgical anatomy the pterional perspective. The pterional transsylvian exposure is the commonest operative approach used by neurosurgeons to access a wide range of pathologies in the anterior, middle, and posterior cranial fossas. Frontiers cranioorbital and orbitocranial approaches to. In 1949, i saw the late sir hugh cairns approach the orbit through a single pterional trephine opening, which he enlarged with rongeurs. Immersive surgical anatomy of the pterional approach ncbi nih. Inevitably, the extent of exposure will depend on the nature of the pathology and the individual characteristics of the patients anatomy. Mayo clinic skull base and aneurysms rhoton course.
Inthe ptts approach, delicate sylvian dissection and opening ofthe sylvian. Emergency surgery in a severe penetrating skull base injury. Pterional trephination approach to tumors of the infratemporal fossa article pdf available in skull base 24. Standard approach mesh precontoured titanium mesh implants. Educational operative videos mcgovern medical school. The pterional keyhole approach offers similar microsurgical corridors with a substantially. The lateral supraorbital lso approach is a modified method of the classic pterional approach and it has advantages of short skin incision and small craniotomy compared with the pterional approach. Quantitative anatomical analysis and clinical experience with mini pterional and miniorbitozygomatic approaches for. Emergency surgery in a severe penetrating skull base. The pterional or the frontotemporosphenoidal approach is one of the most commonly used surgical approaches in neurosurgery. Eac improves the surgical field in the suprasellar and periclinoid regions. Microsurgery via the pterional keyhole approach rather than use of the standard approach can reduce surgical trauma and promote recovery 11. Introduction pterional transsylvian approach is used to treatpathologies arising from the circle of willis and its vicinity. Pterional approach marking a a representative head ct scan before.
Clipping of bilateral middle cerebral artery aneurysms. Curvilinear incision 1 cm above the zygomatic arch and 1 cm inside the external auditory canal that extends to the superior temporal line and behind the hair implantation edge. Pdf file or convert a pdf file to docx, jpg, or other file format. A primary malignant fibrous histiocytoma of the scalp and. Pterional craniotomy, interfascial dissection for preservation of the frontalis branch, sphenoid wing removal, and cosmetic cranioplasty opening and closure for chiari malformation microvascular decompression for trigeminal neuralgia and hemifacial spasm.
The extended pterional approach allows excellent results for removal of anterior. The pterional approach consists of opening the skull and approach ing the brain through its lateral aspect by removing the frontal bone, the squamous part of the temporal bone, and the greater wing of the sphenoid. Sweatband stability limit uncertainty when positioning the. Designed to correct temporal hollowing in patients who have had surgery involving the pterional approach to the brain. This publication contains information on various drug abuse counseling approaches, written by representatives of many wellknown treatment programs. Increasing the amount of bone removed by using an orbitozygomatic approach instead of a pterional approach converts a narrow space into a wide portal, allowing surgeons to work closer to the surgical target while decreasing the need for brain retraction. Surgeons can manipulate the abovementioned vital structures more effective and safer than endonasal approach.
Usual angle for pterional approach would be around 3060 head rotation to the contralateral side. Equipped with todays microsurgical instruments, the neurosurgeon finds that the pterional approach to skullbase lesions is a more natural and easier procedure than earlierday operations. Thank you for using the download pdf file feature, to download a correct pdf file, please follow the steps. Pterionallateral approach to orbital tumors europe pmc.
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