Microsurgical and Endoscopic Approaches to the Skull Base: Anatomy, Tactics, and Techniques

 

Description:

The one-stop guide to microsurgical and endoscopic treatment of skull base lesions from global experts

A deep knowledge of regional anatomy, improved understanding of pathologies and their behaviors, technological advances, and multidisciplinary collaboration have led to more effective treatments for once inoperable skull base lesions. Microsurgical and Endoscopic Approaches to the Skull Base: Anatomy, Tactics, and Techniques by renowned skull base neurosurgeons Luis A. B. Borba and Jean G. de Oliveira presents a balanced, anatomy-based perspective on microsurgical and endoscopic approaches to manage these highly challenging lesions. The text leverages the best current scientific literature on this topic and insights from global skull base surgery experts.

Organized into 9 sections and 52 chapters, the book starts with discussion of microsurgical and endoscopic instrumentation and neurophysiological monitoring. The subsequent sections cover diverse approaches for skull base lesions involving the sphenoid and parasellar, orbit, anterior fossa, cavernous sinus, temporal bone and jugular foramen, and foramen magnum regions. Each of these sections starts with an introduction, followed by a microsurgical description of the anatomy of the impacted region.

Key Highlights

Contributions from an impressive group of internationally renowned neurosurgeons and otolaryngologists specializing in skull base pathologies

Indications, preoperative and postoperative concerns, nuances, pitfalls, tactics, techniques, and references for further reading provide a comprehensive guide to treatment

A stepwise description of the approach, high-quality four-color drawings, and illustrative cases facilitate acquisition and retention of knowledge

High-quality figures provide greater visual insights and step-by-step guidance on how to perform specific procedures

This unique textbook will help residents, fellows, and practitioners in neurosurgery and otolaryngology make an evidenced-based decision on using the most effective microsurgical and/or endoscopic approach to achieve the best outcomes in patients with skull base lesions.

 

Table of Contents:

 

Section I: Instrumentals and Equipment

1 Instrumentation for Endoscopic Skull Base Surgery

1.1 Introduction

1.2 Special Requirements for Endoscopic Approaches

1.3 Patient Positioning and Operating Room Setup

1.3.1 Positioning

1.3.2 Operating Room Setup

1.4 Endoscopes and Video Systems

1.4.1 Types of Endoscopes: Function and Management

1.4.2 Irrigation Sheaths and Pumps

1.4.3 Pneumatic Holding Arms

1.4.4 Light Sources

1.4.5 High-Definition Digital Cameras and Monitors

1.5 Surgical Instruments

1.5.1 Microdrills Handpieces and Burrs

1.5.2 Microinstruments, Dissectors, and Micro-Ultrasonic Aspirator (microCUSA)

1.6 Neuromonitoring and Neuronavigation in Endoscopic Skull Base Surgery

1.7 Conclusion

References

2 Neurosurgical Instrumentation

2.1 Operating Room

2.2 Microscope

2.3 Neuroendoscopy

2.4 Patient Positioning

2.5 Instruments

2.5.1 Bipolar Coagulator

2.5.2 Scissors

2.5.3 Dissectors

2.5.4 Needle, Suture, and Needle Holder

2.5.5 Brain Retractor

2.5.6 Suction

2.5.7 Drills

2.5.8 Tissue Forceps

2.5.9 Aneurysm and Vascular Clips

References

3 Neurophysiological Monitoring in Skull Base Surgery

3.1 Introduction

3.2 Electromyography (EMG)

3.2.1 Background

3.2.2 Cranial Nerves III, IV, and VI

3.2.3 Cranial Nerve V

3.2.4 Cranial Nerve VII

3.2.5 Cranial Nerves IX, X, and XII

3.2.6 Cranial Nerve XI

3.3 Brainstem Auditory Evoked Potential (BAEP)

3.4 Visual Evoked Potential (VEP)

3.5 Cases

3.5.1 Case 1

3.5.2 Case 2

3.5.3 Case 3

3.6 Conclusion

References

Section II: Anterior Approaches Transnasal and Transoral

4 Anatomical Landmarks of Anterior Approaches: An Endoscopic View

4.1 Introduction

4.2 Nasal Cavity

4.3 Anatomy of the Transshpenoidal, Transtuberculum, and Transplanum Approaches

4.4 Anatomy of the Transethmoidal Transcribriform Approach

4.5 Anatomy of the Transclival and Craniovertebral Junction Approaches

4.6 Anatomy of the Transpterygoid and Infratemporal Approaches

References

5 Direct Microscopic Transsphenoidal Surgery with Hybrid Use of Endoscopy

5.1 Introduction

5.2 Direct Endonasal Microscopic TSS with Hybrid Use of Endoscopy

5.2.1 Patient Preparation

5.2.2 Endonasal Stage I

5.2.3 Sphenoid Sinus Stage II

5.2.4 Intrasellar Stage III

5.2.5 Suprasellar Stage IV

5.2.6 Hybrid Use of Endoscopy

5.2.7 Closure

5.3 Conclusion

References

6 The Extended Transsphenoidal Approach (Mid-maxillotomy) to the Clivus

6.1 Introduction

6.2 Anatomical Background

6.3 Indications

6.4 Surgical Technique

6.5 Patient Positioning

6.6 Incision and Soft Tissues Dissection

6.7 Osteotomy

6.8 Nasal Dissection and Clivus Stage

6.9 Closure

References

7 The Microsurgical Transoral Approach

7.1 Introduction

7.2 Anatomy of the Craniovertebral Junction

7.3 Indications

7.4 Preoperative Evaluation

7.5 Operative Technique

7.6 Endoscopic Endonasal Approach

7.7 Postoperative Care and Complications

7.8 Conclusion

References

8 Elongated and Pediculated Pericranial Flap for Endonasal Reconstruction of the Entire Ventral Skull Base

8.1 Background

8.2 Introduction

8.3 Objective

8.4 Methods

8.5 Surgical Technique

8.6 Results

8.7 Discussion

8.8 Conclusion

References

9 Expanded Endoscopic Endonasal Approaches to the Sellar and Parasellar Regions

9.1 Introduction

9.2 Endoscopic Anatomy of the Sellar and Parasellar Regions

9.2.1 Anterior Skull Base

9.2.2 Sellar and Parasellar Regions

9.2.3 Clival Region and Posterior Skull Base

9.3 Surgical Technique, Technical Nuances, and Complications

9.3.1 Trans-sellar Approach

9.3.2 Transtuberculum Transplanum

9.3.3 Trans-cavernous and Trans-clival (Superior Third)

9.4 Illustrative Cases

9.4.1 Case 1

9.4.2 Case 2

9.5 Conclusion

References

10 The Endoscopic Transpterygoid Approach to the Parasellar and Infratemporal Fossa

10.1 Introduction

10.2 Anatomical Landmarks and Surgical Strategies

10.2.1 Zone 1: Medial Petrous Apex (Infrapetrous)

10.2.2 Zone 2: Petroclival Approaches (Infrapetrous)

10.2.3 Zone 3: Inferior Cavernous Sinus and Quadrangular Space (Suprapetrous)

10.2.4 Zone 4: Superior Portion of the Cavernous Sinus (Suprapetrous)

10.2.5 Zone 5: Transpterygoid Infratemporal Approach (Suprapetrous)

10.3 Limits of the Approach

10.4 Conclusion

References

11 Endoscopic Endonasal Transclival Approach to the Posterior Fossa

11.1 Introduction

11.1.1 Extradural Lesions

11.1.2 Intradural Lesions

11.2 Anatomy

11.3 Tactics and Techniques

11.3.1 Imaging

11.3.2 Technical Approach

11.3.3 Skull Base Reconstruction

11.4 Conclusions

References

Section III: Surgical Approaches to the Orbit

12 Microsurgical Anatomy of the Orbit

12.1 Historical Account

12.2 The Rule of Seven of the Orbit

12.3 Orbital Bones

12.4 Orbital Muscles and Vessels

12.5 Orbital Nerves

12.6 Topographical Relationships and Orbital Surgical Approaches

12.7 Conclusion

References

13 Lateral Orbitotomy Approach to the Orbit and Cavernous Sinus

13.1 Historical Background

13.2 Relevant Surgical Anatomy

13.3 Indications

13.4 Surgical Technique

13.5 Advantages and Disadvantages

13.6 Surgical Outcome and Complications

13.7 Illustrative Cases

13.7.1 Case 1: Cavernous Sinus Lesion Biopsy

13.7.2 Case 2: SOF Lesion Removal

13.7.3 Case 3: Temporal Pole Tumor Removal

13.8 Conclusion

References

14 Transcranial Approaches to the Orbit

14.1 Historical Background

14.2 Relevant Surgical Anatomy of the Orbit

14.2.1 Structure of the Orbit

14.2.2 Nerves of the Orbit

14.2.3 Blood Supply to the Orbit

14.2.4 Muscles of the Orbit

14.2.5 Lacrimal Gland

14.3 Indications for Transcranial Approaches to the Orbit

14.4 Surgical Techniques

14.4.1 Preoperative Preparation

14.4.2 The Subfrontal Route

14.4.3 The Supraorbital Route

14.4.4 The Frontotemporal Approach

14.4.5 The Superolateral Approach

14.5 General Considerations to Avoid Postoperative Complications

14.5.1 Nasal Sinuses

14.5.2 Orbital Fat

14.5.3 Brain Retraction

14.5.4 Reconstruction of OrbitalWalls

14.6 Illustrative Cases

14.6.1 Case 1: Cavernous Hemangioma of the Superomedial Orbital Quadrant

14.6.2 Case 2: Recurrent Pleomorphic Adenoma of the Lacrimal Gland with Intracranial Extension

14.6.3 Case 3: Meningioma of the Lateral Orbit

14.7 Conclusion

References

15 The Medial Endoscopic Approach to the Orbit

15.1 Introduction

15.2 Materials and Methods

15.3 Surgical Technique

15.4 Illustrative Cases

15.4.1 Case 1

15.4.2 Case 2

15.5 Discussion

15.6 Conclusion

References

Section IV: Anterior Approaches to the Skull Base

16 Microsurgical Anatomy of the Anterior Skull Base Through a Cranial View

16.1 Bony Anatomy

16.2 Neurovascular Relationships

16.3 Orbit

References

17 Microsurgical Anatomy of the Anterior Skull Base as Seen Through the Endonasal

17.1 History

17.2 Guiding Principles in Ventral Skull Base Surgery

17.3 Microsurgical Anatomy of the Anterior Cranial Base

17.4 Endocranial Surface of the Anterior Cranial Base: Overview

17.5 Sinonasal Anatomy

17.5.1 The Outer Circumferential-Radial Corridor Overview

17.6 Anatomy from Frontal Sinus to Planum Sphenoidale (Transcribriform Corridor)

17.6.1 Outer Circumferential-Radial Corridor

17.6.2 Inner Circumferential-Radial Corridor (ICRC)

17.7 Anatomy from Planum to the Superior Edge of the Sella (Transtuberculum/Transplanum Corridor)

17.7.1 Outer Circumferential-Radial Corridor (OCRC)

17.7.2 Inner Circumferential-Radial Corridor (ICRC)

17.8 Anatomy of the Orbit (Transorbital Corridor)

17.8.1 Outer Circumferential-Radial Corridor (OCRC)

17.8.2 Inner Circumferential-Radial Corridor (ICRC)

17.9 Conclusion

18 Eyebrow Supraorbital Approach for Skull Base Lesions

18.1 History of Supraorbital Craniotomy

18.2 Relevant Surgical Anatomy

18.3 Anatomical Limitations and Surgical Applications

18.4 Surgical Technique

18.4.1 Positioning and Anesthesia

18.4.2 Skin Incision

18.4.3 Craniotomy

18.4.4 Intradural Dissection

18.4.5 Closure

18.5 Advantages and Disadvantages

18.6 Illustrative Cases

18.6.1 Case 1

18.6.2 Case 2

18.7 Conclusion

References

19 Transbasal/Transcranial Microsurgical Approaches to Anterior Fossa Meningiomas

19.1 Introduction

19.2 Incidence

19.3 Clinical Features

19.3.1 Tuberculum Sellae Meningiomas

19.3.2 Olfactory Groove Meningiomas

19.3.3 Anterior Fossa Floor Meningiomas

19.4 Diagnostic Imaging

19.4.1 Skull Radiography

19.4.2 Digital Subtraction Angiography of the Internal Carotid Artery

19.4.3 Computed Tomography (CT)

19.4.4 Magnetic Resonance Imaging (MRI)

19.5 Surgical Treatment

19.6 Surgical Approaches

19.7 Preoperative Assessment

19.8 Anesthesia

19.9 Surgical Technique for the Approach of Tuberculum Sellae Meningiomas

19.9.1 Positioning

19.9.2 Frontotemporal Craniotomy with Resection of the Supraorbital Rim

19.9.3 Lateral Fissure Splitting

19.9.4 Tumor Resection

19.9.5 Optic Nerves and Chiasm

19.9.6 Arterial Dissection

19.9.7 Pituitary Stalk

19.9.8 Invasion of the Optic Canal and the Cavernous Sinus

19.9.9 Tumor Implantation

19.9.10 Closure

19.10 Surgical Technique for the Approach to Olfactory Groove Meningiomas

19.10.1 Positioning

19.10.2 Bifrontal Craniotomy

19.10.3 Dura Mater Incision

19.10.4 Tumor Resection

19.10.5 Arterial Dissection

19.10.6 Optic Nerves and Chiasm

19.10.7 Tumor Implantation

19.10.8 Closure

19.10.9 Subcranial Approach

19.11 Surgical Technique for the Approach to Meningiomas of the Anterior Fossa Floor

19.12 Postoperative Care

19.13 Results

19.14 Visual Outcome

19.15 Complications

19.16 Damage to the Pituitary Stalk

19.17 Surgical Approach

19.18 Retraction of Brain Tissue

19.19 Damage to Vessels Close to the Tumor

19.20 Mortality

References

20 Orbitocranial Approach

20.1 Introduction

20.1.1 Historical Background

20.1.2 Indications

20.2 Surgical Technique

20.2.1 Position

20.2.2 Skin Incision

20.2.3 Scalp Elevation

20.2.4 Craniotomy

20.2.5 Removal of the Orbital Rim

20.2.6 Reconstruction

20.3 Cases

20.3.1 Case 1

20.3.2 Case 2

References

21 The Extended Endoscopic Endonasal Approach to the Anterior Fossa

21.1 Introduction

21.2 Surgical Approachs

21.2.1 Transplanum Transtuberculum Approach

21.2.2 Surgical technique – transplanum transtuberculum approach

21.2.3 The Transcribriform Approach

21.2.4 Surgical technique transcribriform approach

21.2.5 Reconstruction

21.3 Clinical Cases

21.4 Conclusions

References

Section V: Anterolateral Approaches

22 Microsurgical Anatomy of the Cavernous Sinus

22.1 Introduction

22.2 The Sinus

22.3 Osseous Relationships

22.4 Nerves

22.5 Ligaments

22.6 Internal Carotid Artery and Branches

22.7 Venous Compartments

22.8 Cavernous Sinus Triangles

22.8.1 Clinoidal Triangle

22.8.2 Oculomotor Triangle

22.8.3 Supratrochlear Triangle

22.8.4 Infratrochlear Triangle (Parkinson’s Triangle)

22.9 Middle Fossa and Paraclinoid Triangles

22.9.1 Anteromedial Triangle

22.9.2 Anterolateral Triangle

22.9.3 Posterolateral Triangle (Glasscock’s Triangle)

22.9.4 Posteromedial Triangle (Kawase’s Triangle)

22.9.5 Paraclival Triangles

References

23 Transcavernous Approach

23.1 Introduction

23.1.1 Anatomy of the Cavernous Sinus and Temporal Fossa

23.1.2 Triangles of the Cavernosus Sinus

23.1.3 Triangles of the Middle Fossa

23.2 The Pretemporal Craniotomy

23.2.1 Positioning

23.2.2 Trichotomy

23.2.3 Incision

23.2.4 The Temporal Muscle

23.3 Craniotomy

23.3.1 The Exposure of the LateralWall of the Cavernous Sinus

23.3.2 The Anterior Clinoid

23.3.3 The Meckel’s Cave

23.3.4 Anterior Petrosectomy

23.3.5 Posterior Clinoid

23.4 Discussion

References

24 Microsurgical Anatomy of the Middle Fossa and Petrous Apex

24.1 Background

24.2 Anatomy .

24.2.1 Endocranial Surface and Its Limits

24.2.2 The Foramens of the Middle Fossa

24.2.3 Petrous Apex

24.3 The Middle Fossa as a Surgical Corridor

24.4 Cases

24.4.1 Case 1

24.4.2 Case 2

24.4.3 Case 4

24.5 Conclusions

References

25 Pterional Approach

25.1 Introduction

25.2 Historical Landmarks

25.3 Indications

25.4 Step by step procedure

25.4.1 Positioning

25.4.2 Trichotomy

25.4.3 Skin Incision

25.4.4 Interfascial dissection

25.4.5 Temporal muscle dissection

25.4.6 Craniotomy

25.4.7 Sphenoid wing drilling

25.4.8 Dural opening

25.4.9 Neurosurgical routes

25.4.10 Dural closure

25.4.11 Cranioplasty

25.4.12 Muscle reconstruction

25.4.13 Variations

25.5 Conclusion

25.6 Illustrative Cases

References

26 Anterolateral Skull Base: Anatomy, Surgical Technique, and Nuances

26.1 Surgical Anatomy

26.1.1 Sagittal and Axial Unlocking: A Wider Exposure to Skull Base

26.2 Extended Skin Incision and Craniotomy

26.3 Orbitomeningeal Band Dissection

26.4 Pericavernous Dissection Techniques

26.5 Anterior Clinoidectomy

26.6 Posterior Clinoidectomy

26.7 Petrous Anatomy and Anterior Petrosectomy

26.8 Carotid Anatomy and Relations

References

27 Pretemporal Approach

27.1 Introduction

27.2 Advantages of the Pretemporal Approach

27.3 Anatomical Exposure and Surgical Access

27.4 Indications

27.5 Step-by-Step Procedure

27.5.1 Patient Positioning

27.5.2 Skin Incision

27.5.3 Preservation of the STA

27.5.4 Facial Nerve Branches Preservation

27.5.5 Mobilization of the Temporal Muscle

27.5.6 Craniotomy

27.5.7 Variations and Alternative Routes

27.6 Microsurgical Access to the Interpeduncular Fossa Region

27.7 Conclusion

27.8 Illustrative Cases

References

28 Cranio-Orbit-Zygomatic (COZ) Approach

28.1 Background

28.2 Indications

28.3 Technique

28.3.1 Positioning

28.3.2 Skin Incision and Pericranial Flap

28.3.3 Subfascial Dissection

28.3.4 Zygomatic Osteotomy

28.3.5 Mobilizing the Temporal Muscle

28.4 Craniotomy

28.4.1 Cranial Flap

28.4.2 Orbital Osteotomy

28.5 Closure

28.6 Limitations

28.7 Complications and Avoidance

28.8 Illustrative Cases

28.9 Conclusions

References

29 Anterior Petrosal Approach

29.1 Introduction

29.1.1 Anatomical Background

29.1.2 Indications

29.2 Surgical Technique

29.2.1 Patient Positioning

29.2.2 Skin Incision and Soft Tissue Dissection

29.2.3 Zygomatic Osteotomy

29.2.4 Temporalis Muscle Reflection

29.2.5 Craniotomy

29.2.6 Middle Fossa Dissection

29.2.7 Closure

29.2.8 Complications

References

30 Endoscopic Approach to the Cavernous Sinus Area: Surgical Technique

30.1 Introduction

30.2 Technical Equipment and Surgical Supplies

30.3 Preoperative Preparation Stage

30.3.1 Setup of the Patient and the Surgeon

30.4 Surgical Technique

30.4.1 Stages of the Surgical Procedure

30.5 A Clinical Case

30.6 Perspectives

References

Section VI: Posterolateral Approaches

31 Temporal Bone Anatomy

31.1 Introduction

31.2 Surgical Anatomy

31.2.1 The Squamous Portion

31.2.2 The Tympanic and Styloid Portions

31.2.3 The Mastoid Portion

31.2.4 The Petrous Portion

31.3 Craniotopographic Relationships

Suggested Readings

32 Microsurgical Anatomy of the Jugular Foramen

32.1 Introduction

32.2 Anatomy

32.3 Bone and Osseous Relations

32.4 Meningeal Structure and Cranial Nerves

32.5 Vascular Structures Related to the Jugular Foramen

32.6 Muscular Relationships

32.7 Conclusions

References

33 Anatomy of the Cerebellopontine Angle: A Microscopic Perspective

33.1 A Brief Historical Review

33.2 A Brief Introduction to the Anatomy of the CPA: A Detailed Look

33.3 Surgical Anatomy of the CPA Region

33.3.1 Continent:Walls of the CPA

33.3.2 Content: The Neurovascular Complexes.

References

34 The Posterior Retrolabyrinthine Presigmoid Approach

34.1 Background

34.2 Indications

34.3 Surgical Technique

34.3.1 Patient Positioning

34.3.2 Soft TissueWork

34.3.3 BonyWork

34.3.4 Closure

34.4 Limitations

34.5 Complications and Avoidance

34.6 Illustrative Cases

34.7 Conclusions

References

35 Retrosigmoid Approach

35.1 Introduction

35.1.1 Anatomical Background

35.1.2 Indications

35.2 Surgical Technique

35.2.1 Patient Positioning

35.2.2 Skin Incision and Soft Tissue Dissection.

35.2.3 Craniotomy

35.2.4 Dural Opening and Intradural Steps

35.2.5 Closure

35.2.6 Complications

References

36 Endoscopic Assisted Approach to the Cerebellopontine Angle

36.1 History

36.2 CPA Anatomy

36.3 Advantages/Disadvantages

36.4 Indications

36.5 Vestibular Schwannoma

36.5.1 Vestibular Schwannoma Endoscopic Assisted Approach Technique

36.6 Trigeminal Schwannomas

36.6.1 Trigeminal Schwannoma Endoscopic Assisted Approach Technique

36.7 Epidermoid Tumors

36.8 Meningiomas

36.9 Other Tumors

References

37 Infratemporal Fossa Approach to the Jugular Foramen

37.1 Introduction

37.2 Anatomy

37.3 Technique and Tactics

37.3.1 Positioning

37.3.2 Incision and Superficial Dissection

37.3.3 Muscle and Cervical Region Dissection

37.3.4 Mastoidectomy and Craniotomy

37.3.5 Tactics

37.4 Closure

37.5 Conclusion

References

38 The Facial Reanimation: Multidisciplinary Approaches

38.1 Introduction

38.2 Different Facial Nerve Reconstruction Techniques

38.2.1 Direct Neurorrhaphy

38.2.2 Hypoglossal-Facial Nerve Neurorrhaphy

38.2.3 Alternatives to Classic Hypoglossal-Facial Neurorrhaphy

38.2.4 Masseteric-Facial Nerve Neurorrhaphy

38.2.5 Accessory-Facial Nerve Neurorrhaphy

38.3 Transfacial Anastomosis (Cross-Face Facial Nerve Anastomosis)

38.4 Neuromuscular Transplant

38.5 Conclusion

References

Section VII: Posterior and Lateral Approaches to the Craniocervical Junction

39 Microsurgical Anatomy of the Foramen Magnum

39.1 Brief Historical Review

39.2 Introduction

39.3 Surgical Anatomy of the FM Region

39.4 Extradural Stage

39.4.1 Nuchal Muscles and V3 Segment

39.5 Anatomy of the VA

39.5.1 Vertebral Venous Plexus

39.5.2 Nuchal Lines Method

39.6 Bone Structure and Articulations

39.6.1 Occipital Bone

39.6.2 Occipital Condyles

39.6.3 Atlanto-occipital Joints

39.6.4 Atlanto-axial Joints

39.7 Dural Stage

39.7.1 Dural Venous Sinuses

39.7.2 Surgical Tips

39.8 Intradural Stage

39.8.1 Neural Elements

39.8.2 Denticulate Ligament

39.8.3 Cerebellum

39.8.4 Nerves

39.8.5 Vascular Elements

References

40 Far-Lateral Approach and Its Variants

40.1 Background

40.2 Indications

40.3 Surgical Technique

40.3.1 Patient Positioning

40.3.2 Skin Incision

40.3.3 Intradural versus Extradural Approach

40.3.4 Soft Tissue Dissection

40.3.5 Bone Flap and Dura Opening

40.3.6 Condyle Removal: The Transcondylar Approach

40.3.7 Closure

40.4 Complications and Avoidance

40.5 Illustrative Cases

40.5.1 Case 1

40.5.2 Case 2

40.6 Conclusions

References

41 Surgical Treatment for Atlantoaxial Instability

41.1 Introduction

41.2 Atlantoaxial Dislocation

41.3 Basilar Invagination

41.4 Chiari 1 Malformation and Syringomyelia

41.5 Central or Axial Atlantoaxial Facetal Instability

41.6 Investigations

41.7 Surgery

41.7.1 Operative Technique for Lateral Mass Plate (or Rod) and Screw (Monoaxial or Polyaxial) Fixation (Goel and Laheri)

41.8 Complication Avoidance

41.9 Craniovertebral Realignment for Group A Basilar Invagination: Role of Interarticular Cages

41.10 Technique

41.11 Atlantoaxial Fixation for Group B Basilar Invagination

References

42 Endoscopic Approach to the Craniocervical Junction

42.1 Introduction

42.2 The Endoscopic Endonasal Approach

42.3 Surgical Technique and Anatomic Landmarks

42.4 The Endoscopic Transoral Approach

42.5 The Endoscopic Transcervical Approach

42.6 Surgical Technique

42.7 Approach Selection

42.7.1 Preoperative Imaging

42.8 Patient Selection

42.9 Limitations to the Endoscopic Approaches

42.10 Conclusion

References

Section VIII: Approaches to the Posterior Incisural Space

43 Anatomy of the Posterior Incisural Space: Microscopic Perspective

43.1 Introduction

43.2 Objective

43.3 Microsurgical Anatomy

43.4 Overview

43.4.1 The Posterior Incisural Space

43.4.2 The Inferior and Middle Surface of the Posterior Temporal Lobe and the Occipital Lobe

43.4.3 The Tentorium

44 Anatomy of the Posterior Incisural Space: Endoscopic Perspective

44.1 Introduction

44.2 History

44.3 Anatomy

44.4 Endoscopic-Assisted Microsurgery

44.5 Conclusion

References

45 The Occipito-polar Approach: Study of the Occipital lnterhemispheric Supratentorial Transtentorial Transfalcine Approach

45.1 Introduction

45.2 Patient Series, Anatomical Study, and Methods

45.2.1 Anatomical Study and Patient Series

45.2.2 Surgical Technique

45.3 Illustrative Surgical Cases

45.3.1 Case 1

45.3.2 Case 2

45.4 Evaluation of Surgical Outcomes of the Patients

45.5 Results

45.5.1 Anatomical Study of the Occipito-polar Approach

45.5.2 Surgical Cases

45.6 Discussion

45.7 Conclusions

45.8 Disclosures

References

46 Supracerebellar Infratentorial Approach: Microsurgical Perspective

46.1 Introduction

46.2 Preoperative Evaluation

46.3 Surgical Approach and Operative Techniques

46.4 Median SCIT Approach

46.5 Paramedian SCIT Approach

46.6 Lateral and Extreme Lateral SCIT Approach

46.7 Contralateral SCIT Approach

46.8 Intraoperative Techniques

46.9 Postoperative Management

References

47 Supracerebellar Infratentorial Approach: Endoscopic Perspective

47.1 Introduction

47.2 Evolution of a Surgical Approach

47.2.1 Supracerebellar Infratentorial Approach

47.3 Optimization of Gravity Retraction: Sitting Position

47.4 Use of the Endoscope in Neurosurgery

47.5 Nuances of the Surgical Technique

47.6 Sitting Position

47.7 Off-Midline, Minimally Invasive Craniotomy

47.8 Selection of Craniotomy Location

47.9 Representative Cases

47.9.1 Case 1

47.9.2 Case 2

47.9.3 Case 3

References

48 Supracerebellar Transtentorial Approach

48.1 Introduction

48.2 Historical Landmarks

48.3 Indications

48.4 Preoperative Assessment

48.5 Surgical Technique

48.5.1 Anesthesia and Intraoperative Neurophysiological Monitoring

48.5.2 Positioning

48.5.3 Skin Incision and Muscle Management.

48.5.4 Craniotomy

48.5.5 Dural Opening

48.5.6 Microsurgical Dissection

48.5.7 Tentorial Opening/Resection

48.5.8 Microsurgical Anatomy

48.5.9 Closure

48.6 Conclusion

48.7 Illustrative Cases

References

Section IX: Cerebrovascular Management for Skull Base Surgery

49 STA-MCA Bypass

49.1 Introduction

49.2 Historical Landmarks

49.3 Indications

49.4 Surgery

49.4.1 Preoperative Preparation

49.4.2 Anaesthesia and Monitoring

49.4.3 The Technique

49.4.4 Closure

49.4.5 Postoperative Care

49.4.6 Follow-up

49.5 Conclusion

References

50 High-Flow Cervical Carotid Artery to Middle Cerebral Artery Bypass

50.1 Introduction

50.2 Indications and Preoperative Management

50.3 Microsurgical Anatomy

50.4 Interposition Graft

50.5 Recipient Site

50.6 Donor Site

50.7 Technical Nuances

50.8 Bypass Patency and Intraoperative Troubleshooting

50.9 Conclusion

References

51 Intracranial–Intracranial Bypass for Treatment of Complex Vascular Lesions and Tumors

51.1 Introduction

51.2 Intracranial-Intracranial (IC-IC) Bypass

51.2.1 Single

51.2.2 With Graft Interposition

51.2.3 Combined

51.3 Preoperative Assessment Study

51.4 Surgical Procedure

51.5 Discussion

51.6 Conclusion

References

52 Endoscopic Endonasal Approaches for the Treatment of Vascular Lesions

52.1 Introduction

52.2 Endoscopic Anatomy during Treatment of Vascular Lesions

52.2.1 Vascular Anatomy

52.2.2 Neural Anatomy

52.2.3 Bony Anatomy

52.2.4 Dural Anatomy

52.3 Intraoperative Fluorescence and Imaging Tools in EEA for Vascular Lesions

52.3.1 Endoscopic Indocyanine Green (endoICG)

52.3.2 Sodium Fluorescein

52.3.3 Intraoperative 3D Angiography (3D-DSA)

52.4 Reconstructive Techniques in EEA

52.4.1 Nasal Phase

52.4.2 Sphenoidal Phase

52.4.3 Sealing/Packing Phase

52.5 Operative Nuances

52.6 Aneurysms

52.6.1 Anterior Circulation Aneurysms

52.6.2 Posterior Circulation Aneurysms

52.7 Complications

52.8 Cavernous Malformations

52.8.1 Technical Nuances

52.8.2 Surgical Technique

52.8.3 World Experience

52.9 Vascular Tumors of the Skull Base

52.9.1 Preoperative Evaluation

52.9.2 Intraoperative Technical Nuances

52.10 Conclusion

References

Index

Additional MedOne Access Information

 

An aparitie	30 Aug. 2021
Autor	Jean de Oliveira
Dimensiuni	216 x 279 mm
Editura	Thieme
Format	Hardcover
ISBN	9781626239661
Limba	Engleza
Nr pag	550