Skull Base Surgery of the Posterior Fossa

 

Description:

This text provides a comprehensive and contemporary overview of surgical approaches to lesions of the posterior fossa. It will serve as a resource for neurosurgeons and otologists who treat patients with tumors and vascular diseases of the posterior fossa. It provides a concise review of surgical strategies that address the most important pathologies affecting the posterior fossa. It is richly illustrated with photographs and illustrations of the surgical strategies covered.  All chapters are written by experts with world-wide recognition for their contributions in their respective subspecialty. Skull Base Surgery of the Posterior Fossa will be of great utility to Neurosurgeons, Otolaryngologists, and Radiation Therapists with an interest in diseases that affect the posterior fossa, as well as Senior Residents in Neurosurgery and Otolaryngology, and Fellows of Skull Base Surgery and Otology.

 

 

Table of Contents:

 

Part I: Introduction

1: Surgical Anatomy of the Posterior Fossa

Introduction

Enclosure of the Posterior Fossa

Skull Base

Neural Foramina

Tentorium

Venous Sinuses

Obstacles to Surgery

Contents of the Posterior Fossa

Arteries and Rule of Three

Veins

Special Regions

Cavernous Sinus

Clivus and Petroclival Region

Internal Auditory Meatus and Otological Structures

Jugular Foramen

Surgical Corridors and Related Anatomy

Posterior

Occipital Transtentorial

Supracerebellar Infratentorial

Suboccipital, Telovelar

Posterolateral: Retrosigmoid

Far-Lateral Approach

Posterolateral: Presigmoid

Mastoidectomy

Transcrusal and Translabyrinthine Approaches

Transcochlear and Transotic Approaches

Combined Supra-/Infratentorial Petrosal Approaches

Exposure of Jugular Foramen

Lateral

Anterolateral

Anterior

Credits

References

Part II: Approaches

2: Retrosigmoid Craniotomy and Its Variants

Background

Indications

Anatomy

Cranial and Extradural Anatomy

Intradural Anatomy

Surgical Technique

Positioning

Craniotomy Technique

Reconstruction and Closure

Complications

Conclusions

References

3: Middle Fossa and Translabyrinthine Approaches

Introduction

Preoperative Evaluation

Indications for Surgery

Patient Counseling

Surgery

General Preoperative Preparation

Surgical Technique: Middle Fossa Approach

Surgical Technique: Translabyrinthine Approach

Postoperative Care

Outcomes

Hearing Preservation

Facial Nerve Function

Complications

Cerebrospinal Fluid Leak and Meningitis

Hemorrhage

Sigmoid Sinus Thrombosis

Venous Thromboembolism

Major Neurological Complications

Summary

References

4: Posterior and Combined Petrosal Approaches

Introduction

Preoperative Planning

Role of Intraoperative Monitoring

Petrosal Approach (or Posterior Petrosal Approach)

Patient Positioning

Skin Incision and Craniotomy

Combined Petrosal Approach

Patient Positioning

Skin Incision and Craniotomy

Tumor Resection

Closure

Tricks and Pitfalls

Conclusion

References

5: Far Lateral Approach and Its Variants

Introduction

Anesthetic Technique and Positioning

Incision and Muscle Dissection

Extradural Exposure

Transcondylar Variants

Supracondylar Variants

Paracondylar Variants

Intradural Exposure

Conclusions

References

6: Endoscopic Endonasal Approach for Posterior Fossa Tumors

Introduction

Endoscopic Endonasal Transclival Approach

Extradural Posterior Fossa Tumors

Chondrosarcomas and Chordomas

Preoperative Radiological Assessment

Approach Selection

The Role of EEA

Intradural Posterior Fossa Tumors

Meningiomas

Preoperative Radiological Assessment

Pathological Anatomy

Petroclival Meningiomas

Clival Meningiomas

Foramen Magnum Meningiomas

EEA Indications in Posterior Fossa Meningiomas

Advantages and Limitations

Skull Base Reconstruction

References

Part III: Specific Diseases

7: Petroclival Meningiomas

Introduction

Natural History and Clinical Presentation

Preoperative Assessment and Planning

Radiological Imaging

Preoperative Hearing Status

Preparation for Cerebral Revascularization

The Role of Intraoperative Electrophysiological Neuromonitoring and Safe Anesthetic Techniques

Decision-Making and Treatment Strategies

Surgical Approaches

Transpetrosal Approaches

Anterior Transpetrosal (Kawase’s) Approach

Indications and Limitations

Surgical Technique and Nuances

Complications and Their Avoidance

Posterior Transpetrosal Approach

Indications and Limitations

Surgical Technique and Nuances

Complications and Their Avoidance

Combined Transpetrosal Approach

Indications and Limitations

Surgical Technique and Nuances

Complications and Their Avoidance

Treatment Outcomes in the Multimodality Management Era

Conclusions

References

8: Meningiomas of the Cerebellopontine Angle

Anatomic Classification

Surgical Approaches

APFM

MPFM

PPFM

Case Examples

Case 1: APFM

Case 2: MPFM

Case 3: PPFM: Small-Sized Tumor

Case 4: PPFM: Large-Sized Tumor

Discussion

References

9: Tentorial Meningiomas

Introduction

Incisural Type

Surgical Planning

Illustrative Case

Case 1: Retrosigmoid Approach (Fig. 9.2)

Case 2: Retrosigmoid Approach with Drilling of the Petrous Apex (Fig. 9.3)

Case 3: Anterior Transpetrosal Approach (Fig. 9.4)

Case 4: Combined Transpetrosal Approach (Fig. 9.5)

Falcotentorial Type

Surgical Planning

Illustrative Case

Case 5: Posterior Interhemispheric Transtentorial Approach (Fig. 9.7)

Lateral Type

Surgical Planning

Illustrative Case

Case 6: Retrosigmoid Approach (Fig. 9.8)

Case 7: Combined Presigmoid and Retrosigmoid Approach with Resection of Tumor Invading the Sigm

Posterior Type

Surgical Planning

Illustrative Case

Case 8: Suboccipital Approach with Resection of Invasion into the Transverse Sinus (Fig. 9.10)

Case 9: Aggressive Resection with Reconstruction of the Superior Sagittal Sinus (Fig. 9.11)

Conclusions

References

10: Foramen Magnum Meningiomas

Introduction

Clinical Presentation

Evolution of Surgical Approach to FMM

Classification

Preoperative Assessment

Surgical Considerations

Monitoring

Specific Microsurgical Considerations

Outcomes and Complications

Conclusions

References

11: Vestibular Schwannomas

Introduction

Retrosigmoid Approach

Indications

Surgical Technique

Surgical Risks and Complications

Surgical Outcome

Middle Fossa Approach

Indications

Relevant Surgical Anatomy

IAC Localization Techniques in the Petrous Bone

Surgical Technique

Bony Exposure

Dural Opening and Tumor Dissection Techniques

Limitations of the MFA

Surgical Risk and Complications

Surgical Outcome for MFA

Translabyrinthine Approach for Vestibular Schwannoma

Indications

Tumor Removal Techniques

Surgical Risks and Complications

Facial Nerve Preservation with the Translabyrinthine Approach

Limitations of Translabyrinthine Approach

Specific Perioperative Considerations

Conclusion

References

12: Epidermoid Cyst

Introduction

Clinical Presentation

Imaging and Differential Diagnosis

Management

Surgical Approach

Complication Avoidance

Surgical Outcome

Management of Recurrence and Malignant Transformation

Conclusion

References

13: Metastasis to the Posterior Fossa

Introduction

Metastasis to the Cerebellum

Metastasis to the Base of Skull

Patient Presentation

Diagnosis and Selection for Surgical Intervention

Perioperative Care and Surgical Techniques for Metastasis to the Posterior Fossa

Preoperative Care

Surgical Approaches to the Posterior Fossa

Midline Approach for Vermial or Medial Hemispheric Lesions

Paramedian and Retrosigmoid Approaches for Lateral and Far Anterolateral Lesions

Superior Cerebellar Approach

Excision of Metastatic Lesions

Postoperative Care and Complications

Stereotactic Radiosurgery for Treatment of Posterior Fossa Metastasis

Conclusions

References

14: Microsurgical Management of Posterior Fossa Vascular Lesions

Introduction

Surgical Vascular Anatomy of the Posterior Circulation

Posterior Circulation Aneurysms

Incidence of Aneurysms of the Posterior Circulation

Presentation of Aneurysms of the Posterior Circulation

Natural History of Aneurysms of the Posterior Circulation

Indications for Interventions for Aneurysms of the Posterior Circulation

Posterior Fossa Arteriovenous Malformations

Incidence of Arteriovenous Malformations of the Posterior Fossa

Presentation of Arteriovenous Malformations of the Posterior Fossa

Natural History of Arteriovenous Malformations of the Posterior Fossa

Indications for Interventions for Arteriovenous Malformations of the Posterior Fossa

Brainstem and Cerebellar Cavernous Malformations

Incidence of Cavernous Malformations of the Brainstem and Cerebellum

Presentation of Cavernous Malformations of the Brainstem and Cerebellum

Natural History of Cavernous Malformations of the Brainstem and Cerebellum

Indications for Intervention for Cavernous Malformations of the Brainstem and Cerebellum

Preoperative Evaluation

Patient History and General Considerations

Diagnostic Imaging

Operative Adjuncts

Neuromonitoring and Mapping

Intraoperative Evaluation of Blood Flow

Cerebral Protection and Hypothermia

Pharmacological Cardiac Arrest

Approaches and Approach Selection to Posterior Fossa Vascular Lesions

Approaches to the Ventral Midbrain/Posterior Fossa

Approaches to the Lateral Midbrain

Approaches to the Dorsal Midbrain

Approaches to the Ventral Pons

Approaches to the Lateral Pons

Approaches to the Dorsal Pons

Approaches to the Ventral Medulla

Approaches to the Lateral Medulla

Approaches to the Dorsal Medulla and Cervicomedullary Junction

Outcomes of Microsurgery

Posterior Circulation Aneurysms

Basilar and Vertebral Artery Aneurysms

Posterior Inferior Cerebellar Artery Aneurysms

Posterior Cerebral Artery, Superior Cerebral Artery, and Anterior Inferior Cerebellar Artery Aneur

Posterior Fossa Arteriovenous Malformations

Brainstem and Cerebellar Cavernous Malformations

Conclusions

References

Index

 

An aparitie	2018
Autor	Couldwell
Dimensiuni	17.78 x 1.42 x 25.4 cm
Editura	Springer
Format	Hardcover
ISBN	9783319670379
Limba	Engleza
Nr pag	237