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DOI: 10.1055/s-0031-1275242
© Thieme Medical Publishers
When Is Posterolateral Orbitotomy Useful in a Pterional Craniotomy? A Morphometric Study
Publication History
Publication Date:
30 March 2011 (online)
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ABSTRACT
Adding posterolateral orbitotomy to pterional craniotomy allows greater exposure of the anterolateral skull base. However, there is a paucity of literature quantifying the relative benefit of adding posterolateral orbitotomy for various surgical targets. Our study is a step to address this issue. We performed dissections of five cadaveric heads (10 sides). The anterior communicating artery (A-Com) complex, posterior chiasm (anterior third ventricular region), ipsilateral optic canal, and ipsilateral supraclinoid internal carotid artery (ICA) bifurcation were chosen as targets. A pterional craniotomy was performed and the targets were morphometrically analyzed. Subsequently, posterolateral orbitotomy was done and analysis repeated. The field of view and measurements quantifying the angle of attack were compared. Addition of orbitotomy to pterional craniotomy increased the angle of exposure to ICA bifurcation, anterior third ventricular region, and A-Com complex by average of 15%, 29%, and 50%, respectively. Our study shows the addition of a posterolateral orbitotomy to the pterional craniotomy improves the angle of attack to the anterior third ventricular region and the A-Com complex, thus supporting the use of orbitopterional craniotomy for suprasellar lesions extending into anteroinferior third ventricle and A-Com aneurysms that point superiorly/posteriorly.
KEYWORDS
Pterional craniotomy - posterolateral orbitotomy - Morphometric - study
REFERENCES
- 1 Yasargil M G. Microsurgery of CNS Tumors. Instrumentation and Equipment, Laboratory Training, Surgical Approaches, Strategies, Tactics and Techniques, Surgery and Results of Extrinsic and Intrinsic Tumors, Interventional Neuroradiology, Neuroanesthesia, Complications. New York: Thieme Medical; 1996: 36-50
- 2 Yasargil M G. Microsurgical Anatomy of the Basal Cisterns and Vessels of the Brain, Diagnostic Studies, General Operative Techniques and Pathological Considerations of the Intracranial Aneurysms. New York: Thieme Stratton; 1984: 215-233
- 3 Alaywan M, Sindou M. Fronto-temporal approach with orbito-zygomatic removal. Surgical anatomy. Acta Neurochir (Wien). 1990; 104 79-83
- 4 Honeybul S, Neil-Dwyer G, Lees P D, Evans B T, Lang D A. The orbitozygomatic infratemporal fossa approach: a quantitative anatomical study. Acta Neurochir (Wien). 1996; 138 255-264
- 5 Schwartz M S, Anderson G J, Horgan M A, Kellogg J X, McMenomey S O, Delashaw Jr J B. Quantification of increased exposure resulting from orbital rim and orbitozygomatic osteotomy via the frontotemporal transsylvian approach. J Neurosurg. 1999; 91 1020-1026
- 6 Andaluz N, Van Loveren H R, Keller J T, Zuccarello M. Anatomic and clinical study of the orbitopterional approach to anterior communicating artery aneurysms. Neurosurgery. 2003; 52 1140-1148 discussion 1148-1149
- 7 Figueiredo E G, Deshmukh P, Zabramski J M et al.. Quantitative anatomic study of three surgical approaches to the anterior communicating artery complex. Neurosurgery. 2005; 56 (2 Suppl) 397-405 discussion 397-405
- 8 Gonzalez L F, Crawford N R, Horgan M A, Deshmukh P, Zabramski J M, Spetzler R F. Working area and angle of attack in three cranial base approaches: pterional, orbitozygomatic, and maxillary extension of the orbitozygomatic approach. Neurosurgery. 2002; 50 550-555 discussion 555-557
- 9 McArthur L L. An aseptic surgical access to the pituitary body and its neighborhood. JAMA. 1912; 58 2009-2011
- 10 Smith R R, Al-Mefty O, Middleton T H. An orbitocranial approach to complex aneurysms of the anterior circulation. Neurosurgery. 1989; 24 385-391
- 11 Yasargil M G, Fox J L, Ray M W. The operative approach to aneurysms of the anterior communicating artery. In: Krayenbühl H, ed. Advances and Technical Standards in Neurosurgery. New York: Springer-Verlag; 1975. 2: 113-170
- 12 Jane J A, Park T S, Pobereskin L H, Winn H R, Butler A B. The supraorbital approach: technical note. Neurosurgery. 1982; 11 537-542
- 13 Al-Mefty O. Supraorbital-pterional approach to skull base lesions. Neurosurgery. 1987; 21 474-477
- 14 Czirják S, Szeifert G T. Surgical experience with frontolateral keyhole craniotomy through a superciliary skin incision. Neurosurgery. 2001; 48 145-149 discussion 149-150
- 15 Dare A O, Landi M K, Lopes D K, Grand W. Eyebrow incision for combined orbital osteotomy and supraorbital minicraniotomy: application to aneurysms of the anterior circulation. Technical note. J Neurosurg. 2001; 95 714-718
Bharat GuthikondaM.D.
Assistant Professor of Neurosurgery, Department of Neurosurgery
Louisiana State University Health Sciences Center-Shreveport, 1501 Kings Highway, P.O. Box 33932, Shreveport, LA 71130-33932
Email: bguthi@lsuhsc.edu