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The transsylvian corridor through minimally invasive transcranial approaches: a comparative anatomical study
Neurosurgical Review ( IF 2.5 ) Pub Date : 2020-11-18 , DOI: 10.1007/s10143-020-01439-4
Rafael Martinez-Perez 1 , Andre Beer-Furlan 2 , Thiago Albonette-Felicio 1 , Douglas A Hardesty 1, 3 , Ahmed Mohyeldin 4 , Takuma Hara 1 , Ricardo L Carrau 1, 3 , Daniel M Prevedello 1, 3
Affiliation  

Minimally invasive transcranial approaches (MITAs) continue to expand in popularity in neurosurgery. Only few MITAs allow sufficient sylvian exposure to enable wide use of the transsylvian corridor. In this study, we aim to compare the transsylvian corridor in two MITAs: the minipterional (MPTa) and the extended supraorbital eyebrow approaches (XSEa). Eight cadaver heads were used to quantify the surgical exposure and maneuverability along the sylvian fissure and the insular lobe provided by the MPTa and the XSEa. Surgical exposure was calculated by means of the exposed length of the sylvian fissure and by the area framed within three extreme points in the insular lobe. Maneuverability was assessed by means of the surgical freedom along the sylvian cistern. XSEa provides twice the frontal exposure and half of the temporal exposure in comparison to the MPTa (p < 0.001 and p = 0.02, respectively). No significant differences were found between the two craniotomies in the length of the exposure of the sylvian fissure, area of insular exposure, or surgical freedom. Both the MPTa and the XSEa afford sufficient grades of exposure along the sylvian fissure and the insular lobe, although the viewing angle is significantly different between the two approaches. Such properties allow either to be used for microsurgery deep within the sylvian cistern. The use of additional corridors, such as the subfrontal route (XSEa) and pretemporal route (MPTa), may influence selection of either the minipterional or the extended supraorbital approaches according to the origin of the surgical pathology addressed.



中文翻译:

通过微创经颅入路的经侧裂走廊:一项比较解剖学研究

微创经颅手术 (MITAs) 在神经外科领域继续流行。只有少数 MITA 允许足够的侧裂暴露以广泛使用跨侧裂通道。在这项研究中,我们的目标是比较两个 MITA 中的经侧裂通道:微翼点入路 (MPTa) 和延长的眶上入路 (XSEa)。八个尸体头被用于量化手术暴露和可操作性沿外侧裂和由 MPTa 和 XSEa 提供的岛叶。手术暴露是通过外侧裂的暴露长度和岛叶中三个极值点内的区域计算的。机动性通过沿侧裂池的手术自由度进行评估。p  < 0.001 和p  = 0.02,分别)。两种开颅手术在外侧裂暴露长度、岛叶暴露面积或手术自由度方面没有显着差异。MPTa 和 XSEa 都提供了足够的沿外侧裂和岛叶的暴露等级,尽管两种方法的视角明显不同。这些特性允许用于外侧池深处的显微外科手术。根据手术病理的起源,额外通道的使用,例如额下入路 (XSEa) 和颞前入路 (MPTa),可能会影响微型或扩展眶上入路的选择。

更新日期:2020-11-19
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