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This anatomic study evaluated the extent that a fronto-orbital osteotomy (FOO) added to a bilateral frontal craniotomy widened the exposure to the midline compartment of the anterior, middle, and posterior cranial fossae. The goal was to determine if osteotomy would significantly increase angles for two targets: the foramen magnum (FM) and anterior...
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... the supraorbital nerve and vascular bundle were separated from their foramina, the periorbita was stripped circumferentially. Periorbita was dissected $2.5 cm posteriorly and extending medially up to the anterior ethmoidal artery. The temporalis muscles were reflected laterally, leaving a cuff of muscle on the bone flap to facilitate closure (Fig. ...
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The objective of the study is to describe our experience in the surgical management of foramen magnum meningiomas with regard to the clinical-radiological findings, the surgical approach and the outcomes after mid-term follow up. Over a 5-year period, 15 patients presenting with meningiomas of the foramen magnum underwent surgical treatment. The me...
Cranial nerve foramina are integral exits from the confines of the skull. Despite their significance in cranial nerve pathologies, there has been no comprehensive anatomical review of these structures. Owing to the extensive nature of this topic we have divided our review into two parts; Part II, presented here, focuses on the foramina of the poste...
Configuration and size of the foramen magnum and posterior fossa plays an important role in the pathophysiology of the posterior fossa and craniovertebral junction disorders. This study is aimed to find out various dimensions of the foramen magnum and posterior fossa.
This is a prospective study of 100 consecutive normal computerized tomography (CT...
![Table 8 . Current and historical data on linear diameters [mm] and area...](profile/Jerzy-Walocha/publication/233805886/figure/tbl2/AS:669293339484179@1536583375701/Current-and-historical-data-on-linear-diameters-mm-and-area-mm-2-of-the-foramen_Q320.jpg)
Background:
The foramen magnum is an important anatomical opening in the base of the skull through which the posterior cranial fossa communicates with the vertebral canal. It is also related to a number of pathological conditions including Chiari malformations, various tumours, and occipital dysplasias. The aim of the study was to evaluate the mor...
Background:
The clivus is a bone region between dorsum cella and foramen magnum. It can be evaluated very clearly in routine brain magnetic resonance imaging (MRI) dueto its central location.
Objectives:
Quantitative and qualitative evaluation of the clivus and its changes according to age in a group of healthy people.
Patients and methods:
Th...
Citations
... It has been demonstrated to be safe and effective in treating aneurysms of the bifurcation of the internal carotid and middle cerebral arteries. Some isolated reports have suggested that an extended variation in this approach, involving the removal of the orbital roof, pterion, sphenoid wing, and anterior clinoid process, along with an extradural anterior clinoidectomy, can further expand the surgical field and provide access to the most profound areas of the skull base [15][16][17][18][19][20][21][22][23][24]. ...
Unlabelled:
The sphenoid ridge approach (SRA) was initially described as a surgical technique for treating vascular pathologies near the Sylvian fissure. However, limited studies have systematically explored the use of skull base techniques in pediatric patients. This study investigated an extended variation in the sphenoid ridge approach (E-SRA), which systematically removed the pterion, orbital walls (roof and lateral wall), greater sphenoid wing, and anterior clinoid process to access the base of the skull.
Objective:
This report aimed to evaluate the advantages of the extradural removal of the orbital roof, pterion, sphenoid wing, and anterior clinoid process as a complement to the sphenoid ridge approach in pediatric patients.
Patients and methods:
We enrolled 36 patients with suspected neoplastic diseases in different regions. The E-SRA was performed to treat the patients. Patients were included based on the a priori objective of a biopsy or a total gross resection. The surgical time required to complete the approach, associated bleeding, and any complications were documented.
Results:
Our results demonstrated that the proposed a priori surgical goal, biopsy, or resection were successfully achieved in all cases. In addition, using the E-SRA technique was associated with a shorter operative time, minimal bleeding, and a lower incidence of complications. The most frequently encountered complications were related to dural closure.
Conclusions:
The extended sphenoid ridge approach represents a safe and effective option for managing intracranial tumors in pediatrics.
... More frequently, the area of access has been measured indirectly (Table S1, Fig. 2a, b). Alaywan and Sindou [4] introduced the concept of the Bfield of view angle^ (Fig. 2a), which has been used extensively [1,3,4,10,15,22,23,27,29,34,38,39,41,42,44,47,50,51,56,57,62,66,67,75,82,83,89,94,97,100,103,104], with varying technology ( Table 2). ...
There is a growing awareness of the need for evidence-based surgery and of the issues that are specific to research in surgery. Well-conducted anatomical studies can represent the first, preclinical step for evidence-based surgical innovation and evaluation. In the last two decades, various reports have quantified and compared neurosurgical approaches in the anatomy laboratory using different methods and technology. The aim of this study was to critically review these papers. A PubMed and Scopus search was performed to select articles that quantified and compared different neurosurgical approaches in the preclinical setting. The basic characteristics that anatomically define a surgical approach were defined. Each study was analyzed for measured features and quantification method and technique. Ninety-nine papers, published from 1990 to 2013, were included in this review. A heterogeneous use of terms to define the features of a surgical approach was evident. Different methods to study these features have been reported; they are generally based on quantification of distances, angles, and areas. Measuring tools have evolved from the simple ruler to frameless stereotactic devices. The reported methods have each specific advantages and limits; a common limitation is the lack of 3D visualization and surgical volume quantification. There is a need for a uniform nomenclature in anatomical studies. Frameless stereotactic devices provide a powerful tool for anatomical studies. Volume quantification and 3D visualization of the surgical approach is not provided with most available methods.
... Anatomical and clinical reports have documented the benefits of the complementary addition of an orbital osteotomy in terms of increased exposure and decreased incidence of iatrogenic brain injury because of the decreased need for brain retraction and the obviation of sylvian fissure dissection. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] However, in our used for its selection. 3,[18][19][20][21][22][23][24][25] To date, no morphometric criteria exist to aid the surgeon during the preoperative planning phase in the selection of additional orbitotomy. ...
... 3,8,[21][22][23][26][27][28][29] However, these morphometric data revealed a large variability in the angulation encountered in the sagittal angle and the consequent increments of exposure afforded by orbitotomy. 1,2,4,10,11,15,25,30 In the operative field, this translates into the impression that, at times, the addition of an orbitotomy and its added risks and surgical times may be unnecessary and on other occasions may be of significant value. Furthermore, because these measurements were taken on a bidimensional image, the measurements of the real angles, which are a product of oblique lines, were potentially affected. ...
... For those patients, orbital osteotomy affords > 10 degrees of increased exposure, which translates in increments that range from 75 to 137% in the sagittal plane. 1,2,4,10,11,15,25,30 According to our analysis, orbital heights of 11 mm are consistently associated with angles within the 20-degree range. Therefore, we concluded that patients with orbital heights of ! ...
Objectives In anatomic and radiologic morphometric studies, we examine a predictive method, based on preoperative imaging of the anterior cranial base, to define when addition of orbital osteotomy is warranted.
Design Anatomic and radiographic study.
Setting In 100 dry skulls, measurements in the anterior cranial fossa included three lines and two angles based on computerized tomography (CT) scans taken in situ and validated using frameless stereotactic navigation. The medial angle (coronal plane) was the intersection between the highest point of both orbits and the midpoint between the two frontoethmoidal sutures to each orbital roof high point. The oblique angle (sagittal plane) was the intersection at the midpoint of the limbus sphenoidale.
Results No identifiable morphometric patterns were found for our classification of anterior fossae; the two-tailed distribution pattern was similar for all skulls, disproving the hypothetical correlation between visual appearance and morphometry. Orbital heights (range: 6.6–18.7 mm) showed a linear relationship with medial and oblique angles, and they had a linear distribution relative to angular increments. Orbital heights > 11 mm were associated with angles ≥ 20 degrees and more likely to benefit from orbitotomy.
Conclusion Preoperative CT measurement of orbital height appears feasible for predicting when orbitotomy is needed, and it warrants further testing.
... As expected, the angle of basal view increased by 11 ± 3°, or 56.6%, with removal of the orbital rim, a finding similar to that previously reported by us and others. 1,2,4,10,11,14 The aggregate of these arbitrarily selected parameters was summarized in a more "gestaltic" concept, that is, the operative view, which is the final view and vector of attack afforded by each approach. In a sequence starting with the pterional approach, followed by the supraorbital craniotomy, and ending in the transorbital craniotomy, we found that the operative view results in anterior translation of the field, with an increasing widening of a rhomboidal field, as seen with the pterional approach, into a rather pentagonal field as seen with the transorbital approach, which has the widest field. ...
Background:
The anatomy laboratory can provide the ideal setting for the preclinical phase of neurosurgical research. Our purpose is to comprehensively and critically review the preclinical anatomical quantification methods used in cranial neurosurgery.
Methods:
A systematic review was conducted following the PRISMA guidelines. The PubMed, Ovid MEDLINE, and Ovid EMBASE databases were searched, yielding 1667 papers. A statistical analysis was performed using R.
Results:
The included studies were published from 1996 to 2023. The risk of bias assessment indicated high-quality studies. Target exposure was the most studied feature (81.7%), mainly with area quantification (64.9%). The surgical corridor was quantified in 60.9% of studies, more commonly with the quantification of the angle of view (60%). Neuronavigation-based methods benefit from quantifying the surgical pyramid features that define a cranial neurosurgical approach and allowing post-dissection data analyses. Direct measurements might diminish the error that is inherent to navigation methods and are useful to collect a small amount of data.
Conclusion:
Quantifying neurosurgical approaches in the anatomy laboratory provides an objective assessment of the surgical corridor and target exposure. There is currently limited comparability among quantitative neurosurgical anatomy studies; sharing common research methods will provide comparable data that might also be investigated with artificial intelligence methods.
Purpose of review:
Classical orbital approaches in skull base surgery have involved large incisions with extensive bone removal resulting in prolonged recovery with associated morbidity and mortality. The purpose of this review is to explore recent advances in skull base surgery that are applicable to the orbital surgeon.
Recent findings:
Transnasal endoscopic surgery provides access to the medial 180 degrees of the orbit. Access to the lateral 180 degrees may be obtained using transmaxillary and transcranial techniques. Transorbital approaches and multiport techniques further expand the reach of the skull base surgeon. These minimally invasive techniques are supplanting the classical pterional, frontotemporal, frontotemporal orbitozygomatic, frontal, and subfrontal approaches.
Summary:
The role of the orbital surgeon in skull base surgery is changing. Transnasal and transcranial approaches to orbital disorders using minimally invasive techniques are becoming more common. In addition, transorbital access to the skull base, paranasal sinuses, and anterior and middle cranial fossa is offering new opportunities for the orbital surgeon.
Object:
The transbasal approach (TBA) is an anterior skull base approach, which provides access to the anterior skull base, sellar-suprasellar region, and clivus. The TBA typically involves a bifrontal craniotomy with orbital bar and/or nasal bone osteotomies performed in 2 separate steps. The authors explored the feasibility of routinely performing this approach in 1 piece with a quantitative cadaveric anatomical study, and present an operative case example of their approach.
Methods:
Seven latex-injected cadaveric heads underwent a 1-piece TBA, followed by additional bone removal typical for a traditional 2-piece approach. Six surgical angles relative to the pituitary stalk, as well as the surface area of the orbital roof osteotomy, were measured before and after additional bone removal. The vertical angle from the frontonasal suture to the foramen cecum was measured in all specimens. In addition to an anatomical study, the authors have used this technique in the operating room, and present an illustrative case of resection of an anterior skull base meningioma.
Results:
Morphometric results were as follows: the vertical angle from the frontonasal suture to the foramen cecum ranged from 17.4° to 29.7° (mean 23.8° ± 4.8°) superiorly. Of the 6 surgical angle measures, only the middle horizontal angle was increased in the 2-piece versus the 1-piece approach (mean 43.4° ± 4.6° vs 43.0° ± 4.3°, respectively; p = 0.049), with a mean increase of 0.4°. The surface area of the orbital osteotomy was increased in the 2-piece versus the 1-piece approach (mean 2467 mm(2) ± 360 mm(2) vs 2045 mm(2) ± 352 mm(2), respectively; p < 0.001). The patient in the illustrative clinical case had a good outcome, both clinically and cosmetically.
Conclusions:
The 1-piece TBA provides an alternative to the traditional 2-piece approach. It allows easier reconstruction, potentially decreased operative time, and improved cosmesis. While more of the orbital roof can be removed with the 2-piece approach, this additional bone removal offers only a small increase in 1 of 6 surgical angles that were measured.
The present study was undertaken to determine the morphometric relationships between specific aspects of the cranial anterior and middle fossae because of their importance as landmarks in surgical approaches to the skull base. Bilateral and midline measurements were made between specific anatomic landmarks. The mean midline anteroposterior width of the lesser wing of the sphenoid and distance from the crista galli to the tuberculum sellae were 20 and 35.6 mm, respectively. Significant differences (P<0.05) between right and left sides measurements were observed for the length of the lesser wing of the sphenoid (46.6 mm right, 44.8 mm left), the distance between the crista galli and the lateral tip of the sphenoid (53.1 mm right, 51.1 mm left), and the angle subtended by the distance between the tuberculum sellae and the internal acoustic meatus (57.3 degrees right, 55.1 degrees left). No other differences in bilateral measurements were observed. The mean length of the lateral tip was 2.6 mm; the mean distance between the crista galli and the midpoint of the lesser wing was 31.5 mm; the mean distances between the foramen ovale and the anterior clinoid process and the midpoint of the lesser wing were 23.0 and 32.1 mm, respectively. The mean distances between the internal acoustic meatus and the lateral tip and the tuberculum sellae were 55.9 and 49.5 mm, respectively. The mean angle between the midline and the lateral tip measured at the crista galli was 59.10 degree. The mean angle subtended by the distance from the crista galli to the tuberculum sellae at the lateral tip was 43.30 degree. A sound knowledge and understanding of the relationships between morphometric measurements and the relevant anatomic structures in relation to the sphenoid may be of use to neurosurgeons.
Cranial base fractures still represent a challenging issue. A multidisciplinary approach and the contribution of different specialists is mandatory. There is still a controversy regarding the correct approach to these trauma due to the diversity of opinions as well as surgical approaches and timing.
