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ULTIMO FASCICOLOJOURNAL OF NEUROSURGICAL SCIENCES

Rivista di Neurochirurgia

Indexed/Abstracted in: e-psyche, EMBASE, PubMed/MEDLINE, Neuroscience Citation Index, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 1,651

Periodicità: Bimestrale

ISSN 0390-5616

Online ISSN 1827-1855

 

Journal of Neurosurgical Sciences 2001 Marzo;45(1):19-28

 ORIGINAL ARTICLES

Frontotemporal orbit­o­zy­go­mat­ic cran­i­ot­o­my to ­expose the cav­ern­ous ­sinus and its sur­round­ing ­regions. Microsurgical anat­o­my

Jian F.-Z. 1,2, Santoro A. 1, Innocenzi G. 3, Wang X.-W. 2, Liu S.-S. 2, Cantore G. 1, 3

1 Department of Neurosurgical Sciences, Neurosurgery I, University of Rome “La Sapienza”, Rome, Italy;
2 Department of Neurosurgery, Beijing Hospital, Beijng, China;
3 ­IRCCS Neuromed. Pozzilli (IS), Italy

Background. The micro­sur­gi­cal anat­o­my of the cav­ern­ous ­sinus and its sur­round­ing ­regions ­were exam­ined via fron­to­tem­po­ral orbit­o­zy­go­mat­ic (­FTOZ) cran­i­ot­o­my. Combined ­with oth­er ­deep oste­ot­o­mies, the pos­sibil­ity of expos­ing the pet­ro­cli­val ­region and bas­i­lar ­artery was ­also ­explored.
Methods. The ­study was ­made on 20 ­sides of 10 cadav­er­ic spec­i­mens ­fixed ­with for­mal­in, ­with the ­help of the sur­gi­cal micro­scope (mag­nifi­ca­tion 5-15).
Results. The ­FTOZ was per­formed ­with fron­to­tem­po­ral and orbit­o­zy­go­mat­ic ­flaps. Extradurally, V2, V3, the tri­gem­i­nal gan­gli­on, the pos­te­ri­or ver­ti­cal seg­ment of the intra­ca­ver­nous ICA and the VI ­nerve ­were ­exposed by ­FTOZ cran­i­ot­o­my. By fur­ther remov­al of the ­petrous ­apex (Kawase’s tri­an­gle), expo­sure ­could be extend­ed to the pet­ro­cli­val ­region; ­with ante­ri­or mod­ifi­ca­tion of the micro­scop­ic ­light, in 50% of the spec­i­mens, expo­sure ­reached as low as the con­ver­gence of the ver­te­bral arter­ies. The ante­ri­or ­part of the cav­ern­ous ­sinus and the orbi­tal ­apex ­were exam­ined by remov­ing the ante­ri­or cli­noid pro­cess, orbi­tal ­roof and unroof­ing the ­optic ­canal. Intradurally, the intra­pe­dun­cu­lar fos­sa (­upper 1/3 of the cli­vus) was exam­ined. The intra­ca­ver­nous cra­ni­al ­nerves and ves­sels ­were stud­ied via lat­er­al and super­i­or ­wall approach­es. By remov­ing ­both the ante­ri­or and pos­te­ri­or cli­noid pro­cess­es togeth­er, in 80% of the spec­i­mens, the expo­sure ­could be car­ried as far as the mid­point of the bas­i­lar ­artery.
Conclusions. ­FTOZ cran­i­ot­o­my ­could be ­used to ­treat ­lesions involv­ing the cav­ern­ous ­sinus and its sur­round­ing ­regions. Incorporated ­with the ­petrous apec­to­my, it ­could be ­used to ­expose the pet­ro­cli­val ­region and, in select­ed cas­es, expo­sure ­could be extend­ed to the con­ver­gence of the ver­te­bral arter­ies. Combined ­with ante­ri­or and pos­te­ri­or cli­noi­dec­to­mies, it ­could ­also be ­used to ­treat mid­point ­regions of the bas­i­lar ­artery.

lingua: Inglese


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