ezrefa.blogg.se - Eloquent brain

#Eloquent brain manual#
#Eloquent brain skin#

burr hole edges sealed with bone wax and remaining bony slivers resected.

dual burr holes placed: one at the MacCarty keyhole (7 mm superior and 5 mm posterior to the frontozygomatic suture) and one just above the zygomatic arch in the squamous part of the temporal bone, so just posterior to the temporozygomatic suture (or use single burr hole) 8.

flap retracted anteriorly and secure with fishhooks.

myocutaneous flap dissection: skin, connective tissue and galea mobilized from the underlying loose connective tissue and periosteum through either interfascial or subfascial approaches to preserve the frontal and parietal branches of the superficial temporal artery and the temporal branch of the facial nerve (to prevent frontalis and sometimes orbicularis oculi palsy).

#Eloquent brain skin#

skin incision: curvilinear or arcuate semi-coronal frontotemporal incision performed, starting from superior margin of zygomatic arch, 1 cm anterior to the tragus, aiming towards the midline along, ideally posterior to the hairline (the pterion lies anterior to the incision).hair shaved, skin prepared, marked, and local anesthetic and epinephrine injected.

#Eloquent brain manual#

head is immobilized in Mayfield or Sugita head frame, rotated contralaterally and extended somewhat (depending on access required, and to allow frontal lobe to naturally sink into the cranial vault reducing manual retraction).ProcedureĪ broad outline of steps followed in performing a pterional craniotomy includes 7: Inaccessibility of a specific lesion, therefore, constitutes a strong contraindication, while significant risk to adjacent eloquent brain tissue suggests a relative contraindication although this must be balanced against the possibility of alternative approaches and the risk of not performing the procedure. The suitability of the pterional approach should be considered along with the assessment of appropriate imaging. aneurysm clipping (ruptured or unruptured).Indications where pterional approaches are used, as permitted by anatomical accessibility, include: distal vertebrobasilar system of posterior circulation (top of basilar, proximal posterior cerebral artery, superior cerebellar artery).anterior circulation (intracranial internal carotid artery, anterior and middle cerebral arteries, anterior communicating artery, posterior communicating artery).insula, basal ganglia, mesial temporal lobes, hippocampus, upper brainstem (midbrain).skull base of the anterior and middle cranial fossae.

The pterional approach allows exposure to numerous important anatomical areas, including The pterional region is usually the thinnest part of the human calvarium making it susceptible to traumatic fracture with consequent rupture of the middle meningeal artery and then extradural hemorrhage. This is also relevant to keep in mind when performing burr hole craniotomies to avoid inadvertently ‘plunging’ the drill into the cranial cavity. The frontal (anterior) branch of the middle meningeal artery typically runs deep to the pterion within the dual layers of the dura mater. The sphenofrontal and coronal sutures meet at the anterior aspect of sphenoparietal suture and the sphenosquamosal and squamosal sutures meet at posterior aspect of sphenoparietal suture. Or equally by the confluence of five cranial sutures The pterion is defined as the anatomical region formed around the approximation of four cranial bones In general, extended pterional approaches can increase the operative corridor through additional bony resection, whereas minimally invasive approaches, such as the mini-pterional approach, reduce disruption of surrounding healthy tissue at the potential cost of reduced accessibility of a large lesion and with the assumed risk of difficulty handling intraoperative complications like massive hemorrhage. These include the pretemporal, orbitozygomatic, minimally invasive and the so-called ‘keyhole’ approaches 2-5. Since its original description, several variants have been described that allow additional indications to be addressed efficiently and with minimal disruption on surrounding tissue. Techniques used before this were variously based on subfrontal, transcallosal, interhemispheric subfrontal, and frontoparietal approaches 1. It was originally described and popularized by Yasargil in the 1970s to address the treatment of aneurysmal disease of the anterior communicating artery.