Bernardo Antonio, Evins Alexander I
Department of Neurological Surgery, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York, USA.
Department of Neurological Surgery, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York, USA.
World Neurosurg. 2023 Apr;172:131-145. doi: 10.1016/j.wneu.2022.11.055.
Surgical approaches to the sellar and parasellar regions are highly challenging due to the densely packed nature of the traversing neurovasculature. The frontotemporal-orbitozygomatic approach offers a wide angle of exposure for the management of lesions involving the cavernous sinus, parasellar region, upper clivus, and adjacent neurovascular structures. It combines the pterional approach with different osteotomies that remove the superior and lateral walls of the orbit and zygomatic arch. Extradural exposure and preparation of the periclinoid region, whether as initial preparation for a combined intraextradural approach to deep-seated skull base targets or as the main avenue of surgical exposure, can substantially enlarge surgical corridors and minimize the need for brain retraction in this very confined microsurgical space. We provide a stepwise description of how we perform the fronto-orbitozygomatic approach and an associated series of surgical maneuvers and techniques that can be utilized in a variety of anterior and anterolateral approaches, either alone or in combination, to tailor exposure to a given lesion. These techniques are not limited to traditional skull base approaches and represent a valuable addition to every neurosurgeon's armamentarium as enhancements to common surgical approaches.
由于鞍区及鞍旁区域穿行的神经血管结构密集，对其进行手术入路极具挑战性。额颞眶颧入路为涉及海绵窦、鞍旁区域、上斜坡及相邻神经血管结构的病变的处理提供了广阔的暴露视角。它将翼点入路与不同的截骨术相结合，去除眶上壁和外侧壁以及颧弓。硬膜外暴露和床突旁区域的准备，无论是作为联合硬膜内外入路处理深部颅底靶点的初始准备，还是作为手术暴露的主要途径，都能显著扩大手术通道，并在这个非常狭窄的显微手术空间中尽量减少脑牵拉的需求。我们逐步描述了我们如何实施额眶颧入路以及一系列相关的手术操作和技术，这些操作和技术可单独或联合用于各种前入路和前外侧入路，以根据特定病变调整暴露范围。这些技术不仅限于传统的颅底入路，而且作为对常见手术入路的改进，是每位神经外科医生手术器械库中的宝贵补充。
