Marques Lopes de Araujo Ricardo, Zimelewicz Oberman Dan, Christiaan Welling Leonardo, Chaurasia Bipin, Evins Alexander I, Bernardo Antonio, Isolan Gustavo Rassier, Paulo Dourado Jose, Rabelo Nicollas Nunes, Figueiredo Eberval G
Department of Neurosurgery, University of Sao Paulo School of Medicine, Sao Paulo, Brazil.
Department of Neurological Surgery, Weill Cornell Medicine/ New York-Presbyterian Hospital, New York, United States.
Surg Neurol Int. 2024 Aug 30;15:305. doi: 10.25259/SNI_550_2024. eCollection 2024.
The pterional craniotomy, described by Yasargil and Fox in 1975, constitutes the most traditional and important surgical access in vascular neurosurgery. Minimally invasive alternatives include the minipterional (MP) and lateral supraorbital (LSO) craniotomies, which avoid complications such as injury to the frontal branch of the facial nerve, temporal muscle dysfunction, depression of the craniotomy site, frontal sinus opening, and cosmetically unacceptable outcomes. We evaluated and compared the exposures provided by MP and LSO craniotomies through quantitative measurements of the surgical exposure area around the circle of Willis and parasellar regions, as well as angular and linear exposures of the internal carotid artery (ICA) bifurcation, middle cerebral artery (MCA), midpoint of the anterior communicating artery, and tip of the basilar artery (BA).
Seven fresh cadavers were dissected at the São Paulo Medical Examiner's Office, SP, and three at the skull base laboratory of Weill Cornell Medical College, New York, USA. The craniotomies were performed sequentially, initially with the LSO craniotomy followed by the MP. After the craniotomy, the surgical exposure area, craniotomy area, and angular exposures in the horizontal and vertical axes were determined.
The MP craniotomy provided better angular exposure for the ipsilateral MCA, while the LSO craniotomy and BA provided better vertical axis exposures. The LSO craniotomy provided better angular exposure in the vertical axis for the midpoint of the anterior communicating artery and contralateral ICA bifurcation. Regarding surgical exposure and craniotomy area, there were no statistically significant differences.
The MP craniotomy offers a significantly larger surgical exposure compared to the LSO craniotomy, with specific advantages regarding angular exposure to important neurovascular structures. This study provides important quantitative data to guide the choice between these minimally invasive access techniques in vascular neurosurgery.
翼点开颅术由亚萨吉尔（Yasargil）和福克斯（Fox）于1975年描述，是血管神经外科最传统且重要的手术入路。微创替代方法包括微翼点（MP）和眶上外侧（LSO）开颅术，可避免诸如面神经额支损伤、颞肌功能障碍、开颅部位凹陷、额窦开放以及美容效果不佳等并发症。我们通过定量测量 Willis 环和鞍旁区域周围的手术暴露面积，以及颈内动脉（ICA）分叉、大脑中动脉（MCA）、前交通动脉中点和基底动脉（BA）尖端的角度和线性暴露，评估并比较了MP和LSO开颅术所提供的暴露情况。
在巴西圣保罗法医办公室对7具新鲜尸体进行解剖，在美国纽约威尔康奈尔医学院颅底实验室对3具进行解剖。依次进行开颅术，先进行LSO开颅术，然后是MP开颅术。开颅术后，确定手术暴露面积、开颅面积以及水平和垂直轴上的角度暴露情况。
MP开颅术为同侧MCA提供了更好 的角度暴露，而LSO开颅术和BA在垂直轴上提供了更好的暴露效果。LSO开颅术在前交通动脉中点和对侧ICA分叉的垂直轴上提供了更好的角度暴露。在手术暴露和开颅面积方面，无统计学显著差异。
与LSO开颅术相比，MP开颅术提供的手术暴露明显更大，在重要神经血管结构的角度暴露方面具有特定优势。本研究提供了重要的定量数据，以指导血管神经外科中这些微创入路技术之间的选择。
