Surgical approaches for the lateral mesencephalic sulcus
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Citações na Scopus
11
Tipo de produção
article
Data de publicação
2020
Título da Revista
ISSN da Revista
Título do Volume
Editora
AMER ASSOC NEUROLOGICAL SURGEONS
Autores
SPETZLER, Robert F.
PREUL, Mark C.
Citação
JOURNAL OF NEUROSURGERY, v.132, n.5, p.1653-1658, 2020
Resumo
OBJECTIVE The brainstem is a compact, delicate structure. The surgeon must have good anatomical knowledge of the safe entry points to safely resect intrinsic lesions. Lesions located at the lateral midbrain surface are better approached through the lateral mesencephalic sulcus (LMS). The goal of this study was to compare the surgical exposure to the LMS provided by the subtemporal (ST) approach and the paramedian and extreme-lateral variants of the supracerebellar infratentorial (SCIT) approach. METHODS These 3 approaches were used in 10 cadaveric heads. The authors performed measurements of predetermined points by using a neuronavigation system. Areas of microsurgical exposure and angles of the approaches were determined. Statistical analysis was performed to identify significant differences in the respective exposures. RESULTS The surgical exposure was similar for the different approaches-369.8 +/- 70.1 mm(2) for the ST; 341.2 +/- 71.2 mm(2) for the SCIT paramedian variant; and 312.0 +/- 79.3 mm(2) for the SCIT extreme- lateral variant (p = 0.13). However, the vertical angular exposure was 16.3 degrees +/- 3.6 degrees for the ST, 19.4 degrees +/- 3.4 degrees for the SCIT paramedian variant, and 25.1 degrees +/- 3.3 degrees for the SCIT extreme- lateral variant craniotomy (p < 0.001). The horizontal angular exposure was 45.2 degrees +/- 6.3 degrees for the ST, 35.6 degrees +/- 2.9 degrees for the SCIT paramedian variant, and 45.5 degrees +/- 6.6 degrees for the SCIT extreme-lateral variant opening, presenting no difference between the ST and extreme-lateral variant (p = 0.92), but both were superior to the paramedian variant (p < 0.001). Data are expressed as the mean +/- SD. CONCLUSIONS The extreme-lateral SCIT approach had the smaller area of surgical exposure; however, these differences were not statistically significant. The extreme-lateral SCIT approach presented a wider vertical and horizontal angle to the LMS compared to the other craniotomies. Also, it provides a 90 degrees trajectory to the sulcus that facilitates the intraoperative microsurgical technique.
Palavras-chave
brainstem surgery, lateral mesencephalic sulcus, surgical approaches, safe entry zones, supracerebellar infratentorial approach, subtemporal craniotomy, anatomy
Referências
- Abla AA, 2011, NEUROSURGERY, V68, P403, DOI 10.1227/NEU.0b013e3181ff9cde
- Bailey P, 1939, INTRACRANIAL TUMORS
- Bricolo A, 1991, Acta Neurochir Suppl (Wien), V53, P148
- Bricolo A, 1995, Adv Tech Stand Neurosurg, V22, P261
- Bricolo A, 2009, PRACTICAL HDB NEUROS, P349
- Brown AP, 1996, BNI Q, V12, P20
- Cavalcanti DD, 2016, J NEUROSURG, V124, P1359, DOI 10.3171/2015.4.JNS141945
- Cavalcanti DD, 2010, NEUROSURGERY, V66, pONS205, DOI 10.1227/01.NEU.0000369948.37233.70
- Deshmukh VR, 2006, NEUROSURGERY, V58, P202, DOI 10.1227/01.NEU.0000207373.26614.BF
- EPSTEIN F, 1986, J NEUROSURG, V64, P11, DOI 10.3171/jns.1986.64.1.0011
- Ferroli P, 2005, NEUROSURGERY, V56, P1203, DOI 10.1227/01.NEU.0000159644.04757.45
- Figueiredo EG, 2007, NEUROSURGERY, V61, P256, DOI 10.1227/01.neu.0000303978.11752.45
- Figueiredo EG, 2012, J CLIN NEUROSCI, V19, P1545, DOI 10.1016/j.jocn.2012.01.032
- Figueiredo EG, 2008, NEUROSURGERY, V62, P1361, DOI [10.1227/01.NEU.0000233691.23208.9C, 10.1227/01.neu.0000333801.51962.2f]
- Figueiredo EG, 2006, J NEUROSURG, V104, P957, DOI 10.3171/jns.2006.104.6.957
- Figueiredo Eberval Gadelha, 2005, Neurosurgery, V56, P397, DOI 10.1227/01.NEU.0000156549.96185.6D
- Figueiredo EG, 2016, WORLD NEUROSURG, V87, P584, DOI 10.1016/j.wneu.2015.10.063
- Figueiredo EG, 2015, WORLD NEUROSURG, V84, P1907, DOI 10.1016/j.wneu.2015.08.031
- Figueiredo EG, 2000, NEUROSURGERY S2, V59, P212
- Figueiredo EG, 2006, NEUROSURGERY S, V58, pONS13
- Gonzalez LF, 2002, NEUROSURGERY, V50, P550, DOI 10.1097/00006123-200203000-00023
- Howell C M, 1910, Proc R Soc Med, V3, P65
- Januszewski J, 2016, WORLD NEUROSURG, V93, P377, DOI 10.1016/j.wneu.2016.06.019
- Kalani MYS, 2016, J NEUROSURG, V125, P1596, DOI 10.3171/2016.6.JNS161043
- KONOVALOV AN, 1990, J NEUROSURG, V73, P181, DOI 10.3171/jns.1990.73.2.0181
- LASSITER KR, 1971, J NEUROSURG, V34, P719, DOI 10.3171/jns.1971.34.6.0719
- Meola A, 2016, NEUROSURGERY, V79, P437, DOI 10.1227/NEU.0000000000001224
- Porter RW, 1999, J NEUROSURG, V90, P50, DOI 10.3171/jns.1999.90.1.0050
- Recalde RJ, 2008, NEUROSURGERY, V63, P9, DOI [10.1227/01.NEU.0000297062.52433.3F, 10.1227/01.neu.0000317368.69523.40]
- Safavi-Abbasi S, 2010, NEUROSURGERY, V66, P54, DOI 10.1227/01.NEU.0000354366.48105.FE
- Sekhar LN, 2014, WORLD NEUROSURG, V82, DOI 10.1016/j.wneu.2013.07.104
- Siwanuwatn R, 2006, J NEUROSURG, V104, P137, DOI 10.3171/jns.2006.104.1.137
- STEIN BM, 1971, J NEUROSURG, V35, P197, DOI 10.3171/jns.1971.35.2.0197
- VANDENBERGH R, 1990, CLIN NEUROL NEUROSUR, V92, P311, DOI 10.1016/0303-8467(90)90056-B
- Vishteh AG, 2000, NEUROSURGERY, V46, P384, DOI 10.1097/00006123-200002000-00022
- Araujo JLV, 2017, J NEUROSURG, V127, P209, DOI 10.3171/2016.8.JNS16403
- VOIGT K, 1976, NEUROCHIRURGIA, V19, P59
- Wen D Y, 1993, Neurosurg Clin N Am, V4, P457
- Yasargil MG, 1984, MICRONEUROSURGERY