What bone part is important to remove in accessing to the suprachiasmatic region with less frontal lobe retraction in frontotemporal craniotomies
What bone part is important to remove in accessing to the suprachiasmatic region with less frontal lobe retraction in frontotemporal craniotomies
复制标题
在额颞开颅手术中，在额叶回缩较少的情况下进入视交叉上区域时，哪些骨头部分是重要去除的
DOI：
10.1016/j.wneu.2011.03.040
复制
发表时间：
2012
影响因子：
2
通讯作者：
Hayashi Y.
中科院分区：
文献类型：
--
作者：
Kinoshita M;Tanaka S;Nakada M;Ozaki N;Hamada J;Hayashi Y.
前外侧入路是进入前交通动脉复合体（AComA）的视交叉上病变的主要途径之一。翼点（PT）开颅术及其替代方法，包括眶颞开颅术、眶翼点开颅术和微型眶上开颅术，已发展为定制的额颞开颅术。PT开颅术与其替代方法的主要区别之一是去除眶骨沿着蝶骨翼。然而，在额叶回缩中，哪一个骨部分是最重要的，还没有讨论过。我们已经评估了去除眶上杆与去除眶外侧壁沿着与蝶骨翼如何影响额叶回缩水平与视交叉上区暴露面积（AOE）之间的关系。PT颅骨切开术，PT颅骨切开术伴眶上杆切除术（PT-SO开颅术）和PT开颅术，沿蝶骨翼去除外侧眶壁沿着，即，枕骨额突和蝶骨大翼的眶面和大脑面（PT-LO-SW开颅术）。对于每一个开颅手术，在四个不同水平的额叶回缩，即5，10，15，和20毫米，从颅底测量视交叉上区周围的AOE。PTTS在5毫米回缩，PT-LO-SW开颅手术是唯一的开颅手术中，AComA复合体是可见的。在10 mm牵开时，PT-LO-SW开颅术在三种开颅术中提供了最大的AOE，并且AOE显著大于PT开颅术（P = 0.025）。在15-和20-mm的回缩，有三个craniotomies.CONCLUSIONSTreatment的病变在视交叉上区通过一个前外侧的路线，涉及额颞开颅手术，需要充分去除外侧眶壁沿着与更大的蝶骨翼，使脑回缩最小化。
BACKGROUNDThe anterolateral approach is one of the main routes for accessing suprachiasmatic lesions involving the anterior communicating artery (AComA) complex. Pterional (PT) craniotomy and its alternatives, including orbitozygomatic, orbitopterional, and mini-supraorbital craniotomies, have been developed as tailored frontotemporal craniotomies. One of the main differences between PT craniotomy and its alternatives is the removal of the orbital bone along with the sphenoid wing. However, which bone part is the most important to remove has not been discussed in relation to frontal lobe retraction. We have evaluated how the removal of the supraorbital bar versus the removal of the lateral orbital wall along with the sphenoid wing affects the relationship between the levels of frontal lobe retraction and area of exposure (AOE) in the suprachiasmatic region.METHODSWe performed three types of craniotomies: PT craniotomy, PT craniotomy with the removal of the supraorbital bar (PT-SO craniotomy), and PT craniotomy with the removal of the lateral orbital wall along with the sphenoid wing, i.e., the frontal process of the zygomatic bone and the orbital and cerebral faces of the greater sphenoid wing (PT-LO-SW craniotomy). For each craniotomy, the AOE around the suprachiasmatic region was measured at four different levels of frontal lobe retraction, namely, 5, 10, 15, and 20 mm, from the cranial base.RESULTSAt 5-mm retraction, PT-LO-SW craniotomy was the only craniotomy in which the AComA complex was visible. At 10-mm retraction, PT-LO-SW craniotomy afforded the greatest AOE among the three craniotomies, and the AOE was significantly greater than that of PT craniotomy (P = 0.025). At 15- and 20-mm retraction, there were no significant differences among the three craniotomies.CONCLUSIONSTreatment of lesions in the suprachiasmatic region via an anterolateral route involving a frontotemporal craniotomy requires sufficient removal of the lateral orbital wall along with the greater sphenoid wing so that brain retraction is minimized.