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Eyebrow craniotomy for anterior skull base lesions: how I do it.
MedLine Citation:
PMID:  23135067     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND: The eyebrow craniotomy is a less invasive alternative approach for accessing anterior skull base lesions, compared to traditional and more extensive exposures. We give a stepwise description of this minimally invasive technique with discussion on the indications, limitations and key aspects of perioperative management. METHODS: Positioning of the head and planning the surgical corridor are dictated by the nature, site and size of the target lesion. The eyebrow incision should spare the medial and posterolateral neural structures. Microsurgical strategy is based on opening up the basal cisterns and respecting the distorted neurovascular anatomy. Selective use of brain retractor and angulation of the operative microscope enable the surgeon to make use of the "keyhole effect" for accessing a larger target. Perioperative measures are in part dictated by the nature of the pathology, involvement of the optic apparatus and changes to pituitary function. CONCLUSION: The eyebrow craniotomy may be safely used as a minimally invasive approach for a variety of anterior skull base lesions. There is an operative learning curve and some types of pathologies are easier to approach by this technique than others. KEY POINTS: • The eyebrow craniotomy is an alternative less invasive approach for accessing anterior skull base lesions • Positioning of the head and planning the surgical corridor are dictated by the nature, site and size of the target lesion • Microsurgical strategy is based on opening up the basal cisterns and respecting the distorted neurovascular anatomy. • Selective use of brain retractor and angulation of the operative microscope enable the surgeon to make use of the "keyhole effect" for accessing a larger target • Perioperative measures are in part dictated by the nature of the pathology, involvement of the optic apparatus and changes to pituitary function. • There is an operative learning curve and some types of pathologies are easier to approach by this technique than others.
Authors:
Zsolt Zador; Kanna Gnanalingham
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-11-8
Journal Detail:
Title:  Acta neurochirurgica     Volume:  -     ISSN:  0942-0940     ISO Abbreviation:  Acta Neurochir (Wien)     Publication Date:  2012 Nov 
Date Detail:
Created Date:  2012-11-8     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0151000     Medline TA:  Acta Neurochir (Wien)     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
Department of Neurosurgery, Manchester Skull Base Unit, Salford Royal Foundation Trust (SRFT), Manchester, UK.
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