Indications Supraorbital craniotomy allows for relatively easy and rapid access to structures in the anterior, middle cranial fossa and sellar and parasellar regions. This minimally invasive technique provides a subfrontal approach with minimal disruption of normal anatomy, excellent cosmetic results, shorter operation times and hospital stays with faster recovery, and less morbidity. This approach can be used to treat many different intraaxial and extraaxial pathologies in…

Indications Parasagittal approaches are used to treat lesions located near the falx, interhemispheric fissure, or corpus callosum. These lesions often include parasagittal and falcine meningiomas, intraaxial tumors, cavernomas, and arteriovenous malformations (AVMs). The parasagittal approach is also the first step in the transcallosal approach to access lesions in the lateral ventricle, upper aspect of the thalamus through the lateral ventricle, or third ventricle ( Fig. 13.1…

Indications Elevated intracranial pressure (ICP) is one of the most common causes of death and disability following severe traumatic brain injury and ischemic stroke. There have been no new medical treatments for elevated ICP in more than 90 years. A decompressive craniectomy may be a useful surgical option in ICP that is refractory to medical treatment. Decompressive craniectomy is also performed as a prophylactic measure in…

Indications An occipital transtentorial craniotomy can provide excellent exposure for falcotentorial meningiomas and any lesion arising from the precentral cerebellar fissure, posterior incisural space, and adjoining structures. Contraindications Standard medical contraindications for prone positioning. Patent foramen ovale with positive bubble study for sitting position because of risks arising from venous air embolism. You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy…

Indications This approach provides optimal exposure for lesions in the pineal region, posterior third ventricle, and posterior mesencephalon with minimal to no damage to the healthy parenchyma and surrounding structures. You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a member. Log in here

Indications The expanded endonasal transsphenoidal approach is employed for various pathologies involving the sella, suprasellar space, and sphenoid bone, including pituitary adenomas, Rathke pouch cyst, and craniopharyngiomas. Other indications include clival chordomas, meningiomas, metastatic lesions, and medial temporal lobe lesions such as encephaloceles. This approach is minimally traumatic to the brain, avoids brain retraction, does not create visible scars, provides excellent visualization of the pituitary, and…

Indications Tumors of the lateral and anterior third ventricles. Contraindications The transcallosal approach, although it provides exposure to tumors in the lateral and anterior third ventricle, is limited in providing satisfactory access to tumors in the posterior trigone, temporal horn, or superior frontal horn. Patients with these tumors are best approached by the transcortical route, with its own set of indications and complications. Although a partial…

There are multiple variations of the presigmoid approach to the posterior fossa: retrolabyrinthine, transcrusal, translabyrinthine, transotic, and transcochlear. Each variation increases the amount of temporal bone resected, which increases the surgical freedom at the expense of increased surgical morbidity of cranial nerves VII and VIII. In this chapter, we focus on the translabyrinthine and transcochlear approaches (retrolabyrinthine is described in Procedure 20). Translabyrinthine approach Indications The…

Indications Lesions in the cerebellopontine angle and petroclival region can be surgically challenging to resect because of surrounding vascular and eloquent neural structures (i.e., brainstem) that have zero tolerance for retraction. Numerous surgical approaches, such as translabyrinthine, transcochlear, and presigmoid approaches, are part of the surgeon’s armamentarium. Retrosigmoid craniotomy allows for easy and rapid access to the cerebellopontine angle. The extended version of the traditional retrosigmoid…

Indications Majority of the posterior fossa lesions Chiari malformations and other developmental abnormalities Brain tumors including meningiomas, ependymomas, astrocytomas, and medulloblastomas Vascular lesions such as aneurysms, cavernous malformations, arteriovenous malformations, and hemangioblastomas ( Fig. 5.1 ) Posterior fossa infections Contraindications Lesions located in the rostral part of the tentorium: In these cases, consideration should be given to a combined supracerebellar and supratentorial approach. Lesions extending to…

Indications This technique is effective for lesions of the middle fossa (i.e., cavernous sinus, medial temporal lobe, tentorial region, petrous bone, incisura) and posterior fossa (i.e., extraaxial lesions in the petroclival region, intraaxial lesions in the anteromedial region of the superior cerebellum). Lesions that can be approached via a right-sided craniotomy are preferred for an intradural approach. This approach can be expanded by adjuncts, such as…

Indications The frontotemporal “pterional” craniotomy is considered the workhorse of skull base approaches. Temporal lobectomy in patients with medically refractory epilepsy (anterior temporal lobectomy versus selective amygdalohippocampectomy) Removal of sphenoid wing meningiomas and intrinsic frontal/temporal lobe tumors Access to the temporal horn of the lateral ventricle for vascular or neoplastic pathology Temporal lobe lesions of unknown etiology, such as an infection Traumatic pathology such as subdural/epidural…

Indications The occipital craniotomy is an adaptable approach that allows us to access lesions, vascular malformations, and congenital abnormalities located at the occipital lobes, tentorium, torcular herophili, transverse sinus, and sigmoid sinus. Contraindications Any pathology located in the cervical spine that would prevent neck flexion or reduction Patients with persistent foramen ovale (preoperative echocardiogram should be performed if the sitting or semisitting position is considered) You’re…

Indications Exposure of the sphenoid wing, suprasellar and sellar regions, cavernous sinus, and upper clivus. Aneurysms clipping the anterior and posterior circulation (upper basilar and its proximal branches). Resection of extraaxial tumors of the anterior and middle cranial fossa and lateral frontal, temporal intraaxial tumors. Resection of arteriovenous malformations of the perisylvian frontal and temporal regions. You’re Reading a Preview Become a Clinical Tree membership for…