Indications The retrolabyrinthine approach is a hearing-preserving presigmoid approach that uses a mastoidectomy and skeletonization of the sigmoid sinus to expose the presigmoid dura behind the semicircular canals. The principal appeal of this approach is its ability to expose widely…
Indications The middle fossa approach is a largely extradural approach to the bony structures that make up the floor of the middle fossa. Although the convex floor of the middle fossa is the most straightforward region to access with this…
Indications Transsylvian approaches enter the parasellar cisterns on a superior-to-inferior trajectory, forcing the surgeon to work past the carotid artery through the opticocarotid or carotid-oculomotor triangles to access this region, making access of the midbasilar and interpeduncular cisterns difficult. Although…
Indications The suboccipital approach with C1 laminectomy provides adequate visualization of approximately 270 degrees of the circumference around the medulla. This approach does not provide safe access to the 90 degrees anterior to the medulla, however, because the visual angle…
Indications The unilateral and bilateral subfrontal approaches are the workhorse approaches for access to nearly the entire anterior cranial fossa floor; anterior midline parasellar structures such as the tuberculum sella, anterior communicating artery, and optic chiasm; posterior orbit; and orbital…
Indications Frontotemporal craniotomy with orbitozygomatic osteotomy is an adjunct to pterional craniotomy that allows greater rostral trajectory to midline structures. By removing the superior and lateral bony orbit, one gains a more anterior and inferior starting point for the approach…
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,…
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…
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…
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…