PDF(Pubmed)
Abstract：
Background Advances in skull base surgery have increased the need for a detailed understanding of skull base anatomy and its intrinsic relationship to surrounding structures. This has resulted in an improvement in patient outcomes. The frontotemporal orbitozygomatic (FTOZ) transcavernous approach (TCA) is an excellent option for treating complex lesions involving multiple compartments of the skull base, including the sellar and parasellar, third ventricle, orbit, and petroclival region. Objective This article aimed to provide a detailed cadaveric dissection accompanying a thorough procedure description, including some tips and pitfalls of this technique. Methods Microsurgical dissection was performed in four freshly injected cadaver heads at the Cranial Base Neuroanatomy Laboratory, Cleveland Clinic Florida. The FTOZ TCA was performed on both sides of the four specimens. The advantages and disadvantages were discussed based on the anatomic nuances of this approach. Results The FTOZ TCA represented a wide access to the anterior, middle, and posterior fossa. When combined with an anterior clinoidectomy, it allowed for significant and safe internal carotid artery mobilization. This approach created numerous windows, including opticocarotid, carotid-oculomotor, supratrochlear, infratrochlear, anteromedial, anterolateral, and posteromedial triangles. The only drawback was the length of the dissection and the level of surgical acumen required to perform it. Conclusion Despite its technical difficulty, the FTOZ TCA should be considered for the surgical management of basilar apex aneurysms and tumors surrounding the cavernous sinus, sellar/parasellar, retrochiasmatic, and petroclival region. Continuous training and dedicated time in the skull base laboratory can help achieve the necessary skills required to perform this approach.
摘要：
背景技术颅底手术的进展增加了对颅底解剖结构及其与周围结构的内在关系的详细了解的需要。这导致了患者结果的改善。额颞眶（FTOZ）经海绵体入路（TCA）是治疗涉及颅底多个隔室的复杂病变的绝佳选择，包括鞍区和鞍区,第三脑室,轨道,和岩流地区。目的本文旨在提供详细的尸体解剖，并进行详尽的程序描述。包括这项技术的一些技巧和陷阱。方法在颅底神经解剖实验室对四个新鲜注射的尸体头进行显微外科解剖。佛罗里达克利夫兰诊所。在四个样本的两侧进行FTOZTCA。根据这种方法的解剖学细微差别，讨论了其优缺点。结果FTOZTCA代表了通向前部的广泛通道，中间,和后颅窝.当结合前路临床切除术时，它允许显著和安全的颈内动脉动员。这种方法创造了许多窗口，包括视颈动脉,颈动脉-动眼神经,滑车上,耳蜗下，前内侧,前外侧,和后内侧三角形。唯一的缺点是解剖的长度和进行解剖所需的手术敏锐度。结论尽管存在技术难题,FTOZTCA应考虑用于基底尖动脉瘤和海绵窦周围肿瘤的外科治疗，鞍区/鞍区,后交叉,和岩流地区。在颅底实验室进行持续的培训和专门的时间可以帮助实现执行此方法所需的必要技能。
