■翼点开颅术,Yasargil和Fox于1975年描述,构成了血管神经外科手术中最传统和最重要的手术通道。微创替代方案包括小翼(MP)和眶上外侧(LSO)开颅手术,避免了面神经额支损伤等并发症,颞肌功能障碍,开颅手术部位的凹陷,额窦开口,和外观上不可接受的结果。我们通过定量测量Willis和鞍旁区域周围的手术暴露区域,评估并比较了MP和LSO开颅术提供的暴露量,以及颈内动脉(ICA)分叉的角度和线性暴露,大脑中动脉(MCA),前交通动脉的中点,和基底动脉(BA)的尖端。
■在圣保罗法医办公室解剖了7具尸体,SP,和三个在威尔康奈尔医学院的颅底实验室,纽约,美国。顺序进行开颅手术,最初是LSO开颅手术,然后是MP。开颅手术后,手术暴露区域,开颅区,并确定了水平轴和垂直轴上的角曝光量。
■MP开颅术为同侧MCA提供了更好的角度暴露,而LSO开颅术和BA提供了更好的垂直轴暴露。LSO开颅术在垂直轴上为前交通动脉和对侧ICA分叉的中点提供了更好的角度暴露。关于手术暴露和开颅区域,差异无统计学意义。
■与LSO开颅手术相比,MP开颅手术提供了更大的手术暴露量,具有角度暴露于重要神经血管结构的特定优势。这项研究提供了重要的定量数据,以指导血管神经外科手术中这些微创介入技术之间的选择。
UNASSIGNED: The pterional craniotomy, described by Yasargil and Fox in 1975, constitutes the most traditional and important surgical access in vascular neurosurgery. Minimally invasive alternatives include the minipterional (MP) and lateral supraorbital (LSO) craniotomies, which avoid complications such as injury to the frontal branch of the facial nerve, temporal muscle dysfunction, depression of the craniotomy site, frontal sinus opening, and cosmetically unacceptable outcomes. We evaluated and compared the exposures provided by MP and LSO craniotomies through quantitative measurements of the surgical exposure area around the circle of Willis and parasellar regions, as well as angular and linear exposures of the internal carotid artery (ICA) bifurcation, middle cerebral artery (MCA), midpoint of the anterior communicating artery, and tip of the basilar artery (BA).
UNASSIGNED: Seven fresh cadavers were dissected at the São Paulo Medical Examiner\'s Office, SP, and three at the skull base laboratory of Weill Cornell Medical College, New York, USA. The craniotomies were performed sequentially, initially with the LSO craniotomy followed by the MP. After the craniotomy, the surgical exposure area, craniotomy area, and angular exposures in the horizontal and vertical axes were determined.
UNASSIGNED: The MP craniotomy provided better angular exposure for the ipsilateral MCA, while the LSO craniotomy and BA provided better vertical axis exposures. The LSO craniotomy provided better angular exposure in the vertical axis for the midpoint of the anterior communicating artery and contralateral ICA bifurcation. Regarding surgical exposure and craniotomy area, there were no statistically significant differences.
UNASSIGNED: The MP craniotomy offers a significantly larger surgical exposure compared to the LSO craniotomy, with specific advantages regarding angular exposure to important neurovascular structures. This study provides important quantitative data to guide the choice between these minimally invasive access techniques in vascular neurosurgery.