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The pterional-transsylvian approach: an analytical study.

Eberval Gadelha Figueiredo1, Pushpa Deshmukh, Joseph M Zabramski

  • 1Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona 85013, USA.

Neurosurgery
|October 17, 2006
PubMed
Summary

Splitting the sylvian fissure (SF) during pterional (PT) approach surgery improves surgical exposure. Optimal exposure is achieved when dissection reaches the anterior ascendant ramus, with no further benefit from extended splitting.

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Area of Science:

  • Neurosurgery
  • Surgical Anatomy
  • Microsurgery

Background:

  • The pterional (PT) approach is a common neurosurgical technique.
  • Splitting the sylvian fissure (SF) enhances surgical exposure but the extent is based on surgeon preference.
  • Quantifiable data on the impact of SF splitting extent is lacking.

Purpose of the Study:

  • To evaluate the effects of progressive sylvian fissure (SF) splitting on surgical exposure during the pterional (PT) approach.
  • To provide objective data to guide the extent of SF splitting in PT approaches.

Main Methods:

  • The study utilized nine cadaver heads for pterional (PT) craniotomy.
  • Sylvian fissure (SF) splitting was performed in four progressive steps.
  • A computerized tracking system measured surgical exposure of the circle of Willis, angles to the carotid bifurcation, and frontal lobe-skull base distance.

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Main Results:

  • Significant improvements in exposure of the circle of Willis and angles to the carotid bifurcation were observed with progressive SF splitting from step 1 to 3.
  • The distance between the frontal lobe and skull base also increased significantly with SF splitting.
  • No significant additional benefit was found beyond splitting to the anterior ascendant ramus (Step 3).

Conclusions:

  • Surgical exposure of the basal cisterns and circle of Willis via the pterional (PT) approach is optimized when SF dissection reaches the anterior ascendant ramus.
  • Further splitting of the SF beyond this point does not yield additional surgical exposure benefits.