RESUMEN
BACKGROUND: The fronto-temporo-orbito-zygomatic (FTOZ) craniotomy is a commonly utilized surgical approach for many complex skull base lesions, especially lesions traversing skull base compartments. This craniotomy has evolved over multiple stages, originating from the classic pterional craniotomy and many variations that have emerged over time. METHODS: Few clinical and anatomic studies have both shaped these craniotomies as well as provided immense information about instances in which they are most useful. We review the origin and history of the one-piece and two-piece fronto-temporo-orbito-zygomatic craniotomy and deliberate their advantages and disadvantages. RESULTS: The FTOZ craniotomy provides access to the orbit as well as to multiple compartments in the cranium (anterior, middle and upper third posterior cranial fossae); thus, offering a multi-corridor approach to complex skull base lesions. The one-piece and two-piece fronto-temporo-orbitozygomatic craniotomies are two particularly notable variations that have stood the test of time. Selection between the two variations is mostly surgeon preference and comfort with the technique; however, there are certain indications that specifically suit each approach. Additionally, a pictorial review has been crafted to clearly illustrate the cuts to be made in both methods. CONCLUSION: Understanding the evolution of this craniotomy and surgical approach provides an insight into accessing complex skull base pathologies with minimal brain retraction via safe and viable corridors.
RESUMEN
Gout treatment has evolved rapidly in recent decades, and various drugs have been designed for acute and chronic management. Three medications used to treat gout include pegloticase, colchicine, and febuxostat. When prescribing these drugs, important factors to consider include pharmacokinetics, pharmacodynamics, population specifics, benefits, and contraindications. Pharmacokinetic considerations of each drug include absorption, distribution, metabolism, and elimination factors. Pharmacodynamics factors are assessed by their potential for toxicity and effects on serum uric acid levels. Additionally, the drug's targeted population must be considered to avoid unwanted complications in certain pre-existing conditions such as cardiovascular disease or glucose-6-dehydrogenase (G6PD) deficiency. In this paper, we aim to provide insight into the gout medications, pegloticase, colchicine, and febuxostat. This review will include their pharmacokinetics, pharmacodynamics, population specifics, benefits, and contraindications.
