Minipterional Approach for Middle Fossa Skull Base Lesions: Technical Note.

Surgical access to the middle fossa can be technically challenging. As neurosurgery evolves to minimally invasive approaches, the objective of this study is to demonstrate the extension of the Minipterional approach to access the middle fossa. We present a new surgical approach to the middle fossa for the treatment of secondary trigeminal neuralgia. Three cases are reported to illustrate the following techniques: a patient with petrotentorial meningioma and trigeminal neuralgia, a patient with an arachnoid cyst compressing the fifth nerve, and a patient with a middle cerebral artery aneurysm and a long history of TN (trigeminal neuralgia) refractory to medical and surgical treatments. All three experienced full symptom controls with no permanent neurological deficits. Therefore, the Minipterional technique might represent a feasible, effective, and safe option to treat refractory secondary TN. It also allows approaching these lesions when the posterior fossa approach is compromised by anatomical distortion and enables the simultaneous treatment of secondary trigeminal neuralgia and other lesions, such as aneurysms and meningiomas.

The Minimally Invasive Posterolateral Transcavernous-Transtentorial Approach. Technical Nuances, Proof of Feasibility, and Surgical Outcomes Throughout a Case Series of Sphenopetroclival Meningiomas.

OBJECTIVE: Sphenopetroclival (SPC) meningiomas are considered among the most complex skull-base neoplasms to approach surgically. We aim to determine whether some SPC meningiomas can be safely and effectively treated using a modified minimally invasive pterional posterolateral transcavernous-transtentorial approach (MIPLATTA). METHODS: Fourteen patients harboring SPC meningiomas were surgically treated through a MIPLATTA. MIPLATTA includes a minipterional craniotomy, anterior extradural clinoidectomy, peeling of the temporal fossa, decompression of cranial nerves (CNs) in the cavernous sinus, and sectioning of the tentorium to reach the upper part of the posterior fossa. RESULTS: Gross total resection was achieved in 11 of 14 patients (78%), whereas near-total resection was accomplished in the other 3 patients (22%), each of whom underwent a further complementary retrosigmoid approach for gross total tumor resection. There were no deaths, and 13 of 14 patients were independent at 6 months follow-up (modified Rankin Scale score ≤2). One patient had pontine infarction after the procedure and experienced moderate disability at follow-up (modified Rankin Scale score 3). All patients had some degree of CN impairment. Of 38 cranial neuropathies, 15 (39%) improved, 20 (53%) remained stable, and 3 (8%) worsened postoperatively. Four new CN deficits were observed postoperatively in 3 patients (fourth CN, 2 patients; third CN, 1; fifth CN, 1). CONCLUSIONS: MIPLATTA is a useful and safe treatment alternative that allows resection of large SPC tumors with dominant invasion of cavernous sinus and middle fossa, preserves hearing and facial motor function, and provides good chances of recovery of visual and oculomotor deficits.

Extradural minipterional approach for giant intracranial aneurysms.

BACKGROUND: The clinical applicability of the minipterional (MPT) craniotomy is still limited to small and superficial anterior circulation aneurysms. We discuss the technical nuances of a modified MPT approach, the extradural MPT approach (eMPTa), for the treatment of a giant intracranial aneurysm (GIA) arising from the paraclinoid carotid artery. CASE DESCRIPTION: A 44-year-old female presented with facial hypoesthesia and third cranial nerve palsy. Further investigations revealed the presence of a 27 mm aneurysm arising from the communicating segment of the internal carotid artery. The patient underwent surgical clipping through an extradural MPT craniotomy and combined anterior clinoidectomy. Postoperative angio-computed tomography demonstrated complete aneurysm occlusion and patency of the parent vessels. The patient recovered fully from her previous deficits. CONCLUSION: The skull base drilling, interdural dissection, and anterior clinoidectomy are key steps during the eMPTa that optimizes the use of the extradural corridor. Such adaptations are enough to improve the surgical maneuverability along the paraclinoid region and adapt the MPT suitability for the treatment of complex GIA.

The extradural minipterional pretemporal approach for the treatment of spheno-petro-clival meningiomas.

BACKGROUND: Cavernous sinus and petroclival region is an anatomically complex region in close relationship with important neurovascular structures. As such, the surgical treatment of spheno-petro-clival (SPC) meningiomas represents an operative challenge, in which several routes and its combinations might be used. METHODS: We describe in detail the surgical technique of the extradural minipterional pretemporal approach (eMPT-P) to the SPC region and highlight the main anatomical key elements involved in this approach as well as the technical aspects for avoiding surgical complications. CONCLUSION: The eMPT-P is a versatile approach that uses the extradural route, and thereby reduces brain retraction, while provides a good angle of exposure of the SPC region.

Radiocirugía en el tratamiento conservador de las lesiones preinvasoras del cuello uterino / Radiosurgery in the conservative treatment of the preinvader lesions of the uterine cervix

Se realizó un estudio descriptivo prospectivo y analítico con el objetivo de evaluar el comportamiento del Procedimiento de Extirpación con Asa Electroquirúrgica, como tratamiento conservador de lesiones preinvasoras del cuello uterino en la consultas de patología de cuello del Hospital General Docente de Morón en el periodo comprendido entre el primero de Enero de 2005 al 31 de Diciembre de 2006. El universo estuvo constituido por todas las mujeres portadoras de lesiones preinvasoras del cuello uterino a las que se le efectuó biopsia escisional con electrocirugía. Obteniendo como resultado que la frecuencia de utilización del Asa Electro quirúrgica fue de un 73,4 por ciento; la edad más frecuentes fue de 35-39 años; el motivo de consulta más frecuente fue la citología alterada, iniciaron las relaciones sexuales con menos de 17 años, tuvieron antecedentes de dos partos y de tener tres o más parejas sexuales.

A prospective, descriptive and analytical study was carried out with the objective to evaluate the behaviour of the Loop Electrosurgical Excision Procedure (LEEP), as conservative treatment of the preinvader lesions of the uterine cervix in the pathology office at The General Provincial Docent Hospital of Morón during the period among January 1st, 2005 to December 30th, 2006. The universe was constituted for all the women carrier of the preinvader lesions of the uterine cervix which the excisional biopsy had been carried out with electro surgery. The more frequent age was from 35 to 39 years, obtaining as a result that the utilization frequency of the loop electrosurgical was of a 73, 4 percent. The reason more frequent of the consultation was the alter cytology, they started their sexual relation before the 17 years, and they also had more than three sexual relationships.

Radiocirugía en el tratamiento conservador de las lesiones preinvasoras del cuello uterino / Radiosurgery in the conservative treatment of the preinvader lesions of the uterine cervix

Se realizó un estudio descriptivo prospectivo y analítico con el objetivo de evaluar el comportamiento del Procedimiento de Extirpación con Asa Electroquirúrgica, como tratamiento conservador de lesiones preinvasoras del cuello uterino en la consultas de patología de cuello del Hospital General Docente de Morón en el periodo comprendido entre el primero de Enero de 2005 al 31 de Diciembre de 2006. El universo estuvo constituido por todas las mujeres portadoras de lesiones preinvasoras del cuello uterino a las que se le efectuó biopsia escisional con electrocirugía. Obteniendo como resultado que la frecuencia de utilización del Asa Electro quirúrgica fue de un 73,4 por ciento; la edad más frecuentes fue de 35-39 años; el motivo de consulta más frecuente fue la citología alterada, iniciaron las relaciones sexuales con menos de 17 años, tuvieron antecedentes de dos partos y de tener tres o más parejas sexuales (AU)

A prospective, descriptive and analytical study was carried out with the objective to evaluate the behaviour of the Loop Electrosurgical Excision Procedure (LEEP), as conservative treatment of the preinvader lesions of the uterine cervix in the pathology office at The General Provincial Docent Hospital of Morón during the period among January 1st, 2005 to December 30th, 2006. The universe was constituted for all the women carrier of the preinvader lesions of the uterine cervix which the excisional biopsy had been carried out with electro surgery. The more frequent age was from 35 to 39 years, obtaining as a result that the utilization frequency of the loop electrosurgical was of a 73, 4 percent. The reason more frequent of the consultation was the alter cytology, they started their sexual relation before the 17 years, and they also had more than three sexual relationships (AU)