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1.
Surg Radiol Anat ; 41(9): 1045-1051, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31312895

RESUMO

PURPOSE: There has not been a study documenting the distribution of cerebrospinal fluid (CSF) pathways in the anterolateral base of the middle fossa (ALB) and diploe of the pterional region (Pt). The present study aimed to delineate these pathways using magnetic resonance imaging. METHODS: Thin-sliced, axial, and coronal T2-weighted sequences were performed for a total of 358 outpatients, including 20 pediatric patients. RESULTS: Adult population: CSF-filled channels were identified on axial images in the ALB in 57% and in the diploe of the Pt in 65% of 338 patients. These pathways showed variable morphology and number bilaterally. CSF-filled channels were identified on coronal images in the ALB in 14% and in the diploe of the Pt in 100% of 59 patients. These were delineated as linear structures of variable number and thickness. Eleven percent of the pathways identified in the ALB was connected with extracranial channels. Pediatric population: CSF-filled channels were identified on axial images in the ALB in 75% and in the diploe of the Pt in 80% of 20 patients. CONCLUSIONS: The ALB and diploe of the Pt may function as CSF pathways in children and adults. The pathways in the ALB can be a CSF-drainage route connecting to the extracranial sites.


Assuntos
Líquido Cefalorraquidiano/diagnóstico por imagem , Fossa Craniana Média/anatomia & histologia , Imagem por Ressonância Magnética , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Criança , Fossa Craniana Média/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
2.
Otol Neurotol ; 40(2): 246-253, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30624410

RESUMO

HYPOTHESIS: Patient-specific 3D printed models are useful presurgical planning tools because they accurately represent the anatomy and drilling characteristics of the middle cranial fossa (MCF) approach to the internal auditory canal (IAC). BACKGROUND: The MCF approach to the IAC can be challenging due to variability of the bony architecture along the floor of the middle fossa. Patient-specific 3D printed models may enhance surgeon knowledge of a given patient's anatomy when preparing for MCF surgery. METHODS: Six temporal bone models were printed from photoacrylic resin based on CT data obtained from cadaveric specimens using a desktop stereolithography 3D printer. Critical structures to avoid injuring, the facial nerve and membranous labyrinth, were modeled as hollow cavities and filled with indicator paint. Two neurotologists each drilled three 3D printed models and the corresponding cadaveric specimens, and then completed a 41-item visual analog scale questionnaire (score range of each item: 0-10) to assess the model's accuracy, utility, and potential as a training tool. RESULTS: Drilling the model was favorably rated (median score 9.2; range 7.3-9.6) for its ability to provide surgeons with an accurate mental image of the corresponding cadaveric anatomy. Overall similarity of feel of drilling the model in comparison to human bone was moderate (median 7.6; range 6.6-9.0). Surgeons would use this model to prepare for future cases (median 9.4; range 5.1-9.9) and felt it had excellent utility for training purposes (median 9.3; range 8.4-9.9). CONCLUSIONS: Patient-specific 3D printed models provide an anatomically accurate and favorable tool for preparing for MCF surgery.


Assuntos
Fossa Craniana Média/cirurgia , Modelos Anatômicos , Otolaringologia/métodos , Medicina de Precisão/métodos , Impressão Tridimensional , Fossa Craniana Média/anatomia & histologia , Humanos , Osso Temporal/anatomia & histologia , Tomografia Computadorizada por Raios X/métodos
3.
Ophthalmic Plast Reconstr Surg ; 35(2): 141-147, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30124605

RESUMO

PURPOSE: The cranio-orbital and accessory foramina are located in the lateral wall of the orbit and adjacent to the superior orbital fissure. In the literature, there is a lack of consistency concerning the location and morphology of these foramina in different populations. Therefore, considering its clinical importance during orbital surgeries, it was the authors' aim to determine the incidence, location, and number of cranio-orbital and accessory foramina in a Portuguese population and compare the findings with data from other studies. METHODS: A total of 310 orbits from 155 dry skulls from the collection of the Museum of Anatomy of the Faculty of Medicine of Porto were studied. The characterization of both cranio-orbital and accessory cranio-orbital foramina was performed. RESULTS: The cranio-orbital foramen was present in at least 1 orbit per skull in 58.17% with a median diameter of 0.60 ± 0.33 mm. No relation was found between the presence of this foramen and the gender of the individuals or a tendency for laterality. However, it was found that the presence of 1 or more accessory foramina was related to higher diameters of the cranio-orbital foramen. CONCLUSIONS: There might be a relationship between the localization, diameter, and communication of foramina with the cranial fossae. Foramina located on the greater wing of the sphenoid bone presented a larger diameter and communicated with the middle cranial fossa. High diameters of the main vessel in the cranio-orbital foramen may imply more developed branches and collateral irrigation of the orbital structures using 1 or more accessory foramina. Surgeons should be aware of the location of the cranio-orbital foramen to reduce potential sources of hemorrhage during orbital dissections.


Assuntos
Pontos de Referência Anatômicos , Fossa Craniana Média/anatomia & histologia , Procedimentos Cirúrgicos Oftalmológicos , Órbita/anatomia & histologia , Osso Esfenoide/anatomia & histologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Cadáver , Fossa Craniana Média/cirurgia , Humanos , Pessoa de Meia-Idade , Órbita/cirurgia , Portugal , Osso Esfenoide/cirurgia , Adulto Jovem
4.
Orbit ; 38(4): 305-307, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30335562

RESUMO

Purpose: To characterise variations in the location of the optic canal and its entry into the orbit in relation to the sphenoid sinus. Methods: In this observational study, patients with high-resolution computed tomography (CT) scans seen by 2 specialists (RG and DR) over a period of 12 years were reviewed for study entry. The primary outcome measure was characterisation of the optic canal route in relation to the sphenoid sinus and the location of its opening within the orbit. Three-dimensional reconstructions of the bony orbits were created using the Mimics imaging software. Optic canals were classified according to the location of their entry into the orbit. Type 1 was defined as a canalicular course along the lateral wall of the sphenoid sinus and entry into the orbit through the medial wall. Type 2 was defined as a canalicular course in the superior wall of the sphenoid sinus with entry into the orbit through the roof. The angle of entry of each nerve into the orbit was calculated. Results: One-hundred patients (52 females and 48 males) contributed 100 orbits to the study. Type 1 configuration was noted in 90 orbits, whereas Type 2 was noted in 10 orbits. The mean angle (SD) of entry of Type 1 optic nerves into the orbit was 61° (10.7), whereas the angle of entry of Type 2 nerves was 32.35° (6.8). The difference was significant (p < 0.01). Conclusions: This study demonstrates variability of the path and outlet of the optic canal and presents a relatively common (10%) configuration in which the optic canal travels in the roof of the sphenoid sinus rather than the expected position in the lateral wall.


Assuntos
Variação Anatômica , Fossa Craniana Média/anatomia & histologia , Órbita/anatomia & histologia , Seio Esfenoidal/anatomia & histologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Artéria Oftálmica/fisiologia , Nervo Óptico/fisiologia
5.
Int. j. morphol ; 36(4): 1480-1484, Dec. 2018. tab, graf
Artigo em Espanhol | LILACS | ID: biblio-975725

RESUMO

El foramen de Warwick o foramen venoso órbito cavernoso, es un foramen inconstante del ala mayor del esfenoides, situado entre la fisura orbitaria superior y el foramen rotundo. Comunica la órbita con la fosa craneal media y/o con la fosa pterigopalatina y permitiría el paso de la vena oftálmica inferior. La presencia del foramen venoso órbito cavernoso varía entre el 0,38 % y el 0,74 %. Se describe con forma redondeada o crescéntica (semilunar), unilateral o bilateral. El objetivo de este trabajo fue evidenciar la presencia y las características de foramen venoso órbito cavernoso en cráneos secos de individuos adultos chilenos de ambos sexos. Se analizaron 138 cráneos de individuos adultos y de ambos sexos, en búsqueda del foramen venoso órbito cavernoso para determinar la frecuencia, localización, forma, tamaño, orientación y distancias con respecto a la fisura orbitaria superior y el foramen rotundo. Los forámenes encontrados fueron fotografiados, explorados y medidos. La presencia del foramen venoso órbito cavernoso fue del 2,17 % de la muestra, encontrándose en forma unilateral (1,45 %) y bilateral (0,17 %). Con forma redondeada en 3 casos y semilunar en 1 caso. Con orientación hacia la órbita (2 casos) y hacia la fosa pterigopalatina (2 casos). También se evidenció que cuando está presente el foramen venoso órbito cavernoso, la separación entre la fisura orbitaria superior y el foramen rotundo es mayor que en su ausencia. Nuestro estudio demuestra la presencia del foramen venoso órbito cavernoso en la población chilena, con una frecuencia más alta que la observada en otras poblaciones. La localización, orientación y formas coinciden con la literatura, pero difiere en el tamaño (en forámenes redondeados). También pudimos determinar que la fisura orbitaria superior y el foramen rotundo tienden a encontrarse más cercanos en ausencia del foramen venoso órbito cavernoso y por lo tanto más distante cuando esta estructura está presente. Este hecho no está descrito en la literatura. Los resultados de este estudio son importantes para la anatomía, oftalmología, traumatología, imagenología, cirugía e identificación humana. Finalmente y en virtud de la TAI, proponemos llamar a este foramen, foramen venoso órbito cavernoso.


The Warwick's foramen or cavernous orbital venous foramen, is an inconstant foramen from the greater wing of the sphenoid bone, located between the superior orbital fissure and the rotundum foramen. It connects the orbit with the middle cranial fossa and/or with the pterygopalatine fossa and allows for the passage of the inferior ophthalmic vein. The presence of the cavernous orbital venous foramen varies between 0.38 % and 0.74 % in human skulls. It is described as having a rounded or crescentic (semilunar), unilateral or bilateral shape. The objective of the present work was to demonstrate the presence and characteristics of the cavernous orbital venous foramen in dry skulls of Chilean adult individuals of both sexes. One hundred and thirty-eight adult skulls of both sexes were analyzed in search of the cavernous orbital venous foramen to determine the frequency, location, shape, size, orientation and distances with respect to the superior orbital fissure and the rotund foramen. Found foramina were photographed, explored and measured. The cavernous orbital venous foramen was present in 2.17 % of the sample, and was both unilateral (1.45 %) and bilateral (0.17 %). It had a rounded and lunate shape in 3 and 1 cases, respectively. Moreover, it was orientated towards the orbit (2 cases) and towards the pterygopalatine fossa (2 cases). It was also evidenced that when the cavernous orbital venous foramen is present, the separation between the superior orbital fissure and the rotund foramen is greater than in its absence. Our study demonstrates the presence of the cavernous orbital venous foramen in the Chilean population, with a higher frequency than described previously. The location, orientation and observed forms agree with the literature, but differ in size (in rounded shape foramen). We could also determine that the superior orbital fissure and the rotundum foramen tend to be closer in the absence of the cavernous orbital venous foramen and, therefore, are more distant when this structure is present. This fact is not described in the literature. The results of this study are important for anatomy, ophthalmology, traumatology, imaging, surgery and human identification. Finally, and by virtue of the International Anatomical Terminology (IAT), we propose to call this structure the cavernous orbital venous foramen.


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Órbita/anatomia & histologia , Seio Cavernoso/anatomia & histologia , Fossa Craniana Média/anatomia & histologia , Chile
6.
J Craniomaxillofac Surg ; 46(10): 1703-1706, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30100384

RESUMO

BACKGROUND: The arcuate eminence (AE) is a bony prominence on the middle fossa plate of the temporal bone, hypothesized to be variably associated with superior semicircular canal (SSC) relief, temporal lobe sulcus, and subjacent air cells. We present various morphometric parameters of the AE, as seen using a middle fossa approach. MATERIALS AND METHODS: The study used 18 formalin-preserved cadaveric human temporal bones. Various morphological and morphometric parameters pertaining to topographic orientation of the AE in relation to surrounding landmarks used in a middle mossa approach were noted, before and after microdissection of the AE under a Leica M320 F12 microscope, using otologic microdrills and suction irrigation. The morphometric parameters were analyzed using ImageJ 1.46r software. RESULTS: The overall incidence of AE was 83% (n = 15/18). The most common shape and pattern noted were linear (53.3%, 8/15) and dual arc (46.7%, 7/15), respectively. Mean angle between the AE and SSC was 19°, with a standard deviation of 15° and a range of 2-49°. The AE overlapped the SSC in 40% (6/15) of bones, and did not correspond to the SSC in 7% of cases. A partially overlapping positional correspondence was noted in 53.3% (8/15). CONCLUSION: When present, the AE corresponds to the SSC in 40% of cases, but it can serve as a rough guide to the SSC in up to 93% of cases. Surgeons need to be familiar with the varying morphology of AEs in order to execute a rapid and safe dissection during middle fossa approaches.


Assuntos
Pontos de Referência Anatômicos/anatomia & histologia , Fossa Craniana Média/anatomia & histologia , Osso Temporal/anatomia & histologia , Adulto , Humanos , Microscopia
7.
Angle Orthod ; 88(6): 757-764, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30004786

RESUMO

OBJECTIVES:: The purpose of this three-dimensional (3D) study was to assess retrospectively the middle cranial fossa and central skull base of patients treated with the Herbst appliance (HA). MATERIALS AND METHODS:: 3D surface virtual models of 40 Class II, division 1 malocclusion patients were generated from cone-beam computed tomography (CBCT) acquired before treatment (T0) and after 8 months of HA treatment (T1). T0 and T1 3D models were superimposed volumetrically at the anterior cranial fossa. Twenty subjects who had been treated with the Herbst appliance (HAG) were compared to 20 subjects who were not treated orthopedically. The latter group served as a comparison control group (CG). Quantitative assessments of the location and directional changes were made with linear and angular measurements between anatomical landmarks. Qualitative assessments of the spatial behavior of the middle cranial fossa and central skull base relative to the anterior cranial fossa were displayed graphically for visualization with color maps and semitransparent overlays. Non-parametric tests were performed to compare the between the HAG and CG. RESULTS:: Point-to-point linear measurements and skeletal rotation (pitch, roll, and yaw) changes were very small along the observational period and were not significantly different between HAG and CG. Visual analysis of color maps and overlays confirmed that no changes in the cranial base were associated with HA. CONCLUSIONS:: HA therapy did not produce clinically significant changes in the middle cranial fossa and central skull base.


Assuntos
Fossa Craniana Média/diagnóstico por imagem , Aparelhos Ortodônticos Funcionais , Base do Crânio/diagnóstico por imagem , Adolescente , Estudos de Casos e Controles , Criança , Tomografia Computadorizada de Feixe Cônico , Fossa Craniana Média/anatomia & histologia , Fossa Craniana Média/patologia , Humanos , Imagem Tridimensional , Má Oclusão de Angle Classe II/diagnóstico por imagem , Má Oclusão de Angle Classe II/patologia , Má Oclusão de Angle Classe II/terapia , Aparelhos Ortodônticos Funcionais/efeitos adversos , Base do Crânio/anatomia & histologia , Base do Crânio/patologia
8.
Curr Opin Otolaryngol Head Neck Surg ; 26(5): 286-292, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29957681

RESUMO

PURPOSE OF REVIEW: To review the current literature on the extended middle cranial fossa (xMCF) approach and to provide a comprehensive description of the relevant anatomy, indications, surgical technique, results, and complications. RECENT FINDINGS: The xMCF approach expands the surgical exposure provided by the sMCF approach, allowing access to the internal auditory canal, cerebellopontine angle, prepontine cistern, anterior petrous apex, petrous carotid artery, Meckel's cave, cavernous sinus, mid and upper clivus, and posterior lesions approaching the jugular foramen. Preservation of serviceable hearing is possible with success rates approximating 50% in vestibular schwannoma and meningioma resection, and facial nerve outcome is excellent. SUMMARY: The xMCF is an important approach for difficult to access lesions that additionally offers the possibility of hearing preservation. This approach is also useful for vascular lesions, auditory brainstem implantation, and lesions of mid-brainstem.


Assuntos
Fossa Craniana Média/cirurgia , Craniotomia/métodos , Fossa Craniana Média/anatomia & histologia , Craniotomia/efeitos adversos , Perda Auditiva/etiologia , Perda Auditiva/prevenção & controle , Humanos , Aneurisma Intracraniano/cirurgia , Meningioma/cirurgia , Neuroma Acústico/cirurgia
9.
J Craniofac Surg ; 29(4): 1069-1071, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29543680

RESUMO

Trauma to the mandible can occasionally be a life-threatening event. Although extremely rare with only 56 reported patients in the English language, fracture of the floor of the middle cranial fossa with protrusion of the mandibular condyle into the middle cranial fossa was first reported in 1963 by Dingman. The authors review the anatomy of the temporomandibular joint in relation to the middle cranial fossa and demonstrate the possible complications due to condylar intrusion with anatomical dissection.


Assuntos
Fossa Craniana Média/anatomia & histologia , Côndilo Mandibular/anatomia & histologia , Articulação Temporomandibular/anatomia & histologia , Humanos , Fraturas Cranianas
10.
J Int Adv Otol ; 14(2): 290-294, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29460825

RESUMO

OBJECTIVE: There is still ongoing research on the relationship of arcuate eminence (AE) and superior semicircular canal (SSC). We aimed to evaluate the precision of predictability of SSC through the morphology of AE via radiological means. MATERIALS AND METHODS: This investigation is performed on 12 dry skulls belonging to Mersin University Medical Faculty department of anatomy. Computed tomography (CT) assessment is performed with 0.5-mm-thin sections temporal bone algorithm on dry skulls which were marked with fixated copper wire by scotch tapes on the most prominent part of the middle fossa floor assuming the location of AE. The data are reformatted on the workstation with vitrea 2.0. The distances of the determined three points including lateral (A), apical (B), and medial (C) of the SSC and the copper wire are measured radiologically. Also, the height between the most apical part of the SSC to the floor of the skullbase (H) is measured. The angles between the placed copper wires and the SSC (E) are calculated. The angle between SSC and the midpoint of the IAC (F) and SSC to the sulcus of the greater GSPN (G) were measured. The nearest distance was measured between the most posterior part of the SSC and the point marked by the perpendicular line drawn from the medial border of the petrous bone to the most posterior part of the internal auditory canal (IAC) (D). RESULTS: The right and left A, B, and C distances are 2.54+/- 2.75, 3.67+/-3.16, 5.85+/-3.77; 2.92+/-2.24, 3.68+/-2.93, 6.09+/-3.40, respectively. We could not find any statistical significance when the right A, B, and C distances were compared with the left values. Examination of the values revealed that C distance is greater than the A distance of the same side both for right (p=0.040) and left (p=0.022) measurements. The calculated left and right E angles are 30.313+/-12.838, and 35.558+/-18.437 degrees, respectively. Statistical significance was not found between the right and left angles. The right and left F, G angles were 53.17, 47.25; 93.58, 100.92 degrees; and D distances are 8.01, 8.13 millimeters, respectively. Statistical significance was not found when right and left E, F, G angles and D distances were compared. Among 12 left and 12 right sides, the copper wire was found to be nearly overlapping to SSC in two in the right and only one in the left. CONCLUSION: This study reveals that there is a great variability predicting the exact location of SSC through the prominence of AE. Complementary studies are needed with greater number of dry skulls and cadavers. Comparison of different hypothesis including the effect of temporal lobe sulcus is to be discussed to better enlighten the exact relationship of the aforementioned anatomical structures.


Assuntos
Fossa Craniana Média/diagnóstico por imagem , Dissecação/métodos , Canais Semicirculares/anatomia & histologia , Algoritmos , Cadáver , Fossa Craniana Média/anatomia & histologia , Fossa Craniana Média/cirurgia , Humanos , Osso Petroso/anatomia & histologia , Osso Petroso/diagnóstico por imagem , Osso Petroso/cirurgia , Canais Semicirculares/diagnóstico por imagem , Canais Semicirculares/cirurgia , Osso Temporal/anatomia & histologia , Osso Temporal/diagnóstico por imagem , Osso Temporal/cirurgia , Tomografia Computadorizada por Raios X/métodos
11.
J Med Syst ; 42(2): 38, 2018 Jan 16.
Artigo em Inglês | MEDLINE | ID: mdl-29336001

RESUMO

The objective of this paper is to present a morphometric study of the middle cranial fossa from the study of 87 patients using cutting edge multislice computed tomography scans (32 detectors) and Magnetic Resonance Imaging. The study presents a detailed anatomical-radiological and morphometric analysis of the middle cranial fossa as well as its neurovascular elements in normal conditions. The implications of this investigation in training and clinical contexts are discussed.


Assuntos
Fossa Craniana Média/anatomia & histologia , Neuroimagem/métodos , Adulto , Idoso , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
12.
Clin Anat ; 31(5): 724-733, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28556192

RESUMO

The extracranial-intracranial (EC-IC) bypass using the maxillary artery (MA) has been successfully completed using a radial artery (RA) graft but the complicated anatomy and narrow exposure make it difficult. The purpose of this article is to define the microsurgical exposure of the MA through the middle fossa and describe the branches, diameter, and length of the MA available for the EC-IC bypass in the sphenopalatine fossa and anterior part of the infratemporal fossa. 5 cadaveric specimens were dissected bilaterally (10 MA dissections) to define the microsurgical anatomy of the MA through an intracranial approach. The exposable branches of the MA at the level of the infratemporal and sphenopalatine fossae were the anterior deep temporal, posterior superior alveolar, and infraorbital arteries. The origin of each branch could be exposed. The available section of the MA for use as a donor vessel is between the origin of the anterior deep temporal artery and the infraorbital artery. The mean exposable length of the MA was 19.4 mm. The mean outer diameter of the donor MA was 3.2 mm. Tension-free EC-IC bypass was possible using a RA graft between the MA and the middle cerebral artery, the MA and the supraclinoid internal carotid artery (ICA), or the MA and the petrous ICA. Exposure of the MA at the infratemporal and sphenopalatine fossae is complicated but provides length and diameter suitable as a donor artery for the EC-IC bypass. Clin. Anat. 31:724-733, 2018. © 2017 Wiley Periodicals, Inc.


Assuntos
Revascularização Cerebral/métodos , Artéria Maxilar/anatomia & histologia , Artéria Maxilar/transplante , Adulto , Fossa Craniana Média/anatomia & histologia , Humanos , Microcirurgia , Fossa Pterigopalatina/anatomia & histologia
13.
World Neurosurg ; 111: e261-e266, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29269064

RESUMO

BACKGROUND: The arcuate eminence (AE) has been traditionally used in middle cranial fossa (MCF) surgery as a guide to accurate location of the superior semicircular canal (SSC) deep within the temporal bone. However, the anatomic relationship between the AE and SSC is controversial. We evaluated the anatomic coincidence between the AE and the SSC in the MCF surface. Distances between the most relevant anatomic structures in the MCF and prevalence of SSC dehiscence were measured. METHODS: We analyzed 75 (150 sides) 0.75-mm slice thickness temporal bone computed tomography scans and classified the AE and SSC relationship as coincident and noncoincident. Radiologic findings were reported independently in a blind fashion by 2 authors. Data were presented as mean ± SD or frequency and percentage. Student t test or an unequal variance t test was used. Interobserver agreement among readings was assessed using κ statistic for categorical variables and intraclass Kendall tau-a correlations for continuous measures. P < 0.05 was considered to indicate statistical significance. RESULTS: The AE matched the SSC in only 31.3% of cases. The AE could be localized as lateral as 11.6 mm from the SSC. It was impossible to identify the AE in 33 scans (22.0%). SSC dehiscence was found in 5 cases (3.3%). A few millimeters separated most analyzed landmarks, and a wide variability in secondary measurements was observed. CONCLUSIONS: The AE does not systematically overlie the SSC and should not be routinely used as a reference to reach this structure in MCF surgery.


Assuntos
Pontos de Referência Anatômicos , Fossa Craniana Média/anatomia & histologia , Osso Temporal/cirurgia , Fossa Craniana Média/diagnóstico por imagem , Estudos Transversais , Humanos , Interpretação de Imagem Assistida por Computador , Tomografia Computadorizada por Raios X
14.
Oper Neurosurg (Hagerstown) ; 13(5): 614-621, 2017 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-28922880

RESUMO

BACKGROUND: In the last decade, endoscopic skull base surgery has significantly developed and generated a plethora of techniques and approaches for access to the cranial ventral floor. However, the exploration for the least-aggressive, maximally efficient approach continues. OBJECTIVE: To describe in detail an anatomical study, along with the technical nuances of a novel endoscopic approach to Meckel's Cave (MC) using a lateral transorbital (LTO) route. METHODS: Eighteen orbits of injected cadaveric specimens were operated on, using an endoscopic LTO approach to MC, middle cranial fossa, and paramedian skull base preserving the orbital rim. Surgical navigation and an after-the-fact infratemporal craniectomy were utilized to identify the limits of the approach. RESULTS: Following a transorbital approach opening a trapezoid window at the superolateral aspect (average 166.7 mm 2 ), a middle fossa "peeling" and full visualization of MC was accomplished with no difficulties in all specimens. The entire approach was performed extradurally without the need to expose the temporal lobe. CONCLUSION: In a cadaveric model, the endoscopic LTO approach affords a direct route to access MC. Its main advantage is that it is minimally disruptive in nature, less brain retraction is required, and it reaches the middle fossa in an anterolateral perspective. It also requires no manipulation of the temporalis muscle, limited cosmetic incision, and rapid recovery. It seems a viable alternative to traditional approaches for lesions lateral to the cranial nerves at the cavernous sinus and MC, that is, schwannomas. Clinical utilization of this approach will challenge its efficacy and identify limitations.


Assuntos
Fossa Craniana Média/anatomia & histologia , Fossa Craniana Média/cirurgia , Procedimentos Neurocirúrgicos/métodos , Órbita/cirurgia , Cadáver , Seio Cavernoso/anatomia & histologia , Seio Cavernoso/cirurgia , Endoscópios , Estudos de Viabilidade , Humanos , Neuronavegação , Órbita/anatomia & histologia
15.
Otol Neurotol ; 38(9): 1351-1354, 2017 10.
Artigo em Inglês | MEDLINE | ID: mdl-28796089

RESUMO

HYPOTHESIS: The suprameatal crest and temporal line provides a reliable landmark to the middle fossa dura. BACKGROUND: Surface anatomy of the temporal bone is used to guide mastoid surgery, but studies investigating these landmarks are limited. The aim of this study was to examine the anatomical relationship of the middle fossa dura to the temporal line. METHODS: Thirty-two fresh hemicephalic temporal bones were prepared by drawing four lines along the mastoid including the suprameatal crest and temporal line (line 2), one line 5 mm superior to line 2 (line 1), and one 5 mm inferior to line 2 (line 3), and at Reid's base line (line 4). Four points were marked along these lines anterior to posterior 3 mm apart. A 1 mm bur was used to drill perpendicular to these points to examine the relationship to the middle fossa dura. RESULTS: The dura was found inferior to line 2 in 6.3% at point 1, 6.3% at point 2, 9.4% at point 3, and 18.8% at point 4. The dura in line 1 was found inferior to point 1 in 52.1%, point 2 in 46.9%, point 3 in 56.3%, and point 4 in 62.5%. Only one specimen (3.1%) had dura lying inferior to line 3. No specimens were inferior line 4 at any point. CONCLUSION: The dura of the middle fossa lies superior the temporal line in >80% of specimens and at least 5 mm superior in nearly half. This indicates the temporal line or a line slightly inferior to this is reliably inferior the middle fossa dura.


Assuntos
Fossa Craniana Média/anatomia & histologia , Osso Temporal/anatomia & histologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Processo Mastoide/anatomia & histologia , Pessoa de Meia-Idade
16.
Orbit ; 36(2): 110-117, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28388344

RESUMO

Orbits are connected with the middle cranial fossa via the optic canal, the superior orbital fissure, the M-type orbitomeningeal foramen, the metoptic canal, an accessory anterior opening of the foramen rotundum, and Warwick's canal. They are also in communication with the anterior cranial fossa via the ethmoidal canals and the A-type orbitomeningeal foramen. The anatomy of these conduits has been recently enriched with several details that are summarized and reviewed in this article.


Assuntos
Fossa Craniana Anterior/anatomia & histologia , Fossa Craniana Média/anatomia & histologia , Órbita/anatomia & histologia , Variação Anatômica , Osso Etmoide/anatomia & histologia , Humanos , Artéria Oftálmica/anatomia & histologia , Nervo Óptico/anatomia & histologia , Osso Esfenoide
17.
Surg Radiol Anat ; 39(7): 815-818, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-27837265

RESUMO

Variations of the skull base foramina are quite common and often cause surgical confusion during surgical intervention of the region. The unusual foramen was observed in five (0.98%) adult skulls of black South Africans obtained from the Raymond A Dart collection of human specimens housed in the School of Anatomical Sciences at the University of the Witwatersrand. Three of the five specimens were females while the remaining two were males. In four of the five skulls, the unusual foramen was located anterolateral to the foramen rotundum both on the left and right sides. In the fifth specimen, the foramen was located posterolateral to the foramen rotundum on the left half of the middle cranial fossa. On radiographs, two specimens with unusual foramen on the right showed that the foramen opened into a canal directed inferomedially towards the pterygopalatine fossa. In the remaining three specimens, the canals were blind and shallow. This information is vital during interpretation of CT scans at the base of the skull, as any less well-known foramen may be mistaken for abnormalities leading to surgical complications.


Assuntos
Fossa Craniana Média/anatomia & histologia , Variação Anatômica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
18.
Head Neck ; 38 Suppl 1: E1680-7, 2016 04.
Artigo em Inglês | MEDLINE | ID: mdl-26875705

RESUMO

BACKGROUND: The quadrangular space permits an anterior entry into Meckel's cave while obviating the need for cerebral or cranial nerve retraction. This avenue is intimately associated with the cavernous sinus; thus, from this ventral perspective, it is feasible to visualize the anteromedial, anterolateral, and Parkinson triangles. METHODS: Twenty middle cranial fossae were dissected endonasally under direct endoscopic visualization. Measurements of the surface area of the quadrangular space and the ventrally accessible cavernous sinus triangles were performed using 3 coordinates under image-guided navigation. RESULTS: The surface area of the quadrangular space was 16.36 mm(2) (±2.89 mm(2) ). The anterolateral triangle was the largest (47.27 ± 5.37 mm(2) ), whereas Parkinson's was the smallest (22.46 ± 5.54 mm(2) ); the anteromedial triangle presented an average surface area 36.07 mm(2) (±4.15 mm(2) ). CONCLUSION: The trajectory of the internal carotid artery (ICA) significantly impacts the quadrangular space area and may be a potential parameter for defining the feasibility of this corridor. © 2016 Wiley Periodicals, Inc. Head Neck 38: E1680-E1687, 2016.


Assuntos
Seio Cavernoso/anatomia & histologia , Seio Cavernoso/diagnóstico por imagem , Fossa Craniana Média/anatomia & histologia , Fossa Craniana Média/diagnóstico por imagem , Endoscopia , Cadáver , Nervos Cranianos , Dissecação , Humanos , Nariz
19.
Neurosurg Rev ; 39(1): 87-96; discussion 96-7, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26160680

RESUMO

Surgery of the infratemporal fossa (ITF) and parapharyngeal area presents a formidable challenge to the surgeon due to its anatomical complexity and limited access. Conventional surgical approaches to these regions were often too invasive and necessitate sacrifice of normal function and anatomy. To describe a less invasive transcranial extradural approach to ITF parapharyngeal lesions and to determine its advantages, 17 patients with ITF parapharyngeal neoplasms who underwent tumor resection via this approach were enrolled in the study. All lesions located in the ITF precarotid parapharyngeal space were resected through a small operative corridor between the trigeminal nerve third branch (V3) and the temporomandibular joint (TMJ). Surgical outcomes and postoperative complications were evaluated. Pathological diagnosis included schwannoma in eight cases, paraganglioma in two cases, gangliocytoma in two cases, carcinosarcoma in one case, giant cell tumor in one case, pleomorphic adenoma in one case, chondroblastoma in one case, and juvenile angiofibroma in one case. Gross total resection was achieved in 12 cases, near-total and subtotal resection were in 3 and 2 cases, respectively. The most common postoperative complication was dysphagia. Surgical exposure can be customized from minimal (drilling of retrotrigeminal area) to maximal (full skeletonization of V3, removal of all structures lying lateral to the petrous segment of internal carotid artery) according to tumor size and location. Since the space between the V3 and TMJ is the main corridor of this approach, the key maneuver is the anterior translocation of V3 to obtain an acceptable surgical field.


Assuntos
Fossa Craniana Média/anatomia & histologia , Fossa Craniana Média/cirurgia , Procedimentos Neurocirúrgicos/métodos , Neoplasias da Base do Crânio/patologia , Neoplasias da Base do Crânio/cirurgia , Adolescente , Adulto , Idoso , Craniotomia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Neurilemoma/patologia , Neurilemoma/cirurgia , Paraganglioma/patologia , Paraganglioma/cirurgia , Complicações Pós-Operatórias/epidemiologia , Articulação Temporomandibular/anatomia & histologia , Resultado do Tratamento , Nervo Trigêmeo/anatomia & histologia , Adulto Jovem
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