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Comparative Analysis of Pterional, Supraorbital, Extended Supraorbital, and Transtubercular-Transplanum Approaches for Exposing the Anterior Communicating Artery Complex: A Cadaveric Study.
Zhu, Hongwei; Vigo, Vera; Ahluwalia, Amandeep; Chae, Ricky; El-Sayed, Ivan; Abla, Adib A; Rubio, Roberto Rodriguez.
Afiliação
  • Zhu H; Department of Neurological Surgery, First Affiliated Hospital of Xiamen University, Xiamen, Fujian Province, China; Department of Neurological Surgery, University of California, San Francisco, California, USA; Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, Califo
  • Vigo V; Department of Neurological Surgery, University of California, San Francisco, California, USA; Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, California, USA.
  • Ahluwalia A; Department of Neurological Surgery, University of California, San Francisco, California, USA; Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, California, USA.
  • Chae R; Department of Neurological Surgery, University of California, San Francisco, California, USA; Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, California, USA.
  • El-Sayed I; Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, California, USA; Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, California, USA.
  • Abla AA; Department of Neurological Surgery, First Affiliated Hospital of Xiamen University, Xiamen, Fujian Province, China; Department of Neurological Surgery, University of California, San Francisco, California, USA.
  • Rubio RR; Department of Neurological Surgery, University of California, San Francisco, California, USA; Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, California, USA; Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, California,
World Neurosurg ; 141: e576-e588, 2020 09.
Article em En | MEDLINE | ID: mdl-32522638
ABSTRACT

OBJECTIVE:

We aimed to quantify and compare surgical exposure and freedom at the anterior communicating artery (ACoA) complex using pterional (PT), supraorbital (SO), extended supraorbital withorbital osteotomy (SOO), and endonasal endoscopic transtubercular-transplanum (EEATT) approaches.

METHODS:

Right-sided PT, SO, SOO, and EEATT approaches were performed using 10 cadaveric heads. Surgical exposure and freedom (horizontal and vertical attack angle) at the ACoA complex were measured. The farthest clipping distance from ACoA to A1 (precommunicating segment of the anterior cerebral artery)/A2 (postcommunicating segment of the anterior cerebral artery) was also quantified.

RESULTS:

There was a significantly greater exposure length of right A1 in the PT approach (12.20 ± 2.48 mm) compared with the EEATT approach (9.52 ± 2.09 mm; P = 0.029). Among the 4 approaches, EEATT provided the shortest clipping distance for right A1 (6.56 ± 1.33 mm; P = 0.001) and the longest clipping distance for right A2 (3.36 ± 1.24 mm; P = 0.003). SO, SOO, and PT approaches (2.9 ± 0.9) had more observations on perforators from ACoA than did the EEATT approach (2.0 ± 0.66; P = 0.029). The EEATT approach (50.90 ± 17.45 mm2) provided better exposure of the superior part of the ACoA complex compared with the SO approach (29.37 ± 17.27 mm2; P = 0.05). PT and SOO approaches provided the greatest horizontal (36.88° ± 5.85°) and vertical (19.37° ± 4.70°) attack angle, respectively.

CONCLUSIONS:

The SO, SOO, and PT approaches provided a better hemilateral view of the ACoA complex and similar surgical exposure, whereas the EEATT approach offered greater exposure in the upper part of the ACoA complex, with relatively limited exposure of perforators from ACoA and surgical freedom. The EEATT approach can play a role in exposure of lesion involving the ACoA complex.
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Texto completo: 1 Base de dados: MEDLINE Assunto principal: Órbita / Círculo Arterial do Cérebro / Artéria Cerebral Anterior / Craniotomia / Tubérculo Olfatório / Microcirurgia Limite: Humans Idioma: En Ano de publicação: 2020 Tipo de documento: Article
Texto completo
Imprimir
XML
PubMed Links
Buscar no Google

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Órbita / Círculo Arterial do Cérebro / Artéria Cerebral Anterior / Craniotomia / Tubérculo Olfatório / Microcirurgia Limite: Humans Idioma: En Ano de publicação: 2020 Tipo de documento: Article