Craniotomia pré temporal

O presente artigo visa descrever de forma didática e prática a realização da craniotomia pré-temporal aplicada em oitenta pacientes de 2002 a 2012. Trata-se, portanto, de um texto fundamentalmente descritivo, dividido conforme as principais etapas da realização desta craniotomia, e que descreve com detalhes a técnica com que o presente grupo de autores evolutivamente veio a realizá-la.

neurocirurgia; craniotomia; microcirurgia

Autoria

Feres Chaddad-Neto

Professor of Neurosurgery, Departmento de Neurologia, Universidade Federal de São Paulo (UNIFESP), São Paulo SP, Brazil;Universidade Federal de São PauloBrazilSão Paulo, SP, BrazilProfessor of Neurosurgery, Departmento de Neurologia, Universidade Federal de São Paulo (UNIFESP), São Paulo SP, Brazil;

Neurosurgeon, Instituto de Ciências Neurológicas, São Paulo SP, Brazil;Instituto de Ciências NeurológicasBrazilSão Paulo, SP, BrazilNeurosurgeon, Instituto de Ciências Neurológicas, São Paulo SP, Brazil;

Neurosurgeon, Hospital Beneficência Portuguesa de São Paulo SP, Brazil;Hospital Beneficência Portuguesa de São PauloBrazilSP, BrazilNeurosurgeon, Hospital Beneficência Portuguesa de São Paulo SP, Brazil;

Hugo Leonardo Dória-Netto

José Maria Campos Filho

Mateus Reghin Neto

Evandro Oliveira

Professor and Head of Neurosurgery, Department of Neurology, Faculty of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas SP, Brazil.Universidade Estadual de CampinasBrazilCampinas, SP, BrazilProfessor and Head of Neurosurgery, Department of Neurology, Faculty of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas SP, Brazil.

Coordinator of the Microneurosurgery Laboratory, Instituto de Ciências Neurológicas (ICNE), Hospital Beneficência Portuguesa, São Paulo SP, Brazil.Hospital Beneficência PortuguesaBrazilSão Paulo, SP, BrazilCoordinator of the Microneurosurgery Laboratory, Instituto de Ciências Neurológicas (ICNE), Hospital Beneficência Portuguesa, São Paulo SP, Brazil.

Correspondence
: José Maria de Campos Filho; Praça Amadeu Amaral 27 / 5º andar / Bela Vista; 01327-010 São Paulo SP - Brasil; E-mail: icne@uol.com.br

Conflict of interest: There is no conflict of interest to declare.

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Figuras

Figuras (11)

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Figure 1
. (A): The skin incision starts at the superior rim of the zygomatic arch anterior to the tragus. (B): The skin incision extends to the hemi pupillary contralateral line in the frontal region.

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Figure 2
. Pretemporal craniotomy, the greater and lesser wing of the sphenoid, the squamosal part of the temporal bone and the orbital roof are drilled out. The line shows the S shape dural opening. A: orbital roof, B: sphenoid wing region, C: middle fossa floor.

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Figure 3
. Initially the dura is opened at the frontal region.

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Figure 4
. The dura is opened through the sylvian fissure toward the superior orbital fissure. The dura is reflected on the orbital roof without causing folds or ridges.

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Figure 5
. Finally the temporal lobe is outlined after the S shape dural open.

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Figure 6
. After the dural opening, the lateral fissure and the entire temporal lobe are exposed. A: frontal lobe, B: lateral fissure, C: temporal lobe.

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Figure 7
. The interpeduncular cistern can be accessed between the internal carotid artery and the optic nerve, between the internal carotid artery and the third nerve and retracting or opening the tentorium cerebelli laterally of the third nerve. A: optic nerve, B: carotid artery, C: oculomotor nerve.

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Figure 8
. The pretemporal approach allows a large exposure of the basal cisterns and the visualization of the carotid artery and its bifurcation, the optic nerve, the third nerve. A: carotid artery, B: anterior cerebral artery, C: middle cerebral artery, D: oculomotor nerve.

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Figure 9
. The antero-lateral route shows the interpeduncular cistern through the space between the carotid artery and the third nerve, exposing the basilar artery. A: carotid artery, B: oculomotor nerve, C: basilar artery, D: superior cerebellar artery.

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Figure 10
. Pretemporal craniotomy exposes trans sylvian (A), temporopolar (B) and subtemporal (C) approaches.

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Figure 11
. Temporopolar view (*).

Figure 1 . (A): The skin incision starts at the superior rim of the zygomatic arch anterior to the tragus. (B): The skin incision extends to the hemi pupillary contralateral line in the frontal region.

Figure 2 . Pretemporal craniotomy, the greater and lesser wing of the sphenoid, the squamosal part of the temporal bone and the orbital roof are drilled out. The line shows the S shape dural opening. A: orbital roof, B: sphenoid wing region, C: middle fossa floor.

Figure 3 . Initially the dura is opened at the frontal region.

Figure 4 . The dura is opened through the sylvian fissure toward the superior orbital fissure. The dura is reflected on the orbital roof without causing folds or ridges.

Figure 5 . Finally the temporal lobe is outlined after the S shape dural open.

Figure 6 . After the dural opening, the lateral fissure and the entire temporal lobe are exposed. A: frontal lobe, B: lateral fissure, C: temporal lobe.

Figure 7 . The interpeduncular cistern can be accessed between the internal carotid artery and the optic nerve, between the internal carotid artery and the third nerve and retracting or opening the tentorium cerebelli laterally of the third nerve. A: optic nerve, B: carotid artery, C: oculomotor nerve.

Figure 8 . The pretemporal approach allows a large exposure of the basal cisterns and the visualization of the carotid artery and its bifurcation, the optic nerve, the third nerve. A: carotid artery, B: anterior cerebral artery, C: middle cerebral artery, D: oculomotor nerve.

Figure 9 . The antero-lateral route shows the interpeduncular cistern through the space between the carotid artery and the third nerve, exposing the basilar artery. A: carotid artery, B: oculomotor nerve, C: basilar artery, D: superior cerebellar artery.

Figure 10 . Pretemporal craniotomy exposes trans sylvian (A), temporopolar (B) and subtemporal (C) approaches.

Figure 11 . Temporopolar view (*).

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Craniotomia pré temporal

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[1] Correspondence
: José Maria de Campos Filho; Praça Amadeu Amaral 27 / 5º andar / Bela Vista; 01327-010 São Paulo SP - Brasil; E-mail: icne@uol.com.br