Microsurgical Anatomy of the Interfascial Vein. Its Significance in the Interfascial Dissection of the Pterional Approach

2017 ◽  
Vol 13 (5) ◽  
pp. 622-626 ◽  
Author(s):  
Alvaro Campero ◽  
Pablo Ajler ◽  
Martín Paíz ◽  
Ramiro López Elizalde
Keyword(s):  
Facial Nerve ◽  
Cranial Base ◽  
Technical Detail ◽  
Microsurgical Anatomy ◽  
Fat Pad ◽  
Pterional Approach ◽  
Anatomic Landmark ◽  
Temporal Fascia ◽  
Superficial Temporal Fascia ◽  
Interfascial Dissection

Abstract BACKGROUND: The pterional approach (PA), together with its variants, is still one of the most common methods used by surgeons to reach the anterior and middle cranial base. A highly important technical detail during a PA is the preservation of the frontotemporal branch of the facial nerve, which can be achieved through an interfascial dissection. OBJECTIVE: To describe the anatomy of the interfascial vein (IFV), highlighting its recognition as a significant anatomic reference to perform an interfascial dissection (IFD). METHODS: Eight adult cadaveric heads, fixed with formaldehyde and injected with colored silicone, were studied. In 6 heads, an IFD was performed, simulating a PA. In the 2 remaining heads, the IFV was dissected. In addition, an IFD was performed in 10 patients, studying the IFV anatomy. RESULTS: In the 6 cadaveric heads in which the PA with an IFD was performed, and in the 10 patients who underwent a PA with an IFD, the IFV was found. If the interfascial space is divided into thirds, in all cases, the IFV was located within the middle third of the interfascial fat pad. On the 2 cadaveric heads in which the IFV was anatomically dissected, the IFV was also located within the middle third of the interfascial space. CONCLUSION: Recognizing the IFV in the interfascial space is of great help as an anatomic landmark to confirm that one is actually between both layers of the superficial temporal fascia.

Fronto-temporal branch of facial nerve within the interfascial fat pad: is the interfascial dissection really safe?

2016 ◽  
Vol 158 (3) ◽  
pp. 527-532 ◽  
Author(s):  
Toma Spiriev ◽  
Florian Heinrich Ebner ◽  
Bernhard Hirt ◽  
Thomas Shiozawa ◽  
Corinna Gleiser ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Fat Pad ◽  
Interfascial Dissection

Outcomes of Facial Nerve Palsies after Lateral Cranial Base Surgery

Skull Base ◽  
2007 ◽  
Vol 17 (S 1) ◽  
Author(s):  
Diego Zanetti ◽  
Francesca Casigli ◽  
Nader Nassif ◽  
Roberto Stefini
Keyword(s):  
Facial Nerve ◽  
Cranial Base ◽  
Cranial Base Surgery

Tuberothalamic Infarct after Division of a Hypoplastic Posterior Communicating Artery for Clipping of a Basilar Tip Aneurysm: Case Report

Neurosurgery ◽  
1991 ◽  
Vol 28 (3) ◽  
pp. 456-459 ◽  
Author(s):  
Luca Regli ◽  
Nicolas de Tribolet
Keyword(s):  
Case Report ◽  
Clinical Observation ◽  
Significant Risk ◽  
Posterior Communicating Artery ◽  
Microsurgical Anatomy ◽  
Parent Vessel ◽  
Pterional Approach ◽  
Basilar Tip Aneurysm

Abstract The authors present a case of a tuberothalamic infarct subsequent to division of the posterior communicating artery for clipping of a high-lying aneurysm of the basilar bifurcation using the pterional approach. In view of this clinical observation and some particular aspects of the microsurgical anatomy of the perforating vessels of the posterior communicating artery, we conclude that interrupting this parent vessel carries a significant risk of infarction.

scholarly journals Anatomy of the Orbit

2020 ◽  
Vol 81 (04) ◽  
pp. 319-332
Author(s):  
Stefan Lieber ◽  
Juan C. Fernandez-Miranda
Keyword(s):  
Anterior Part ◽  
Cranial Base ◽  
Surgical Approaches ◽  
Microsurgical Anatomy ◽  
Orbital Apex ◽  
Special Issue ◽  
Superior Orbital Fissure ◽  
Anatomical Structures ◽  
Transnasal Surgery ◽  
Maxillary Sinuses

AbstractThe orbit is a paired, transversely oval, and cone-shaped osseous cavity bounded and formed by the anterior and middle cranial base as well as the viscerocranium. Its main contents are the anterior part of the visual system, globe and optic nerve, and the associated neural, vascular, muscular, glandular, and ligamentous structures required for oculomotion, lacrimation, accommodation, and sensation.A complex stream of afferent and efferent information passes through the orbit, which necessitates a direct communication with the anterior and middle cranial fossae, the pterygopalatine and infratemporal fossae, as well as the aerated adjacent frontal, sphenoidal, and maxillary sinuses and the nasal cavity.This article provides a detailed illustration and description of the microsurgical anatomy of the orbit, with a focus on the intrinsically complex spatial relationships around the annular tendon and the superior orbital fissure, the transition from cavernous sinus to the orbital apex. Sparse reference will be made to surgical approaches, their indications or limitations, since they are addressed elsewhere in this special issue. Instead, an attempt has been made to highlight anatomical structures and elucidate concepts most relevant to safe and effective transcranial, transfacial, transorbital, or transnasal surgery of orbital, periorbital, and skull base pathologies.

Microsurgical Anatomy and Surgical Approaches of the Cranial Base: The Radial Corridors

2020 ◽  
pp. 583-615
Author(s):  
Alejandro Monroy-Sosa ◽  
Srikant S. Chakravarthi ◽  
Austin Epping ◽  
Melanie B. Fukui ◽  
Richard A. Rovin ◽  
...  
Keyword(s):  
Cranial Base ◽  
Surgical Approaches ◽  
Microsurgical Anatomy

Anterior Facial Nerve Rerouting in Cranial Base Surgery: A Comparison of Three Techniques

1996 ◽  
Vol 115 (1) ◽  
pp. 82-88 ◽  
Author(s):  
Peter G. Von Doersten ◽  
Robert K. Jackler
Keyword(s):  
Facial Nerve ◽  
Jugular Foramen ◽  
Jugular Bulb ◽  
Cranial Base ◽  
Clinical Impression ◽  
Canal Wall ◽  
Posterior Aspect ◽  
Pivot Point ◽  
Carotid Canal ◽  
Canal Wall Down

Anterior rerouting of the facial nerve is a maneuver designed to enhance exposure of the jugular foramen and carotid canal during resection of cranial base tumors. Our clinical impression is that the degree of additional exposure afforded by moving the facial nerve varies considerably according to both anatomic variations and the technique used. Three possible techniques exist based on the extent of facial nerve mobilization and point of rotation: canal wall up-second genu pivot point (CWU-2G); canal wall down-second genu pivot point (CWD-2G); and canal wall down-first genu pivot point (CWD-1G). We anatomically studied 20 human cadaver heads to establish clinically relevant guidelines for the selective use of these techniques. At the level of the dome of the jugular bulb, the facial nerve mobilized anteriorly a mean of 4.2 mm for CWU-2G, 10 mm for CWD-2G, and 14 mm for CWD-1G. Detailed analysis of numerous measurements and rotation angles suggests that the typical exposure afforded by the various rerouting techniques is as follows: CWU-2G, complete exposure of the jugular bulb; CWD-2G, exposure of the jugular bulb and a mean of 6 mm of the posterior aspect of the carotid artery; and CWD-1G, exposure of the jugular bulb and entire carotid genu. Minimizing the amount of facial nerve manipulation needed to achieve sufficient surgical exposure helps optimize postoperative functional status.

Anatomy of the Frontotemporal Branch of the Facial Nerve and Indications for Interfascial Dissection

Neurosurgery ◽  
1998 ◽  
Vol 43 (3) ◽  
pp. 563-569 ◽  
Author(s):  
Eduardo Salas ◽  
Ibrahim M. Ziyal ◽  
Ghassan K. Bejjani ◽  
Laligam N. Sekhar
Keyword(s):  
Facial Nerve ◽  
Interfascial Dissection
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