The frontotemporosphenoidal craniotomy, usually denominated pterional craniotomy, was first described by Yasargil in 1975 and is one of the earliest landmarks of the advents of microneurosurgery [1][2][3] . This approach enables, specifically, the exposure of the entire frontoparietal operculum 4,5 , the opening of the entire sylvian fissure 6,7 and all anterior cisterns of the encephalon base 2,5 , which makes both the pterional craniotomy and the transylvian approach the widest used techniques in today's neurosurgery practice.Over the past decades, the pterional craniotomy has undergone a systematization modified by several authors, what also gave rise to more extended types of craniotomies 8,9 . Among then, the supraorbital craniotomy 10 and the orbitofrontozygomatic craniotomy 10-13 stands out. This review offered a detailed description of the technique we use nowadays for this procedure, with modifications arising from its extensive use since its initial proposal, seeking to optimize all its stages, the access and opening of the cisterns, as well as minimize brain retraction. DESCRIPTION OF PROCEDUREPositioning -the patient should be placed supine, with the shoulder at the edge of the surgical table in a neutral position, and head and neck remain suspended after removal of the head support. The head should be secured by a three-pin skull fixation devise (Mayfield or Sugita model) and must be maintained above the level of the right atrium to facilitate venous return. In order to avoid the head holder position to hinder the surgeon' s procedure, the ipsilateral pin of the operative field should be set on the mastoid region, while the two contralateral pins should be on the contralateral superior temporal line, above the temporal muscle, that should not be transfixed. The pin corresponding to the ipsilateral mastoid and the most anterior one corresponding to the contralateral superior temporal line must be in parallel position to prevent any head movement, especially during future traction of cranial wraps made with the aid of fish-hooks.There is a sequence of five movements for the positioning of the head: traction, lifting, deflection, rotation and torsion. ABSTRACTThis review intended to describe in a didactic and practical manner the frontotemporosphenoidal craniotomy, which is usually known as pterional craniotomy and constitute the cranial approach mostly utilized in the modern neurosurgery. This is, then, basically a descriptive text, divided according to the main stages involved in this procedure, and describes with details how the authors currently perform this craniotomy.Key words: craniotomy, microsurgery, neurosurgery. RESUMOA presente revisão visou descrever de forma didática e prática a realização da craniotomia frontotemporoesfenoidal, usualmente denominada pterional, que constitui a craniotomia mais utilizada na prática neurocirúrgica atual. Trata-se, portanto, de um texto fundamentalmente descritivo, dividido conforme as principais etapas envolvidas na realização desse procedimento, que mostr...

Objective Didactically describe the orbitozygomatic craniotomy made in three pieces. Method This approach was performed, from 2002 to 2011, in 49 patients admitted at Beneficência Portuguesa of São Paulo Hospital. Results Twenty-seven patients had vascular lesions and twenty-two suffered for intracranial skull base tumors. The vascular lesions varied from cavernous angiomas inside the mesencephalum, high bifurcation basilar tip aneurysms, superior cerebellar arteries aneurysms and arteriovenous malformations in the interpeduncular cistern. Skull base tumors as meningiomas, interpeduncular hamartomas and third ventricle floor gliomas were among the neoplastic lesions approached. We had no permanent injuries and minimal transient complications had occurred. Conclusion It is a descriptive text, organized in the sequence of the main stages in which such a craniotomy is performed, describing in details the technique in which this group of evolutionarily authors came to accomplish the task.

Medial temporal basal arteriovenous malformations (AVMs) have complex anatomy. They usually drain to the basal vein of Rosenthal, and arterial feeders can arise from the anterior choroidal artery and its branches, or from the posterior cerebral artery. If the AVM is more posterior in the parahippocampal gyrus, there is a predominance of arterial feeders arising from P2P or P3 segments of the posterior cerebral artery. As posterior AVMs are difficult to reach using anterior approaches, the supracerebellar transtentorial approach provides a direct pathway to the malformation, allowing better visualization and exposure of the vascular anatomy.  In this video, we present a 29-yr-old woman with a left parahippocampal AVM with P2P arterial feeders and Rosenthal basal vein drainage. The patient had three months of moderate headache and two abrupt seizures before admission. Emergency computed tomography showed intraventricular hemorrhage. Magnetic resonance imaging and cerebral angiography revealed an AVM located in the parahippocampal gyrus, posterior to pulvinar thalamus. The patient underwent microsurgical treatment in semi-sitting position using a supracerebellar and infratentorial approach with transtentorial resection. The AVM was completely removed, and the patient recovered without neurological deficits. The authors present a 3-dimensional video of the microsurgical steps required to perform a transtentorial approach for AVM resection in the parahippocampal gyrus.  The patient signed the Institutional Consent Form, which allows the use of his/her images and videos for any type of medical publications in conferences and/or scientific articles.

No abstract

Introduction Gangliogliomas are tumors commonly found in the temporal lobe and related to seizures; their appearance in the pineal region is rarely described. This report characterizes the first case of anaplastic ganglioglioma of the pineal region. Case Report The authors describe the case of a 32-year-old woman that developed progressive headache. An MRI investigation revealed a pineal tumor. The patient tested negative for biomarkers and underwent surgery through supracerebellar infratentorial approach and achieved gross total resection of the tumor in a challenging location. Pathological analysis revealed a biphasic neoplasm with the following two distinct phenotypes in separate fields: an immature neuronal component with several atypical mitoses and a mature astrocytic component with bipolar cells, microcysts, and eosinophilic bodies. The Ki67/MIB1 proliferation index was 20-30% in localized hotspots. Based on the pathological findings, the tumor was defined as an anaplastic ganglioglioma World Health Organization (WHO) grade III. Discussion/Conclusion Gangliogliomas are classified as glioneural neoplasms based on the histologic findings described as a mixture of neoplastic astrocytes and neurons. Moreover, these tumors represent 0.4-1.3% of tumors of the central nervous system. Authors describe de novo anaplastic ganglioglioma as 1% of the largest series. Gross total resection and adjuvant treatment may play important role in patients' prognostic. In this case, due to the malignant anaplastic component of her tumor, the patient received treatment with temozolamide and radiotherapy after gross total resection of the lesion.

No abstract

No abstract

No abstract