Anterior Temporal Approach as a Modification of Extended Trans-Sylvian Approach

Abstract

The arachnoidea between the superficial sylvian vein and the temporal lobe is incised, and the bridging veins flowing from the temporal lobe to the superficial sylvian vein and those at the temporal tip are cut. Thus, the temporal lobe is separated from the superficial sylvian vein. The anterior temporal artery is separated from the temporal lobe. These treatments increase the mobility of the temporal lobe. The sylvian fissure is widely opened by compression of the temporal lobe with a spatula placed under the anterior temporal artery. This approach provides good access to the lesions in the interpeduncular cistern.

Dificuldades na microdissecção da fissura e da cisterna silvianas: Estudo anatomocirúrgico em 152 cirurgias neurológicas eletivas

“…Com relação à oclusão da própria veia silviana superficial, diversos autores assinalam que essa veia pode ser ocluída intencionalmente, pois seu sacrifício nunca ou só muito raramente resulta em complicações 4,10,13,19,23,28 . Por outro lado, outros autores enfatizam a importância da preservação dessa via de drenagem venosa pelos potenciais riscos da sua oclusão 7,12,31,33 . Dentre as possíveis conseqüências da oclusão da veia silviana superficial são citadas convulsões, paralisia facial e, quando o acometimento é do lado esquerdo, afasia 18,19,45 .…”

Dissection of the Sylvian Fissure in the Trans-sylvian Approach Based on the Morphological Classification of the Superficial Middle Cerebral Vein

“…Some reports recommend dissection between multiple SMCVs or between the SMCV and the temporal lobe in the trans-sylvian approach for such ideal dissection of the SMCV. 17,18,[26][27][28][29][30][39][40][41] In our 116 cases, almost FSVs and FBBVs, and all SMCVs (FST, SMCCT, TST) and TSVs were preserved. The mobility of the frontal and temporal lobes was sufficient to obtain the wide operative field in almost cases.…”

“…Third, it is impossible to provide sufficient mobility to the temporal lobe by just cutting the BVs with the frontal lobe, since mobility of the temporal lobe is limited by adhesion with the main stems of the SMCV, which usually run on the temporal lobe and the draining point of the SMCV to the skull base sinus. 26,30,[39][40][41] The mobility of the temporal lobe is very important to obtain not only a wide working space but also an operative view from the lateral side. This lateral view makes it possible to confirm the perforators behind the aneurysm and also to reduce the retraction to the frontal lobe in the Neurol Med Chir (Tokyo) XX, Month, 20XX…”

“…9,12,15,16,[23][24][25] Recently, dissection between multiple SMCVs or between the SMCV and the temporal lobe has been recommended. 17,18,[26][27][28][29] However, the method of dissection is rarely discussed in detail in the clinical literature, and a consensus for a best approach has not been obtained, 8,17,18,22,27,28,30) likely due to the various patterns of SMCV anastomoses.…”

Microsurgical clipping for the true posterior communicating artery aneurysm in the distal portion of the posterior communicating artery

“…Two days after the onset of symptoms, the patient underwent right interfascial pterional craniotomy in the manner described by Yasargil et al ., with anterior temporal approach. [ 5 12 14 17 ] Whole length of the PCoA, from the junction of the internal carotid artery (ICA) to the junction of the PCA was confirmed [ Figure 2 ]. The aneurysm was located at proximal to the curvature and the aneurysmal fundus projected supero-medially.…”