RESUMO
Surgical access to the middle fossa can be technically challenging. As neurosurgery evolves to minimally invasive approaches, the objective of this study is to demonstrate the extension of the Minipterional approach to access the middle fossa. We present a new surgical approach to the middle fossa for the treatment of secondary trigeminal neuralgia. Three cases are reported to illustrate the following techniques: a patient with petrotentorial meningioma and trigeminal neuralgia, a patient with an arachnoid cyst compressing the fifth nerve, and a patient with a middle cerebral artery aneurysm and a long history of TN (trigeminal neuralgia) refractory to medical and surgical treatments. All three experienced full symptom controls with no permanent neurological deficits. Therefore, the Minipterional technique might represent a feasible, effective, and safe option to treat refractory secondary TN. It also allows approaching these lesions when the posterior fossa approach is compromised by anatomical distortion and enables the simultaneous treatment of secondary trigeminal neuralgia and other lesions, such as aneurysms and meningiomas.
RESUMO
BACKGROUND: Cavernous sinus and petroclival region is an anatomically complex region in close relationship with important neurovascular structures. As such, the surgical treatment of spheno-petro-clival (SPC) meningiomas represents an operative challenge, in which several routes and its combinations might be used. METHODS: We describe in detail the surgical technique of the extradural minipterional pretemporal approach (eMPT-P) to the SPC region and highlight the main anatomical key elements involved in this approach as well as the technical aspects for avoiding surgical complications. CONCLUSION: The eMPT-P is a versatile approach that uses the extradural route, and thereby reduces brain retraction, while provides a good angle of exposure of the SPC region.
Assuntos
Neoplasias Meníngeas/cirurgia , Meningioma/cirurgia , Procedimentos Neurocirúrgicos/métodos , Neoplasias da Base do Crânio/cirurgia , Seio Cavernoso/cirurgia , Humanos , Procedimentos Neurocirúrgicos/efeitos adversos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Instrumentos CirúrgicosRESUMO
Se realizó un estudio descriptivo prospectivo y analítico con el objetivo de evaluar el comportamiento del Procedimiento de Extirpación con Asa Electroquirúrgica, como tratamiento conservador de lesiones preinvasoras del cuello uterino en la consultas de patología de cuello del Hospital General Docente de Morón en el periodo comprendido entre el primero de Enero de 2005 al 31 de Diciembre de 2006. El universo estuvo constituido por todas las mujeres portadoras de lesiones preinvasoras del cuello uterino a las que se le efectuó biopsia escisional con electrocirugía. Obteniendo como resultado que la frecuencia de utilización del Asa Electro quirúrgica fue de un 73,4 por ciento; la edad más frecuentes fue de 35-39 años; el motivo de consulta más frecuente fue la citología alterada, iniciaron las relaciones sexuales con menos de 17 años, tuvieron antecedentes de dos partos y de tener tres o más parejas sexuales.
A prospective, descriptive and analytical study was carried out with the objective to evaluate the behaviour of the Loop Electrosurgical Excision Procedure (LEEP), as conservative treatment of the preinvader lesions of the uterine cervix in the pathology office at The General Provincial Docent Hospital of Morón during the period among January 1st, 2005 to December 30th, 2006. The universe was constituted for all the women carrier of the preinvader lesions of the uterine cervix which the excisional biopsy had been carried out with electro surgery. The more frequent age was from 35 to 39 years, obtaining as a result that the utilization frequency of the loop electrosurgical was of a 73, 4 percent. The reason more frequent of the consultation was the alter cytology, they started their sexual relation before the 17 years, and they also had more than three sexual relationships.