Overview
This lecture discusses surgical techniques in skull-base neurosurgery, focusing on improving surgical trajectory and visualization by removing specific bony structures.
Surgical Approach Techniques
- Removing the supraorbital rim changes the surgical trajectory, allowing superior access without removing the zygomatic bone.
- This approach is useful for cases with high-riding basilar arteries or supracellular visualizations.
- Taking down the posterior clinoid bone provides better visualization of the upper third of the clivus and down to the eye.
Anatomy and Visualization
- Removing bones like the anterior clinoid process and parts of the sphenoid allows a clear view of critical structures at the skull base.
- Visualized structures include the pituitary gland and stalk, the basilar tip, PCom (posterior communicating artery), P1 and P2 segments of the posterior cerebral artery, and the cavernous sinus.
- Cranial nerves visible in this approach are the oculomotor (III), trochlear (IV), branches of V1 (lacrimal, frontal), and abducens (VI).
- The carotid artery can also be mobilized for improved access.
Key Terms & Definitions
- Supraorbital Rim — The upper edge of the eye socket, removal enhances upward surgical access.
- Posterior Clinoid — A bony projection near the pituitary gland, removal improves visualization of the clivus.
- Clivus — A bony part of the skull base behind the sella turcica.
- Anterior Clinoid Process — A projection of the sphenoid bone near the optic nerve.
- Cavernous Sinus — A venous channel at the base of the skull containing cranial nerves and the internal carotid artery.
- PCom/P1/P2 — Segments and branches of the posterior cerebral and communicating arteries.
Action Items / Next Steps
- Review skull base anatomy, focusing on bones and neurovascular structures mentioned.
- Practice identifying these structures on imaging or anatomical models.
- Prepare for hands-on surgical simulation if available.