Tricks of the Trade (original) (raw)

The pterional access, popularized by Yasargil in 1976, is, to date, the most widely used surgical route in neurosurgery 1,2. This access allows for transylvian and lateral subfrontal views. As well as a straight downward view of the anterolateral aspect of the basilar bifurcation 3,4. Drake introduced the subtemporal approach during the 1970's 5,6. The subtemporal approach offers a lateral view of the interpenducular fossa by retracting the temporal lobe superiorly. The temporopolar approach was first described by Sano in 1980 7. The subtemporal approach offers a lateral view of the interpenducular fossa by retracting the temporal lobe supe riorly. The temporopolar approach consists in pulling back the temporal pole, creating and enlarging an anterolateral view of the interpeduncular fossa. The addition of transylvian and subfrontal views to the subtemporal and temporopolar views is of great importance when a neurosurgeon needs to expose the interpeduncular cistern region or the entire temporal lobe, including the me dial portion. By microsurgical dissection of the Sylvian fis sure, third cranial nerve, crural and ambiens we are able to expose the entire temporal lobe. The pretemporal approach, described by de Oliveira, combines the advantages of all these approaches in one craniotomy 810. This approach exposes the entire temporal lobe in order to offer the transylvian and late ral subfrontal views, from the pterional craniotomy, along with the subtemporal and temporopolar views to access the interpeduncular fossa. Our team has performed eighty pretemporal cranioto mies from 2002 to 2012 at a private medical service. These were done to deal with forty six tumors, eighteen aneurysms, twelve arteriovenous malformations, two cavernous heman gioma and two dural arteriovenous fistula. DescriPtion of PretemPoral craniotomy Positioning 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 sup port. The head should be secured by a threepin skull fixa tion device (Mayfield or Sugita model), and must be main tained above the level of the right atrium to facilitate venous