J Neurol Surg B Skull Base 2018; 79(S 04): S347-S355
DOI: 10.1055/s-0038-1654703
WFSBS 2016
Georg Thieme Verlag KG Stuttgart · New York

Less Invasive Modified Extradural Temporopolar Approach for Paraclinoid Lesions: Operative Technique and Surgical Results in 80 Consecutive Patients

Naoki Otani
1   Department of Neurosurgery, National Defense Medical College, Tokorozawa, Saitama, Japan
,
Terushige Toyooka
1   Department of Neurosurgery, National Defense Medical College, Tokorozawa, Saitama, Japan
,
Satoru Takeuchi
1   Department of Neurosurgery, National Defense Medical College, Tokorozawa, Saitama, Japan
,
Arata Tomiyama
1   Department of Neurosurgery, National Defense Medical College, Tokorozawa, Saitama, Japan
,
Yasuaki Nakao
2   Department of Neurosurgery, Juntendo University Shizuoka Hospital, Shizuoka Prefecture, Japan
,
Takuji Yamamoto
2   Department of Neurosurgery, Juntendo University Shizuoka Hospital, Shizuoka Prefecture, Japan
,
Kojiro Wada
1   Department of Neurosurgery, National Defense Medical College, Tokorozawa, Saitama, Japan
,
Kentaro Mori
1   Department of Neurosurgery, National Defense Medical College, Tokorozawa, Saitama, Japan
› Author Affiliations
Further Information

Publication History

27 January 2018

31 March 2018

Publication Date:
25 May 2018 (online)

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Abstract

Background Extradural temporopolar approach for paraclinoid lesions can provide extensive and early exposure of the anterior clinoid process, and complete mobilization and decompression of the optic nerve and internal carotid artery, which can prevent intraoperative neurovascular injury. The present study investigated the usefulness of our less invasive modified technique and discussed its operative nuances.

Methods We retrospectively reviewed medical charts of 80 consecutive patients with neoplastic (21 patients) and vascular lesions (59 patients) who underwent the modified extradural temporopolar approach between September 2009 and March 2014.

Results Preoperative visual acuity worsened in 4 patients (5.0%) and worsening of visual field function occurred in 10 patients (12.5%). Postoperative outcome was good recovery in 71 patients, moderate disability in 6, severe disability in 2, and death in 1 (due to reruptured aneurysm). No operation-related mortality occurred in the series.

Conclusion Less invasive modified extradural temporopolar approach is safe and can be recommended for the surgical treatment of deeply located aneurysms and skull base tumors to reduce the risk of intraoperative optic neurovascular injury.