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Index
https://t.me/med1917
flocculus 309
foramen lacerum 14, 174, 174–175, 211,
310–311, 351
recurrent artery of 327, 329
foramen magnum 306–308, 339
lesions 232
foramen of Monro 110–111, 111
foramen ovale 182, 243, 274, 316,
317–318, 361
foramen rotundum 137–138, 171, 172,
174, 185, 253, 262, 356, 361
internal carotid artery relationship
361–362, 363
foramen spinosum 182, 262, 274, 316,
317–318, 361
fornix 111
fovea ethmoidal 31–32, 34, 35
frontal bone flap removal 287–289, 289
frontal recess 23, 32, 34–35, 38, 39
frontal scalp anatomy 394
frontal sinus 23, 34–35, 38, 86–90,
145–146, 330, 332
drainage pathway (FSDP) 38
meningioma 40
olfactory neuroblastoma 89
ostium 132
posterior wall 43, 47
preoperative evaluation 38–40
computed tomography 39
magnetic resonance imaging 39–40, 40
preoperative study 38–39
surgery 38–44
case examples 44,
Dr
af type I 40, 41, 41, 42
Draf type IIa 40, 41, 41, 43
Draf type IIb 40, 41, 41, 43, 47
Draf type III 38, 40, 43–44, 45, 46,
282, 283
indications of approach 40, 40
fronto-orbital artery 86
frontoethmoid cells 38
frontopolar artery 86, 332, 334
frontopolar vein 332
46, 47
G
galea 305
Gasserian ganglion 337, 351
artery of 327, 329
glossopharyngeal nerve 16–17, 245, 309,
311, 341, 343–344
median approach 355
Gruber’s ligament 327
gyrus rectus 87, 103, 108, 287, 331, 333
H
habenular commissure 112
Hadad-Bassagaisteguy flap 370
advantages 370
indications 370
see also nasoseptal flap
hemangioma, orbital cavernous 149, 150
hematoma, intracranial 91
Heubner’s artery 109, 332, 334
historical background 4–5
nasoseptal flap 370
hypoglossal canal 232, 235, 295, 306, 308,
311, 319, 339
hypoglossal nerve 12, 14–17, 213, 304,
306, 309, 311, 311, 341, 342, 343
median approach 355–357
hypophyseal artery
inferior 114, 135, 326, 326
superior 100–103, 107, 108, 113, 131,
137, 319, 327–329, 329–331, 332,
333, 334
hypopituitarism 111
I
i-scan 275
image processing 8
inferior turbinate flap 380
anatomy 380–381, 380, 381
contraindications 380
indications 380
reconstruction technique 380
surgical steps 381–382, 381–382
inferolateral trunk 327, 328, 337
infraorbital bundle 146, 148
infraorbital groove 144
infraorbital nerve 29, 77, 145, 147, 149,
185, 240, 240–241, 251, 252–253,
273
infratemporal approach 260
case examples 263, 263–264
complications 263–265
indications 260
surgical steps 260–262, 260–263
infratemporal fossa (ITF) 182, 241, 262,
263
fat pad 185
limits 260
schwannoma 263, 264
infundibular arteries 333
infundibulotomy 23–24
anteroposterior approach 23–24, 25, 26
indications 24
posteroanterior approach 24, 27
infundibulum
craniopharyngioma 111, 112
ethmoidal 38
frontal 39
inion 305
inratrochlear nerve 148
intact bulla technique 41
intercavernous sinuses 335, 336
inferior 333, 336
superior 97, 107, 130, 333, 336, 350
interfalciform ligament 349
internal acoustic meatus 339, 343, 344
internal auditory canal 182, 316, 318
internal carotid artery 10, 12–14, 50, 51,
58, 73, 86–87, 107–108, 122,
53,
131–139, 147, 324–335, 324, 327
ana
tomical relationships 324
Eustachian tube 360, 360
foramen rotundum 361–362, 363
optic nerve 174
opticocarotid recesses 362–364, 364
pituitary gland 327
sellar floor 362, 363
vidian canal 360–361, 361–362
branches 86
cavernous 121, 135, 139, 149, 325–329,
325–328, 336
cervical 262, 263
cisternal 329–335, 329–335
clinoidal 94–102, 329, 329, 362–364,
364
course of 120, 183, 325
displacement 136
genu 172, 173–174, 193, 325
isolation 173–174
infrasellar 135–137
injury during surgery 187, 194, 214
intradural 131
paraclival 88, 135–137, 139, 173–175,
174, 184–186, 193, 201, 211–214,
294–295, 295, 309–312, 325–326,
325–328, 330, 332, 336–337,
361–362, 363
ana
tomy 326, 326–327
lateralization 186
parapharyngeal 186, 244–245, 297,
324, 340, 360, 360
parasellar 88, 90, 135–137, 139, 184,
211, 297, 309, 311, 325–326,
327–329, 328–330, 332, 336–338,
362, 363
anatomy 327–329, 328
petrous 182, 182–186, 189, 211, 214,
272, 297, 324, 360–361, 361–362
exposure 184–186, 185–186
see also intrapetrous carotid artery
approach
supracavernous 329–335, 329–335
supraclinoidal 100, 102, 329–335,
330–335
supralacerum 324, 325–326, 328, 330,
332, 336–337
suprasellar 329, 329
interpeduncular cistern 203–204, 310,
354
interpeduncular fossa 12, 213, 319
interthalamic commissure 111, 113
intraorbital approach 144
case examples 149, 150
complications 149–151
muscular damage 151
neur
al damages 151
vascular damages 149
indications 144
surgical steps 144–149, 145–149
intrapetrous carotid artery approach
182
anatomic background 182
case examples 187, 187–189
complications 187
indications 182–183
instrumentation 183
medial petrous ICA approach 183–184,
184–185
petrous ICA exposure 184–186,
185–186
see also internal carotid artery
J
jugular foramen 234, 236, 240, 245, 295,
309, 311, 339, 344
endoscopic approach 240
indications 240
surgical steps 240–243, 240–245
jugular tubercle 232, 234–235, 295,
309–310, 339
jugular vein, internal 183
juvenile angiofibroma 250, 255
K
Keros classification system 31
L
labyrinthine artery 342–344, 344
lacrimal gland 156, 157
lacrimal nerve 137
lacrimal sac 157, 161
lamina papyracea 11, 29, 30, 30, 33–35,
43, 47, 70, 72, 86–88, 90, 132
removal 146
405
Index
https://t.me/med1917
lamina terminalis 109, 113, 332
cistern 106, 108, 108, 109
lateral nasal wall 22, 22
lateral nasal wall flaps 386
anterior 386–388, 387–389
complications 388–390
indications 386
posterior 386–388, 390
surgical steps 386–388
flap elevation 387–388
incisions 386–387, 388–390
lateral recess 52
lateral retrocanthal approach 157,
158–159, 159
lateral tubercular recess 362, 364
lenticulostriate arteries 334
levator muscle 157
levator veli palatini muscle 243, 243–245
Liliequist’s membrane 203, 204, 310,
341, 355
limbus sphenoidale 94, 95
lingual nerve 183
lingular process 174, 175, 175
longus capitis muscle 233
M
McConnell’s capsular artery 327
macroadenoma 123, 123
removal 123, 124
mammillary body 109–110, 110, 113,
213, 310
mandibular nerve 186, 242–243, 243,
262, 263
maxilla, frontal process 79, 80
maxillary antrostomy 28–29, 170–171,
171
maxillary artery 76, 76–77, 183, 185, 255
internal 171, 172, 178, 185, 241, 262,
272, 296
injury during surgery 263–264
surgical approach 79–82
complications 82
dissection of maxillary sinus
posterior wall 81–82, 81–82
indications 77
transantral approach 79–81, 79–81
maxillary nerve 186, 253, 338
maxillary recess 364
maxillary sinus 11, 24, 29–30, 145–146,
148, 185, 240, 261
floor 245
lateral wall 185
ostium 45, 81, 81, 132, 145, 261
accessory 145
posterior wall 29, 81, 146–147, 149, 171
maxillary artery approach 81–82,
81–82
r
emoval 171, 184, 253, 254
roof 29
squamous cell carcinoma 263, 263
maxillary strut 174, 174–176, 354, 356,
364
removal 175
maxillectomy 185
medial 146
Meckel’s cave/diverticulum 166, 176, 177,
318, 337, 351, 354
anatomic considerations 166
posterior opening 318
sarcomatoid carcinoma 177, 178
schwannoma 176, 320
see also anteromedial corridor approach
medial maxillectomy 60
case example 61–62, 63–65
complications 63
conservative, type 1 surgery 60, 60
extensive, type 2 surgery 60, 61
indications 60
surgical steps 60–61, 60–63
median approaches
abducens nerve 351–352, 351–352
accessory nerve 355
facial nerve 355
glossopharyngeal nerve 355
hypoglossal nerve 355–357
oculomotor nerve 350–351
olfactory nerve 348–349, 348
optic nerve 349, 349–350
trigeminal nerve 351, 351
trochlear nerve 351
vagus nerve 355
vestibulocochlear nerve 355
medulla oblongata 12, 213, 341
meningeal artery
anterior 68, 69, 339
dorsal 135, 326, 326–327
middle 189, 243, 262, 263, 316,
317–318
posterior 306, 309, 339
meningioma 88
clivus 219, 222–223
frontal sinus 40
tuberculum sella 103
meningitis, pneumococcal 53, 55, 56
meningocele 158
meningoencephalocele 51, 53
meningohypophyseal artery 135, 139
meningohypophyseal trunk 326,
middle e
ar 183
middle meatus 42, 79, 79
antrostomy 27–28, 28–29
complications 27–28
indications 27
middle turbinate flap 380
anatomy 382
contraindications 382
indications 382
reconstruction technique 380
surgical steps 382–383, 383
326
N
narrow-band imaging 275
nasal artery
dorsal 148
posterior 79, 121
lateral 380
nasal nerve 137
nasal septum 8, 9, 10–12, 27, 32, 43
disarticulation 11
see also septectomy
nasociliary nerve 137, 147, 148
nasofrontal beak 47
nasolacrimal duct 146
nasopharyngectomy 233, 233, 235, 268
complications 275–276
contraindications to expanded
approach 268, 269, 275
indications for expanded approach 268
preoperative assessment 268
preparation and set-up 268
reconstruction 273–274
surgical steps 268–273, 270–274
nasopharynx 184–185, 245–255
carcinoma 187, 189, 268, 269
nasoseptal artery 308
nasoseptal flap 168, 169–170, 370–375
advantages 370
applications 375–376, 375–377
complications 371
prevention 371–374
CSF leak management 375
Hadad-Bassagaisteguy flap 370
historical background 370
indications 370
pedicled flap 370
positioning 375
postoperative management 375
rescue flap 183
surgical steps 371, 371–374
neuroblastoma, olfactory 88, 89, 290, 291
O
oblique muscle
inferior 157, 305, 306
superior 147–148, 305, 306
occipital artery 299, 299–300, 305
occipital condyle 232, 237–238, 311
drilling 308
occipital protuberance 305
oculomotor nerve 12, 14–15, 109–110,
148–149, 204, 213, 310, 318–319,
325–326, 333–334, 337, 337–338,
341, 342–343
inferior branch 338
median approach 350–351, 354, 355
paramedian approach 352–353, 354
superior branch 338
odontoidectomy 228–229
olfactory bulbs 86, 87, 90, 287, 331
olfactory cleft 43, 47
olfactory fossa 89, 90
olfactory nerve 348
median approach 348–349, 348
olfactory neuroblastoma 88, 89, 290, 291
olfactory tract 331, 333
olfactory vein 330
olive, inferior 311
Onodi cell 34, 51, 52
ophthalmic artery 68, 69, 73, 86, 108, 133,
137, 148–149, 327, 328, 328–329,
330, 331, 332, 333, 333, 335, 338
or
igin 100
ophthalmic nerve 338
ophthalmic vein, superior 147, 148
optic canal 95, 98–100, 120, 138, 144, 349
boundaries 98
decompression 94, 95, 98
maximal, surgical technique 98–99,
98–103
segments 98
optic carotid recess 138, 139
optic chiasm 14, 86, 107–109, 311, 324,
329–332, 334, 354, 355
optic nerve 10, 13–14, 23, 34–35, 50–51, 51,
53, 58, 86, 88, 100, 102, 108, 122, 131,
145–149, 170–172, 311, 325, 329–333
cisternal 101–103
ethmoidal artery relationship 70,
71–73, 285
injury during surgery 73, 149, 151
internal carotid artery relationship 174
intraorbital 148
median approach 349, 349–350, 355
par
amedian approach 350, 350, 354
preforaminal 101, 102
protuberance 119, 122
406
Index
https://t.me/med1917
optic neuropathy 102, 103
optic prominence 94–96
optic protuberance 107, 130
optic recess 130
optic strut 144, 174, 176, 354
opticocarotid recess 10, 13, 52, 58, 119,
184
internal carotid artery relationship
362–364, 364
lateral 52, 94–102, 96–99, 107, 121,
122, 130, 172, 176, 201, 329, 354,
362, 364
medial 95, 107, 122, 172, 201, 362, 364
orbital abscess 149, 150
orbital anatomy 156, 157
orbital fat 146, 156
orbital fissure
inferior 144
superior 136–137, 144, 176, 338, 354,
364
artery of 327
orbital gyri 331
orbital lesions 144
orbital sulcus 331
orbitofrontal artery 103, 331–332, 333,
334
orbitofrontal veins 332
os odontoideum 223, 226, 228–229
ossiculum terminale 226
ostiomeatal complex 41, 42
ostium sphenoidale 50
ovale 137
P
palatine artery
descending 185, 253, 254–255, 255, 273
greater 172, 254, 272, 356
lesser 172, 254
palatine canal 253, 254
palatine nerve 253
greater 251, 272
dissection 178
lesser 251
palatosphenoidal canal 253, 253
palatovaginal artery 251, 252, 253
palatovaginal canal 171, 172–174, 173,
356
papilloma, inverted 61, 63–65
paraclival carotid prominence 10
paraclival recess 351
paramedian approach
middle cranial fossa 352–355, 354
optic nerve 350, 350
posterior cranial fossa 357
parapharyngeal muscle transection 234,
234
parapharyngeal space 244
peduncular veins 342
perforating arteries 332
anterior 330
basilar 343
recurrent 343
pericranial flap 394
anatomy 394
contraindications 394
indications 394
surgical steps 287, 288, 394–396,
395–396
variations 396–397
periorbita 146, 148
persistent trigeminal artery 327–328
petro-occipital fissure 339
petroclinoidal fold 318
petroclival fold 318
petrolingual ligament 182, 325
petrosal nerve
deep 172
greater superficial 172, 316, 317–318
lesser superficial 317–318
petrosal sinus
inferior 326–327, 333, 338–339, 339
superior 316, 318, 326–327, 333, 338,
339
petrous apex 182, 192, 192–193, 339
anterior petrosectomy 192
case example 195, 195
complications 194
indications 192
medial transsphenoidal approach
192–193, 193
surgical steps 192, 192
transpterygoid infrapetrous approach
c
holesterol granuloma 186, 187–188,
petrous veins, superior 342
pharyngeal artery, ascending 245
pharyngobasilar fascia 319
pituitary fossa 54
pituitary gland 50, 102, 107, 108–109,
giant adenoma 139–140, 140
internal carotid artery relationship 327
macroadenoma 123, 123–124,
transposition 109, 113, 113, 200,
case study 204–205, 204–205
complications 205–206
indications 200
intradural preparation 201–203,
pituitary repositioning 201–203,
sinonasal cavity preparation 200
sphenoid preparation 201
pituitary stalk 101–103, 107, 108, 112,
arterial network 329, 331
planum sphenoidale 86–88, 90, 107,
plexus
basilar 214, 333, 339
injury during surgery 214
carotid 311
choroid 111,
cir
cuminfundibular 331, 333
pneumocephalus 91, 112
pneumoencephalus 55, 56
pons 12, 183, 213, 318
ventral 213
pontogrigeminal vein 342
pontomesencephalic veins 342
porus trigeminus 333
posterior commissure 112, 319
posterior fontanelle 28
posterior fossa 294, 295, 318
dural opening 318
see also retrosigmoid approach;
poststyloid space 243, 245
precaruncular approach 160, 161
premammillary artery 333
prepontine cistern 310
, 193–194, 194
185, 185
195, 195
112, 114, 122, 138, 186, 211,
309–311, 319, 329–331
139–140, 140
202–203, 352, 352–355, 355
202–203
202–203
138, 205, 319, 329–331
119–120, 122, 285, 285, 287, 333,
336, 339
111, 113, 309
transclival approach
pterygoid canal 121, 134, 138, 297,
308–309
pterygoid muscle
lateral 183, 185–186, 240–242,
241–242, 255
medial 183, 241, 242, 242
resection 237
pterygoid plate 185
base removal 185
lateral 240, 241, 245, 255, 262, 262,
273, 274
medial 171, 173, 255, 273–274
exposure 170–171, 172
identification 235, 235
removal 273
pterygoid process 134, 273
pterygoid recess 52, 52
pterygoid wedge, medial 171,
p
terygomaxillary fossa 178
pterygopalatine fossa 240, 241, 250,
254–255, 262, 272, 325, 328
endonasal approach 250
case example 256, 257
complications 256
indications 250
instruments 256
surgical steps 250–255, 250–255
schwannoma 256, 257
pterygopalatine ganglion 193, 194, 255
184
Q
quadrangular space 337, 351, 351
R
recessus terminalis 38
rectus capitis muscle
anterior 319
posterior major 305, 306
posterior minor 305, 306
rectus muscle
anterior stiffening 151, 152
inferior 145, 147–149
injury during surgery 151
lateral 145
medial 145, 146–147, 147–149, 338,
350
medial attachment 151, 152
superior 147, 350
recurrent artery
of Heubner 109, 332, 334
of the foramen lacerum 327, 329
retinal artery, central 148, 149
injury during surgery 149
retroinfundibular space 203, 204
retrosellar approach 200
case example 204–205, 204–205
dissection in the interpeduncular
cistern 203, 204
dorsum sellae resection 203
indications 200
intradural preparation 201, 202
pituitary transposition 201–203,
202–203
posterior clinoidectomy 203
sinonasal cavity preparation 200
sphenoid preparation 201, 201
retrosellar area 107–108, 109, 110
retrosigmoid approach 294, 299–301,
299–301
indications 294
rhabdomyosarcoma 44, 46
rhinopharyngeal mucosa 212
407
Index
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rhinopharynx, posterior 117, 118
Rosenmüller fossa 360, 360
rostrum 55
rotundum foramen see foramen
rotundum
S
sagittal sinus, superior 331
scalp anatomy 394
schwannoma
infratemporal 263, 264
Meckel’s diverticulum 176, 320
pterygopalatine fossa 256, 257
trigeminal 320
sella turcica 55, 58, 90, 130
sellar approach 14
transsphenoidal route 13, 116
case example 123, 123–124
closure 121
complications 123
ergonomics 116
general principles 120, 120
indications 116
instrumentation 116–118
intradural dissection 121
nasal phase 117–118, 121
patient positioning 116
preoperative neuroimaging 118–120
preparation 118
sellar phase 119–120, 121, 122
sphenoidal phase 119, 121
sellar floor 10, 107, 116, 119–120, 121,
309, 312
internal carotid artery relationship
362, 363
removal 122, 319
semicircular canal
anterior 182
lateral 182
posterior 182
semispinalis capitis muscle 305, 305
septal artery, posterior 54
septal window, anterior 151, 151
septectomy 10, 10
anteromedial corridor approach 168,
170
subtotal 282, 283
see also nasal septum
septum
nasal 8, 9, 10–12, 27, 32, 43
see also septectomy
sphenoid 10, 50, 51, 120, 201, 201
sigmoid sinus 300, 339
sinonasal tumors 282, 291
see also transbasal/subfrontal-
transcribriform approach
skull base reconstruction 289, 290, 370,
380, 383–384
see also inf
sphenoethmoidal cell, posterior see Onodi
sphenoethmoidal recess 50, 117, 118, 121
sphenoethmoidectomy 146, 146
sphenoid sinus 12–13, 22–23, 34, 45,
anatomy 50–52, 50–52
anterior wall 23, 34–35, 118–119
erior turbinate flap;
lateral nasal wall flaps; middle
turbinate flap; nasoseptal flap;
pericranial flap; transpterygoid
temporoparietal fascia flap
cell
54–55, 87, 116, 146, 183, 201,
332–333, 336
calcification 57
fistula 55
inferior wall 119, 212, 309
ostium 51, 52, 54, 118, 121, 129, 169
posterior wall 51, 107, 130
preoperative evaluation 52–53
computed tomography 52
magnetic resonance imaging 53, 53
nasal endoscopy 52
septae 10, 50, 51, 120, 201, 201
surgery 53–55
case examples 55, 56–57
complications 55, 58
indications 53
transseptal approach 54–55, 55
see also sphenoidotomy
sphenoidal lingula 182, 182, 186, 186
sphenoidotomy
anterior 10, 12
transethmoidal 54, 54
transnasal 53–54, 54
sphenopalatine artery 54, 76–77,
76–77, 119, 171, 171
251–253, 271
endosc
opic ligation success rates 82
injury during surgery 63
palatine bone relationship 252
septal branches 184
surgical approach 78–79, 78–79
complications 82
indications 77
sphenopalatine foramen 77, 171, 173,
178, 251, 251
opening 171
sphenopalatine ganglia 173, 251
spinal artery
anterior 340, 341
posterior 306, 309, 340
spinal cord compression 220, 226–227
spinomedullary junction 341
splenius capitis muscle 299, 305, 305
sternocleidomastoid muscle 305, 305
stria medullaris 112
stylopharyngeal muscle 243, 244
subchiasmatic space 107
suboccipital triangle 305–306, 306
dissection 305–306, 306
sulcus
anterolateral 311
bulbopontine 12
chiasmatic 96–97, 100–101
digastric 300
orbital 331
superficial temporal artery 397
superior lid crease approach 157,
160–161, 162
supra-agger nasi frontal cell 42, 43
suprachiasmatic region 106–107
supracondylar groove 235, 237
supraorbital artery 394
supraorbital nerve 137, 289, 394
suprasellar approach see third ventricle
suprasellar notch 10, 119, 122
supratrochlear artery 394
supratrochlear nerve 137, 394
surgical resection classification 275, 275
swing-door uncinectomy 80, 80
, 240–241, 251,
T
tela choroidea 112
temporal lobe, mesial 213
temporal scalp anatomy 394
temporalis muscle 183, 185, 240, 241
tension pneumocephalus 91
tensor veli palatine muscle 183, 242–243,
242, 243
tentorial artery 135
tentorium 318
thalamogeniculate arteries 342
thalamoperforating arteries 335,
339, 345
anterior 333
thalamus 108–109, 111, 113
third ventricle 108–111, 110
floor 111, 213
infundibular craniopharyngioma 111,
112
suprasellar approach 106
case example 111, 112–113
indications 106
surgical steps 106–111, 107–112
transbasal/subfrontal-transcribriform
approach 282
case example 290, 291
complications 291
indications 282
instruments 291
surgical steps 282–289
anterior cranial fossa exposure
284–285, 285
anterior falx cerebri resection 285,
286
centripetal resection of ethmoidal
box 283–284, 284
coronal incision 286, 288
cranioplasty 289, 290
crista galli removal 285, 285
dural exposure 285, 286
dural resection 286, 287
first olfactory fiber identification
282, 283
frontal bone flap removal 287–289,
289
frontal sinusotomy 282, 283
pericranial flap harvesting 287, 288
septectomy 282, 283
skull base reconstruction 289, 290
subfrontal/transbasal craniotomy
287, 289
transclival approach 14, 210, 211,
211–212, 294, 316–318, 319
”above and below” approach 215
basilar artery approach 342–343
case examples 212, 214
complications 214, 318
extended approach to the ventrolateral
brain stem 307–313
case example 311, 312–313
complications 311–312
intradural exposure 310–311,
310–311
midline and paramedian exposure
309–310, 310
nasal and sphenoidal phases
308–309, 309–310
pa
tient positioning 308
indications 210, 316
intradural exposure 212, 212–213
landmarks 210
limitation 215
nasal and sphenoidal steps 211, 211
patient positioning 210
posterior fossa approach 294–299,
294–298, 301
408
Index
https://t.me/med1917
skull base reconstruction 212
vertebral artery approach 339–340, 340
transcondylar/transtubercular approach
see far medial approach to the
inferior third of the clivus
transconjunctival deep fornix approach
159–160, 159–160
transcribriform approach 14, 86,
330–335, 332
case example 88, 89–90, 92
complications 89–92
indications 86
olfactory nerve 348–349, 348
surgical steps 86–88, 86–88
transfrontal pericranial flap see
pericranial flap
transnasal transbasal approach
see transbasal/subfrontal-
transcribriform approach
transnasal transpharyngeal approach
219–221
case examples 220–221, 224–225
surgical steps 219–220
transnasal transsphenoidal approach see
transsphenoidal approach
transoral approach, craniovertebral
junction 221–223, 228–229
transorbital approach 156
anesthesia 158
approaches 156–157, 157
lateral retrocanthal approach 157,
158–159, 159
precaruncular approach 157, 160,
161
superior lid crease approach 157,
160–161, 162
transconjunctival deep fornix
approach 157, 159–160, 159, 160
globe retraction 158
instruments 157
preoperative planning 156
transpharyngeal approach see transnasal
transpharyngeal approach
transplanum supra-retrosellar corridor
341–342
transplanum transtuberculum approach
see transtuberculum transplanum
approach
transpterygoid infrapetrous approach
185, 185, 193–194, 194
transpterygoid temporoparietal fascia
flap
anatomy 397, 397
contraindications 397
indications 397
surgical steps 397–400, 398–400
transpterygoidal corridor 325–326, 325,
326, 329, 335–337
transsphenoidal approach 10, 335, 336
craniovertebral junction 218–219
case examples 219, 220–223
surgical steps 219
petrous apex 192–193,
see also se
transtuberculum transplanum approach
case example 102, 103
maximal optic canal decompression
optic canal boundaries and segments
transverse pontine vein 342
transverse sinus 299, 300
trapezius muscle 305, 305
trigeminal artery, persistent 327–328
trigeminal nerve 137, 166, 175–176, 213,
fourth branch 184
mandibular branch 173, 272
maxillary branch 173, 175, 325, 326,
median approach 351, 351
ophthalmic branch 325, 337, 338
paramedian approach 352–353
second branch 185
third branch 183, 189, 262
trigeminal schwannoma 264
trochlea 157
trochlear nerve 15, 137, 213, 316, 318,
median approach 351, 355
paramedian approach 352–353, 354
tuber cinereum 109, 109, 110
tuberculosis 229
tuberculum sella 10, 13, 97, 120, 130,
menin
turbinate
inferior 8, 9–11, 39, 117–118
middle 8, 9, 11–12, 22–27, 30–35, 39,
superior 12, 30, 33, 34–35, 117–119
llar approach
14, 94–95, 94–98, 329–330, 330
98–99, 98–103
98, 98
300, 301, 310, 310, 318, 333, 337,
343, 344
328, 336–338, 352
337, 337
201–202, 339
gioma 103
artery 380–381, 380–381
see also inferior turbinate flap
42–43, 79–80, 117–119
lamella 33
lateralization 118
resection 8, 9, 133, 145
see also middle turbinate flap
lamellae 23, 34–35
resection 133
193
U
uncinate process 23, 23–25, 30, 38, 39, 41,
42, 79–80, 132
attachment variations 38, 39
uncinectomy 23, 132
anteroposterior approach 23–24, 25–26
indications 24
posteroanterior approach 24, 27
swing-door 80, 80
V
vagus nerve 16–17, 245, 309, 311, 341,
343–344
median approach 355
ventral pathway 8–12
extended approaches 10
nasal steps 8–10
surgical corridors to the ventral
brainstem 10–12
transsphenoidal approach 10
vertebral artery 12, 14, 16–17, 213, 301,
304, 305, 306–309, 310, 311–312,
319, 339, 339, 341
anatomy 340–341
dissection 305–306, 306, 307
extraosseous segment 339
extraspinal segment 339
foraminal segment 339
intradural segment 339–341
medullary perforating branches 340
muscle branch 307
vertebrobasilar junction 310, 341, 355
vertebrobasilar system 339, 339
vestibulocochlear nerve 16, 311, 318, 341,
343–344
median approach 355
paramedian approach 357
vidian artery 184, 194, 325–326, 336–337
mobilization 173, 173
vidian canal 171, 172, 173, 184, 194, 211,
272, 325, 336–337, 353, 356
displacement 236
exposure 173
internal carotid artery relationship
360–361, 361–362
isolation 172–173, 172–173
vidian nerve 52, 53, 138, 171–175, 172,
183–184, 184, 186, 189, 193–194,
211, 214, 214, 253–254, 272,
194,
273, 295, 295, 310, 318, 356, 362
mobiliza
tion 173, 173
skeletonization 194
virtual 3D model generation 8
vomer 120, 211
resection 233, 233
vomer–sphenoid junction 308–309
409
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