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Michael W. Mcdermott - One of the best experts on this subject based on the ideXlab platform.
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tailored extended Bifrontal Craniotomy for anterior skull base tumors anatomic description of a modified surgical technique and case series
Operative Neurosurgery, 2018Co-Authors: Michael Safaee, Michael W. Mcdermott, Arnau Benet, Philip V TheodosopoulosAbstract:Author(s): Safaee, Michael M; McDermott, Michael W; Benet, Arnau; Theodosopoulos, Philip V | Abstract: BACKGROUND:Open transcranial approaches to the anterior skull base remain an integral component of current skull base practice. Evolution of these and other techniques has resulted in revisions of standard, tried-and-true methods in attempts to improve patient outcomes and cosmesis, while still providing the best combination of surgical exposure and ergonomics. OBJECTIVE:To describe a modified approach for midline tumors of the anterior skull base. METHODS:We describe the anatomy and techniques of a modified extended Bifrontal Craniotomy for anterior skull base tumors. Case examples and a postoperative 3-dimensional computed tomographic reconstruction of the Craniotomy are provided. RESULTS:The technique has been employed with success in 3 tuberculum sellae meningiomas where the anterior limit of the tumor is several centimeters back from the inner table of the frontal bone. The mean distance from the tumor to inner table was 2.8 cm (range 1.3-3.8 cm). Mean tumor dimensions were 3.0 cm (transverse), 3.5 cm (anterior-posterior), and 2.2 cm (craniocaudal). Average operative time was 557 min. No cases had new T2/fluid-attenuated inversion recovery magnetic resonance imaging signal of the inferior frontal lobe to indicate retraction injury. CONCLUSION:The tailored extended Bifrontal Craniotomy for anterior skull base tumors provides adequate access to the anterior cranial fossa and has replaced our standard extended Bifrontal approach. Keeping the osteotomy cut lines outside of the orbit reduces orbital swelling and mechanical disruption of conjugate eye movements in the early postoperative period, while allowing for minimal frontal lobe retraction and providing sufficient surgical exposure along the anterior skull base.
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Extended Bifrontal Craniotomy for Midline Anterior Fossa Meningiomas:Minimization of Retraction-Related Edema and Surgical Outcomes
Operative Neurosurgery, 2006Co-Authors: John H. Chi, Andrew T. Parsa, Mitchel S. Berger, Sandeep Kunwar, Michael W. McdermottAbstract:Abstract OBJECTIVE: Meningiomas of the anterior cranial base can be approached with a variety of techniques. The extended Bifrontal approach is often thought to be associated with increased morbidity because of the need for extensive removal of the bone and longer surgical times. The authors have attempted to quantitate retraction-related edema occurring after surgery to determine whether the extra bone removal limits retraction and reduces the chance of brain injury. METHODS: Charts were reviewed for patients who underwent extended Bifrontal craniotomies performed for meningiomas at the University of California, San Francisco, between 1997 and 2005. Magnetic resonance imaging scans obtained before and after surgery were reviewed for brain edema as indicated by fluid-attenuated inversion recovery/T2 abnormality and grouped into four categories: A, no edema; B, edema restricted to the gyrus rectus; C, edema beyond the gyrus rectus; and D, extensive Bifrontal edema. RESULTS: Forty-five patients were identified. Fifty-four percent of patients had tumors with a diameter of more than 4 cm. Simpson Grade 2 or 3 resection was achieved in 82% of patients, and the average operative time was 12.3 hours. Vision outcome was favorable in 74% of patients. Extent of fluid-attenuated inversion recovery abnormality remained unchanged in 87.5%, with 91% of patients in categories A or B edema remaining in those categories after surgery. There were no infections and there were two cerebrospinal fluid leaks. CONCLUSION: The extended Bifrontal approach is a safe surgical procedure with limited morbidity that the authors think: 1) prevents secondary brain injury from excessive retraction; 2) offers great flexibility of view for the surgeon; and 3) should be considered the preferred approach compared with the standard Bifrontal Craniotomy for large tumors of the anterior cranial base.
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Extended Bifrontal Craniotomy for midline anterior fossa meningiomas: minimization of retraction-related edema and surgical outcomes.
Neurosurgery, 2006Co-Authors: John H. Chi, Andrew T. Parsa, Mitchel S. Berger, Sandeep Kunwar, Michael W. McdermottAbstract:Meningiomas of the anterior cranial base can be approached with a variety of techniques. The extended Bifrontal approach is often thought to be associated with increased morbidity because of the need for extensive removal of the bone and longer surgical times. The authors have attempted to quantitate retraction-related edema occurring after surgery to determine whether the extra bone removal limits retraction and reduces the chance of brain injury. Charts were reviewed for patients who underwent extended Bifrontal craniotomies performed for meningiomas at the University of California, San Francisco, between 1997 and 2005. Magnetic resonance imaging scans obtained before and after surgery were reviewed for brain edema as indicated by fluid-attenuated inversion recovery/T2 abnormality and grouped into four categories: A, no edema; B, edema restricted to the gyrus rectus; C, edema beyond the gyrus rectus; and D, extensive Bifrontal edema. Forty-five patients were identified. Fifty-four percent of patients had tumors with a diameter of more than 4 cm. Simpson Grade 2 or 3 resection was achieved in 82% of patients, and the average operative time was 12.3 hours. Vision outcome was favorable in 74% of patients. Extent of fluid-attenuated inversion recovery abnormality remained unchanged in 87.5%, with 91% of patients in categories A or B edema remaining in those categories after surgery. There were no infections and there were two cerebrospinal fluid leaks. The extended Bifrontal approach is a safe surgical procedure with limited morbidity that the authors think: 1) prevents secondary brain injury from excessive retraction; 2) offers great flexibility of view for the surgeon; and 3) should be considered the preferred approach compared with the standard Bifrontal Craniotomy for large tumors of the anterior cranial base.
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Subperiosteal, subperiorbital dissection and division of the anterior and posterior ethmoid arteries for meningiomas of the cribriform plate and planum sphenoidale: technical note.
Neurosurgery, 1995Co-Authors: Michael W. Mcdermott, Jack Rootman, Felix DurityAbstract:ABSTRACTREMOVAL OF MENINGIOMAS from the region of the cribriform plate and the planum sphenoidale may entail a Bifrontal Craniotomy and an interruption of the tumor's blood supply along the floor of the anterior cranial base. However, with this approach, the presence of bulky tumor above makes it di
Valter Angelo Sperling Cescato - One of the best experts on this subject based on the ideXlab platform.
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Preservation of the olfactory tract in Bifrontal Craniotomy
Arquivos De Neuro-psiquiatria, 2002Co-Authors: Paulo Henrique Pires De Aguiar, Guilherme A Pulici, Leonardo O Lourenco, Juan Antonio Castro Flores, Valter Angelo Sperling CescatoAbstract:The anterior cranial base and the suprasellar and parasellar regions approach and its several methods have been described since 1981 by Suzuki et al. [3, 14, 15]. Extended frontal approaches, however, necessitate removal of the crista galli and sectioning of the olfactory rootlets with the associated risk of anosmia, cerebrospinal fluid (CSF) leak, and the need for complex reconstruction of the frontal floor [11, 12]. Bifrontal Craniotomy is the conventional approach to lesions in these locations [10, 11], but its shortcoming has been the damage to the olfactory tract [7].
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Preservation of the Olfactory Tract in Bifrontal Craniotomy
Arquivos de neuro-psiquiatria, 2002Co-Authors: Paulo Henrique Pires De Aguiar, Guilherme A Pulici, Leonardo O Lourenco, Juan Antonio Castro Flores, Valter Angelo Sperling CescatoAbstract:The Bifrontal Craniotomy approach used to be associated with a high percentage of olfactory tract damage. We present our experience with this technique, that was used with excellent results in a series of 11 patients that underwent the surgical approach described in this paper. We support the idea that bilateral subfrontal Craniotomy allows a wide operative exposure as well as the complete anatomic and functional preservation of the olfactory tracts bilaterally.
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Preservation of the olfactory tract in Bifrontal Craniotomy Preservação do trato olfatório em craniotomias bifrontais
Academia Brasileira de Neurologia (ABNEURO), 2002Co-Authors: Paulo Henrique Pires De Aguiar, Guilherme A Pulici, Leonardo O Lourenco, Juan Antonio Castro Flores, Valter Angelo Sperling CescatoAbstract:The Bifrontal Craniotomy approach used to be associated with a high percentage of olfactory tract damage. We present our experience with this technique, that was used with excellent results in a series of 11 patients that underwent the surgical approach described in this paper. We support the idea that bilateral subfrontal Craniotomy allows a wide operative exposure as well as the complete anatomic and functional preservation of the olfactory tracts bilaterally.A craniotomia Bifrontal costumava estar associada com alta incidência de lesão do trato olfatório. Apresentamos nossa experiência com técnica que foi usada com excelentes resultados numa série de 11 pacientes que foram submetidos à abordagem cirúrgica descrita neste estudo. Defendemos a idéia de que a craniotomia bilateral subfrontal permite uma exposição cirúrgica ampla bem como a completa preservação anatômica e funcional dos tratos olfatórios bilateralmente
John H. Chi - One of the best experts on this subject based on the ideXlab platform.
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Extended Bifrontal Craniotomy for Midline Anterior Fossa Meningiomas:Minimization of Retraction-Related Edema and Surgical Outcomes
Operative Neurosurgery, 2006Co-Authors: John H. Chi, Andrew T. Parsa, Mitchel S. Berger, Sandeep Kunwar, Michael W. McdermottAbstract:Abstract OBJECTIVE: Meningiomas of the anterior cranial base can be approached with a variety of techniques. The extended Bifrontal approach is often thought to be associated with increased morbidity because of the need for extensive removal of the bone and longer surgical times. The authors have attempted to quantitate retraction-related edema occurring after surgery to determine whether the extra bone removal limits retraction and reduces the chance of brain injury. METHODS: Charts were reviewed for patients who underwent extended Bifrontal craniotomies performed for meningiomas at the University of California, San Francisco, between 1997 and 2005. Magnetic resonance imaging scans obtained before and after surgery were reviewed for brain edema as indicated by fluid-attenuated inversion recovery/T2 abnormality and grouped into four categories: A, no edema; B, edema restricted to the gyrus rectus; C, edema beyond the gyrus rectus; and D, extensive Bifrontal edema. RESULTS: Forty-five patients were identified. Fifty-four percent of patients had tumors with a diameter of more than 4 cm. Simpson Grade 2 or 3 resection was achieved in 82% of patients, and the average operative time was 12.3 hours. Vision outcome was favorable in 74% of patients. Extent of fluid-attenuated inversion recovery abnormality remained unchanged in 87.5%, with 91% of patients in categories A or B edema remaining in those categories after surgery. There were no infections and there were two cerebrospinal fluid leaks. CONCLUSION: The extended Bifrontal approach is a safe surgical procedure with limited morbidity that the authors think: 1) prevents secondary brain injury from excessive retraction; 2) offers great flexibility of view for the surgeon; and 3) should be considered the preferred approach compared with the standard Bifrontal Craniotomy for large tumors of the anterior cranial base.
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Extended Bifrontal Craniotomy for midline anterior fossa meningiomas: minimization of retraction-related edema and surgical outcomes.
Neurosurgery, 2006Co-Authors: John H. Chi, Andrew T. Parsa, Mitchel S. Berger, Sandeep Kunwar, Michael W. McdermottAbstract:Meningiomas of the anterior cranial base can be approached with a variety of techniques. The extended Bifrontal approach is often thought to be associated with increased morbidity because of the need for extensive removal of the bone and longer surgical times. The authors have attempted to quantitate retraction-related edema occurring after surgery to determine whether the extra bone removal limits retraction and reduces the chance of brain injury. Charts were reviewed for patients who underwent extended Bifrontal craniotomies performed for meningiomas at the University of California, San Francisco, between 1997 and 2005. Magnetic resonance imaging scans obtained before and after surgery were reviewed for brain edema as indicated by fluid-attenuated inversion recovery/T2 abnormality and grouped into four categories: A, no edema; B, edema restricted to the gyrus rectus; C, edema beyond the gyrus rectus; and D, extensive Bifrontal edema. Forty-five patients were identified. Fifty-four percent of patients had tumors with a diameter of more than 4 cm. Simpson Grade 2 or 3 resection was achieved in 82% of patients, and the average operative time was 12.3 hours. Vision outcome was favorable in 74% of patients. Extent of fluid-attenuated inversion recovery abnormality remained unchanged in 87.5%, with 91% of patients in categories A or B edema remaining in those categories after surgery. There were no infections and there were two cerebrospinal fluid leaks. The extended Bifrontal approach is a safe surgical procedure with limited morbidity that the authors think: 1) prevents secondary brain injury from excessive retraction; 2) offers great flexibility of view for the surgeon; and 3) should be considered the preferred approach compared with the standard Bifrontal Craniotomy for large tumors of the anterior cranial base.
Akira Teramoto - One of the best experts on this subject based on the ideXlab platform.
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Surgical technique for the prevention of cerebrospinal fluid leakage after Bifrontal Craniotomy.
World neurosurgery, 2013Co-Authors: Yasuo Murai, Takayuki Mizunari, Shiro Kobayashi, Akira TeramotoAbstract:Background Cerebrospinal fluid leakage and meningitis caused by frontal sinus (FS) exposure are characteristic complications of Bifrontal Craniotomy used for treating skull base tumors and anterior communicating artery aneurysms. Prevention of these complications is of utmost importance. We describe in detail our procedure for sealing exposed FSs during Bifrontal Craniotomy and present the results and outcomes of the procedure. Methods A total of 51 consecutive patients who had undergone Bifrontal Craniotomy for tuberculum sellae meningiomas, craniopharyngiomas, anterior cerebral artery aneurysms, or other frontal skull base lesions at our institute were selected for the study. Our technique for sealing exposed FSs is described below. The mucosa was sterilized using surgical cotton dipped in iodine. After Craniotomy, the exposed mucosa was sealed using 7-0 nylon sutures, whereas Gelfoam with fibrin glue was used to ensure watertight closure. The exposed portions of the FSs were covered by bone covers made of internal table bone and sealed. As a final layer, frontal periosteal flaps were sutured to the frontal base dura mater. Results Postoperative cerebrospinal fluid leakage or meningitis did not occur in any of our patients. Conclusion Our results indicate the effectiveness of our technique in the prevention of FS-related postoperative complications.
Keitaro Kai - One of the best experts on this subject based on the ideXlab platform.
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Frontal Sinus Repair Using Polymethyl Methacrylate After Bifrontal Craniotomy.
World neurosurgery, 2018Co-Authors: Jin Matsuura, Tadahiro Otsuka, Takashi Nakagawa, Keitaro KaiAbstract:Background In many cases in which Bifrontal Craniotomy is performed, the frontal sinus is opened, and postoperative complications occur. Various methods to close the frontal sinus have been reported. However, all these methods require skill to perform and take time. The aim of this study was to report results obtained with closure of the frontal sinus using polymethyl methacrylate, which is a simpler method. Methods From December 2008 to June 2018, 122 patients with a ruptured anterior communicating aneurysm were transported to the authors' facility, and 52 patients consecutively underwent Bifrontal Craniotomy with opening of the frontal sinuses, which were then filled with polymethyl methacrylate. Results Mean follow-up period was 21.8 months; the longest follow-up was 116 months. No cerebrospinal fluid leakage or other complications were observed. Conclusions The method of filling the frontal sinus with polymethyl methacrylate reported in this study was safe and had no complications. This method should be considered as a method of frontal sinus closure.