Professor Dolenc edited the first comprehensive and up-to-date text dealing with the cavernous sinus. His book addressed anyone concerned with the diagnosis and treatment of lesions of the skull base. Now, twenty years later, the same author edits a new volume with articles by specialists in the topic presenting the state-of-the-art in this technology.
Leseprobe
Neuromonitoring in central skull base surgery (p. 89-90)
W. Eisner, T. Fiegele
Neurosurgical Department, Medical University Innsbruck, Innsbruck, Austria
Introduction
Intraoperative electrophysiological monitoring has become increasingly common in neurosurgery. Such methods prevent postoperative deficits by warning the surgeon of the imminent injury to neuronal structures. Monitoring sensorimotor, cognitive (language and short term memory), and cranial nerve function (except hearing) during cerebellopontine angle operations has been well established.
Yet monitoring the function of nuclei and fiber tracts in the floor of the fourth ventricle and cranial nerves traversing the central skull base is more demanding - ranging from recording site challenges (e.g., within the orbit) to interpreting the more subtle electrophysiological findings. Preserving motor cranial nerve function has long been a problem for skullbase surgeons. Currently, however, the continuous recording of compound muscle action potentials (CMAPs) from muscles enervated by cranial nerves III-XII makes it possible to monitor skull base and cavernous sinus operations as reliably as those performed in the cerebellopontine angle.
Problems in central skull base surgery
Space occupying lesions occurring at the central skull base endanger three primary systems: (1) cranial nerves I-VI include four motor nerves, two sensory nerves, and one of the mixed functions. Lesions extending from the central skull base to the foramen magnum may affect any or all cranial nerves, I-XII. (2) The vascular system of the anterior circulation, including connections with the posterior circulation, as it impacts the cerebral hemispheres and basal ganglia. (3) The hypothalamic and hypophyseal system (concerned with endocrine function) is beyond the scope of this article. The basis for intraoperative electrophysiological monitoring involves stimulating various cranial motor nerves, then recording subclinical contractions of the muscles they innervate. Continuous recording of muscle activity during surgical dissection has the capacity to reveal contact with or injury to a cranial nerve. The percentage reduction of a supramaximal CMAP compared to that at the beginning of the operation indicates the percentage of functional neuron loss.
Historical overview
On 14 July 1898, Dr. Fedor Krause in Berlin first described the use of cranial nerve monitoring during posterior fossa surgery to section a cochlear nerve for tinnitus. He noted that .. . .unipolar faradic irritation of the facial nerve trunk with the weakest possible current of the induction apparatus resulted in contractions of the right facial region, especially of the orbicularis oculi, as well as of the branches supplying the nose and the mouth . . .. [65]. The patient exhibited facial paresis immediately following surgery which almost completely resolved by the next day. Krause also noted contractions of the shoulder, which he thought were due to the stimulation of the spinal accessory nerve that .. . .had undoubtedly been reached by the current, because it was, together with the acusticus, bathed in liquor that had trickled down . . ... Thus, Krause was not only the first to describe locating a cranial nerve by electrical stimulation, but also the first to encounter the confounding problem of an artifact being produced by the spread of current! Frazier used a similar technique during an operation for the relief of vertigo, and pointed out the importance of preserving the facial nerve, which he noted could be identified by "galvanic current". [36].
Inhalt
Anatomy of the cavernous sinus.- The middle cranial base and cavernous sinus.- The transition between the cavernous sinus and orbit.- Venous anatomy of the lateral sellar compartment.- Central skull base anatomy as seen through the endoscope.- Surgical approaches to the central skull base.- Evolution from the classical pterional to the contemporary approach to the central skull base.- Extended endoscopic endonasal transsphenoidal approach to supra-parasellar tumors.- Neuromonitoring in central skull base surgery.- Neuromonitoring in central skull base surgery.- Surgical treatment of vascular lesions in the central skull base.- Surgical treatment of large/giant carotid-ophthalmic and other intradural internal carotid artery aneurysms.- Surgical treatment of basilar apex aneurysms surgical approaches and techniques.- Aneurysms of the intracavernous ICA: Current treatment.- Surgical treatment of tumorous lesions in the central skull base.- Cavernous sinus meningiomas.- Surgery of cavernous sinus meningiomas: advantages and disadvantages.- Trigeminal neurinomas: surgical considerations.- Bypasses for cavernous sinus tumors: history, techniques, and current status.- Giant pituitary tumors: surgical treatment of 265 cases.- Radiosurgery in treatment of central skull base tumors.- The role of Gamma Knife surgery in the management of non-meningeal tumors of the cavernous sinus.
Leseprobe
Neuromonitoring in central skull base surgery (p. 89-90)
W. Eisner, T. Fiegele
Neurosurgical Department, Medical University Innsbruck, Innsbruck, Austria
Introduction
Intraoperative electrophysiological monitoring has become increasingly common in neurosurgery. Such methods prevent postoperative deficits by warning the surgeon of the imminent injury to neuronal structures. Monitoring sensorimotor, cognitive (language and short term memory), and cranial nerve function (except hearing) during cerebellopontine angle operations has been well established.
Yet monitoring the function of nuclei and fiber tracts in the floor of the fourth ventricle and cranial nerves traversing the central skull base is more demanding - ranging from recording site challenges (e.g., within the orbit) to interpreting the more subtle electrophysiological findings. Preserving motor cranial nerve function has long been a problem for skullbase surgeons. Currently, however, the continuous recording of compound muscle action potentials (CMAPs) from muscles enervated by cranial nerves III-XII makes it possible to monitor skull base and cavernous sinus operations as reliably as those performed in the cerebellopontine angle.
Problems in central skull base surgery
Space occupying lesions occurring at the central skull base endanger three primary systems: (1) cranial nerves I-VI include four motor nerves, two sensory nerves, and one of the mixed functions. Lesions extending from the central skull base to the foramen magnum may affect any or all cranial nerves, I-XII. (2) The vascular system of the anterior circulation, including connections with the posterior circulation, as it impacts the cerebral hemispheres and basal ganglia. (3) The hypothalamic and hypophyseal system (concerned with endocrine function) is beyond the scope of this article. The basis for intraoperative electrophysiological monitoring involves stimulating various cranial motor nerves, then recording subclinical contractions of the muscles they innervate. Continuous recording of muscle activity during surgical dissection has the capacity to reveal contact with or injury to a cranial nerve. The percentage reduction of a supramaximal CMAP compared to that at the beginning of the operation indicates the percentage of functional neuron loss.
Historical overview
On 14 July 1898, Dr. Fedor Krause in Berlin first described the use of cranial nerve monitoring during posterior fossa surgery to section a cochlear nerve for tinnitus. He noted that .. . .unipolar faradic irritation of the facial nerve trunk with the weakest possible current of the induction apparatus resulted in contractions of the right facial region, especially of the orbicularis oculi, as well as of the branches supplying the nose and the mouth . . .. [65]. The patient exhibited facial paresis immediately following surgery which almost completely resolved by the next day. Krause also noted contractions of the shoulder, which he thought were due to the stimulation of the spinal accessory nerve that .. . .had undoubtedly been reached by the current, because it was, together with the acusticus, bathed in liquor that had trickled down . . ... Thus, Krause was not only the first to describe locating a cranial nerve by electrical stimulation, but also the first to encounter the confounding problem of an artifact being produced by the spread of current! Frazier used a similar technique during an operation for the relief of vertigo, and pointed out the importance of preserving the facial nerve, which he noted could be identified by "galvanic current". [36].
Inhalt
Anatomy of the cavernous sinus.- The middle cranial base and cavernous sinus.- The transition between the cavernous sinus and orbit.- Venous anatomy of the lateral sellar compartment.- Central skull base anatomy as seen through the endoscope.- Surgical approaches to the central skull base.- Evolution from the classical pterional to the contemporary approach to the central skull base.- Extended endoscopic endonasal transsphenoidal approach to supra-parasellar tumors.- Neuromonitoring in central skull base surgery.- Neuromonitoring in central skull base surgery.- Surgical treatment of vascular lesions in the central skull base.- Surgical treatment of large/giant carotid-ophthalmic and other intradural internal carotid artery aneurysms.- Surgical treatment of basilar apex aneurysms surgical approaches and techniques.- Aneurysms of the intracavernous ICA: Current treatment.- Surgical treatment of tumorous lesions in the central skull base.- Cavernous sinus meningiomas.- Surgery of cavernous sinus meningiomas: advantages and disadvantages.- Trigeminal neurinomas: surgical considerations.- Bypasses for cavernous sinus tumors: history, techniques, and current status.- Giant pituitary tumors: surgical treatment of 265 cases.- Radiosurgery in treatment of central skull base tumors.- The role of Gamma Knife surgery in the management of non-meningeal tumors of the cavernous sinus.
Titel
Cavernous Sinus
Untertitel
Developments and Future Perspectives
Autor
Editor
EAN
9783211721384
ISBN
978-3-211-72138-4
Format
E-Book (pdf)
Hersteller
Herausgeber
Genre
Veröffentlichung
31.07.2009
Digitaler Kopierschutz
Wasserzeichen
Dateigrösse
10.21 MB
Anzahl Seiten
227
Jahr
2009
Untertitel
Englisch
Features
Unterstützte Lesegerätegruppen: PC/MAC/eReader/Tablet
Auflage
2. Aufl.
Unerwartete Verzögerung
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