Principles and Practice of Keyhole Brain Surgery PDF
Preview Principles and Practice of Keyhole Brain Surgery
MediaCenter.thieme.com plus e-content online To access additional material or resources available with this e-book, please visit http://www.thieme.com/bonuscontent. After completing a short form to verify your e-book purchase, you will be provided with the instructions and access codes necessary to retrieve any bonus content. TPS23x31-2|12.01.15-12:41 TPS23x31-2|12.01.15-12:41 TPS23x31-2|12.01.15-12:41 Principles and Practice of Keyhole Brain Surgery Charles Teo, AM, MBBS, FRACS Director Centre for Minimally Invasive Neurosurgery Sydney, Australia Conjoint Associate Professor University of New South Wales Sydney, Australia Yeoh Ghim Seng Visiting Professor National University Hospital Singapore Michael E. Sughrue, MD Assistant Professor of Neurological Surgery Department of Neurosurgery University of Oklahoma Health Sciences Center Oklahoma City, Oklahoma, USA 1,041 illustrations Thieme Stuttgart (cid:129) New York (cid:129) Delhi (cid:129) Rio de Janeiro TPS23x31-2|12.01.15-12:41 LibraryofCongressCataloging-in-PublicationData Importantnote:Medicineisanever-changingscienceundergoingcontin- ualdevelopment.Researchandclinicalexperiencearecontinuallyexpand- Teo,Charles,author. ingourknowledge,inparticularourknowledgeofpropertreatmentand Principlesandpracticeofkeyholebrainsurgery/CharlesTeo,MichaelE. drug therapy. Insofar as this book mentions any dosage or application, Sughrue. readers may rest assured that the authors, editors, and publishers have p.;cm. madeeveryefforttoensurethatsuchreferencesareinaccordancewiththe Includesindex. stateofknowledgeatthetimeofproductionofthebook. ISBN978-3-13-175851-4(hardback)--ISBN978-3-13-175861-3(eISBN) Nevertheless,thisdoesnotinvolve,imply,orexpressanyguaranteeor I.Sughrue,MichaelE.,author.II.Title. responsibility on the part of the publishers in respect to any dosage [DNLM:1. Craniotomy--methods.2. SurgicalProcedures,Minimally instructions and forms ofapplicationsstated in thebook. Every user is Invasive--methods.3. NeurosurgicalProcedures--methods. 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ArgentinaBuilding16thfloor,AlaA,228PraiadoBotafogo RiodeJaneiro22250-040Brazil +552137363631 Illustrator:StevenMills Coverdesign:ThiemePublishingGroup TypesettingbyThomsonDigital,India PrintedinChinabyEverbestPrintingCo. 54321 Thisbook,includingallpartsthereof,islegallyprotectedbycopyright.Any use,exploitation, orcommercialization outsidethenarrowlimitsset by ISBN978-3-13-175851-4 copyrightlegislationwithoutthepublisher’sconsentisillegalandliableto prosecution.Thisappliesinparticulartophotostatreproduction,copying, Alsoavailableasane-book: mimeographing or duplication of any kind, translating, preparation of eISBN978-3-13-175861-3 microfilms,andelectronicdataprocessingandstorage. TPS23x31-2|12.01.15-12:41 Idedicatethisbooktomywife,Genevieve,withoutwhoseloveandsacrificeIwouldnotbewhoIamtoday; tomybeautifuldaughters,Alex,Nikki,Katie,andSophie,withoutwhomIwouldnothavehadsucha balancedandenjoyablelife;tomypatients,withoutwhosecourageandtrustIwouldnotgetup everymorningandsay...“there’sgottobeabetterway”;andtomyfellows,whokeepmehonest. CharlesTeo,AM,MBBS,FRACS Idedicatethisbooktomywife,whoisalwaysthereattheendofalongday;tothoseteacherswhowere patientenoughtosuffermylearningcurve;andtomyfather,whoalwayswasmore interestedinmysuccessthanIwas. MichaelE.Sughrue,MD TPS23x31-2|12.01.15-12:41 |23.12.14-16:04 Contents VideoContents................................................................................................. xi Foreword........................................................................................................ xiii Preface.......................................................................................................... xiv Acknowledgments............................................................................................. xvi Contributors.................................................................................................... xvii Abbreviations................................................................................................... xviii 1 AnIntroductiontotheKeyholeConcept..................................................................... 2 MichaelE.SughrueandCharlesTeo 1.1 Introduction..................................... 2 1.3 WhatArethePropertiesofKeyhole?.............. 2 1.2 WhatDoestheTerm“Keyhole”ActuallyMean?.... 2 2 CognitivePrinciplesofPlanningKeyholeApproaches...................................................... 6 MichaelE.SughrueandCharlesTeo 2.1 Introduction..................................... 6 3 TechnicalPrinciplesofOperatinginKeyholeCraniotomies................................................ 12 MichaelE.SughrueandCharlesTeo 3.1 Introduction..................................... 12 3.6 WhentoBringintheEndoscope.................. 14 3.2 OverallFlowofaKeyholeOperation............... 12 3.7 Low-ProfileOperativeField....................... 15 3.3 MaximalUtilizationofaMinimalIncision.......... 12 3.8 MakeSpaceEarly ................................ 15 3.4 FrequentMicroscopeAdjustment................. 12 3.9 UsetheRightTools............................... 16 3.5 AnticipatoryMicroscopePositioning.............. 12 4 TheRoleofEndoscopyinKeyholeSurgery .................................................................. 20 MichaelE.SughrueandCharlesTeo 4.1 Introduction..................................... 20 4.5.1 Inspection....................................... 22 4.5.2 Clarification..................................... 22 4.2 ABriefIntroductiontotheEndoscope............. 20 4.5.3 Intervention..................................... 22 4.3 SafeEndoscopeTechnique........................ 20 4.6 ACatalogofCommonEndoscopeAngles.......... 22 4.4 EndoscopeLogistics.............................. 21 4.5 WhenIstheEndoscopeUseful?................... 22 5 AnAtlasofIntracranialEndoscopy........................................................................... 30 ZubairHasan 5.1 Introduction..................................... 30 5.3.1 TranscribriformApproach........................ 42 5.3.2 TranstubercularApproach........................ 43 5.2 ParasellarEndoscopy............................. 30 5.4 RetrosigmoidEndoscopy......................... 46 5.3 EndonasalEndoscopy ............................ 40 vii |23.12.14-16:04 Contents 5.4.1 TransclivalApproach............................. 54 5.6 SuboccipitalEndoscopy.......................... 57 5.5 TranscallosalEndoscopy.......................... 55 6 StepsinCommonKeyholeApproaches...................................................................... 62 MichaelE.SughrueandCharlesTeo 6.1 Introduction..................................... 62 6.5.1 BasicSteps...................................... 72 6.2 TheBasicConvexityKeyhole...................... 62 6.6 RetrosigmoidApproach.......................... 73 6.2.1 BasicSteps...................................... 62 6.6.1 BasicSteps...................................... 73 6.3 Eyebrow(Supraorbital)Craniotomy............... 63 6.7 InterhemisphericApproaches .................... 75 6.3.1 BasicSteps...................................... 65 6.7.1 BasicTechnique................................. 75 6.3.2 Closure ......................................... 67 6.3.3 TheFourPearlsforOptimalCosmetic 6.8 SuboccipitalApproaches......................... 75 Outcomes....................................... 67 6.8.1 LimitedParamedianSuboccipitalApproach ....... 75 6.4 Mini-PterionalCraniotomy....................... 70 6.8.2 LimitedVermianApproach....................... 77 6.8.3 Mini-TelovelarApproach......................... 77 6.4.1 BasicSteps...................................... 72 6.5 Mini-SubtemporalCraniotomy ................... 72 7 EndonasalSurgeryandItsCurrentRoleinNeurosurgicalParadigms .................................... 80 MichaelE.SughrueandCharlesTeo 7.1 Introduction..................................... 80 7.4.1 SellarPathology................................. 80 7.4.2 Craniopharyngiomas ............................ 81 7.2 AVeryBriefIntroductiontoEndonasal 7.4.3 MedialCavernousSinusPathology................ 81 Approaches ..................................... 80 7.4.4 ClivusPathology................................. 81 7.4.5 PetrousApex.................................... 81 7.3 WhereDoEndonasalEndoscopic ApproachesFitIn?............................... 80 7.4.6 InfratemporalFossa/ParajugularRegion........... 81 7.4.7 OlfactoryGroove ................................ 83 7.4 WhenDoWeUseanEndonasal Approach? ...................................... 80 8 KeyholeSurgeryforSupratentorialIntra-AxialTumors.................................................... 86 MichaelE.Sughrue,StevenMillsandCharlesTeo 8.1 Introduction..................................... 86 8.9 Guideline6:SticktoSimpleandFamiliar ApproachesWheneverPossible................... 90 8.2 KeyholeSurgery................................. 86 8.10 Guideline7:OrientIncisionsParalleltoNerves..... 91 8.3 HowtoPlanaKeyholeApproachtoanIntra-Axial 8.11 Guideline8:CheatWheneverPossible ............ 91 BrainTumor..................................... 87 8.12 KeyholeCraniotomiesinSpecificLocations........ 92 8.4 Guideline1:DeterminetheSizeoftheKeyhole Needed ......................................... 88 8.12.1 FrontalLobeTumors............................. 92 8.5 Guideline2:TheTwo-PointRule.................. 88 8.13 SpecificExamples................................ 92 8.6 Guideline3:ViewtheIdealKeyholeintheContext 8.13.1 SimpleConvexityTumor,NoOpercular ofEloquentBrainRegions........................ 88 Involvement .................................... 92 8.13.2 DeepFrontalTumor.............................. 93 8.7 Guideline4:ViewtheIdealKeyholeintheContext ofFissures ...................................... 90 8.13.3 LowFrontalGliomathroughtheEyebrow......... 93 8.13.4 ExtensiveFrontalSurfaceTumorInvolvement..... 94 8.8 Guideline5:ViewtheIdealKeyholeintheContext 8.13.5 FrontalLobectomy:OpercularSparing ofSurgicalIntentions............................ 90 orOpercularInvolving........................... 94 viii
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