Abordul neurochirurgical al bazei craniului
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ABORDUL NEUROCHIRURGICAL AL
BAZEI CRANIULUI
ETAJ ANTERIORlinie mediana subdural
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LOCALIZAREA LEZIUNILOR
INTRACRANIAN
INTRACRANIAN CU INTERESAREA NERVULUI OPTIC +/- COMPLEX ACA-ACoA
INTRACRANIAN CU EXTENSIE IN SINUSURILE PARANASALE
INTRACRANIAN CU EXTENSIE IN SINUSURILE PARANASALE +/- COMPLEX ACA-ACoA
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ABORD NEUROCHIRURGICAL
A. BIFRONTAL
B. UNILATERAL SUBFRONTAL
C. PTERIONAL
D. FRONTO-ORBITAL
E. TRANSBAZAL
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ABORDUL BIFRONTAL INDICATII
Leziunile fronto-bazale anterior de chiasma optica si de PW
Leziunile extra/intraaxiale frontale
Leziunile genunchiului corpului calos
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ABORDUL BIFRONTAL
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ABORDUL BIFRONTAL
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ABORDUL BIFRONTAL
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ABORDUL BIFRONTAL
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ABORDUL BIFRONTAL
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ABORDUL BIFRONTAL
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ABORDUL BIFRONTAL
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ABORDUL BIFRONTAL
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ABORDUL BIFRONTAL
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ABORDUL BIFRONTAL
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ABORDUL BIFRONTAL
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ABORDUL BIFRONTALCOMPLICATII INTRAOPERATORII Hemostaza inadecvata volet cutanat Lezarea nervului facial Lezarea nervului supraorbitar Lezarea durei mater si a SLS Hemostaza improprie la nivelul SLS si
venelor aferente Leziuni cerebrale prin tractiune
inadecvata HED Hematoame epicraniene
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ABORDUL BIFRONTAL
AVANTAJE
Expunerea simetrica a etajului anterior
Permite rezectia radicala a leziunilor
Permite indepartarea plafonului orbitar
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ABORDUL BIFRONTAL
DEZAVANTAJE
Deschiderea sinusurilor frontale
Marginea inferioara este deasupra nivel orbita
Herniere cerebrala cu rezectie cerebrala
Sacrificarea SLS ACA-ACoA si chiasma
optica la pol posterior
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ABORDUL SUBFRONTAL UNILATERAL INDICATII
Fistula cranio-durala postraumatica
Tumori sant olfactiv
Deschiderea plafonului orbitar
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ABORDUL SUBFRONTAL UNILATERAL
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ABORDUL SUBFRONTAL UNILATERAL
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ABORDUL SUBFRONTAL UNILATERAL
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ABORDUL FRONTAL UNILATERAL
AVANTAJE DEZAVANTAJE
Nu expune lobul frontal controlateral
Nu intereseaza SLS
Camp operator ingust
Tractiune cerebrala importanta
Necesita rezectie cerebrala
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ABORDUL PTERIONAL INDICATII
Leziuni anterioare chiasmei si cu interesarea nervului optic
Tumori regiune orbitara Tumori selare /paraselare Anevrisme circulatie anterioara si
anevrisme bazilara Tumori de clivus
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ABORDUL PTERIONAL
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ABORDUL PTERIONAL
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ABORDUL PTERIONAL
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ABORDUL PTERIONAL
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ABORDUL PTERIONAL
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ABORDUL PTERIONAL
AVANTAJE DEZAVANTAJE
Timp scurt interventie
Risc mic pentru fistula LCR
Deschiderea precoce a cisternelor bazale
Vizualizare precoce a NO, ACI,ACA
Distanta mica os-leziune
Unghi ingust de lucru Pol superior leziune
nevizualizat Distanta mare de
lucru catre polul opus al leziunii
Plafonul orbitar mascheaza linia mediana
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ABORDUL FRONTO-ORBITAL UNILATERAL INDICATII
Leziuni de dimensiuni mari situate in etajul anterior al bazei craniului
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ABORDUL FRONTO-ORBITAL UNILATERAL
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ABORDUL FRONTO ORBITAL UNILATERAL
AVANTAJE DEZAVANTAJE
Calea cea mai scurta catre leziune, vizualizare maxima
Identificarea imediata NO, ACI
Deschiderea precoce a cisternelor bazale
Elimina retractia cerebrala
Manipulare facila ACA
Timp indelugat de lucru
Deschiderea frecventa a sinusului frontal
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ABORDUL TRANSBAZALINDICATII
Leziunile etajului anterior care ivadeaza baza craniului
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ABORDUL TRANSBAZAL
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ABORDUL TRANSBAZAL
AVANTAJE DEZAVANTAJE
Vizualizarea etajului anterior al bazei craniului concomitent cu structuile de vecinatate
Tehnica chirurgicala dificila
Durata mare de timp pentru abord si reconstructie
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ALEGEREA ABORDULUI CHIRURGICAL
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ABORDUL NEUROCHIRURGICAL AL ETAJULUI ANTERIOR AL BAZEI CRANIULUI
Interesare sinus paranasal
retractie cerebrala
Ligatura SSS
Fistula LCR
Expunere camp operator
complexitate
timp abord
DA Mare DA risc ↑ Buna Moderata
+++ Bifrontal
DA Foarte mare
NU Risc moderat
Minima Scazuta + Unilateral
NU Moderata
NU Risc ↓ Buna Scazuta + Pterional
DA Minima NU Risc moderat
Foarte buna
Moderata
++ Fronto-orbital
DA Minima NU risc ↑ Foarte buna
Mare ++++
transbazal
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