Abordajes endoscópicos ventrales y multiportales al encéfalo. Aplicaciones neuroquirúrgicas mínimamente invasivas
[eng] The brain ventral surface has been historically considered as a complex area to reach due to technical and operative difficulties when accessing it through 'classical' neurosurgical transcranial approaches. In recent years, 'ventral' approaches through the nose (endonasal)...
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| Tipo de recurso: | tesis doctoral |
| Estado: | Versión publicada |
| Fecha de publicación: | 2018 |
| País: | España |
| Institución: | Universidad de Barcelona |
| Repositorio: | Dipòsit Digital de la UB |
| OAI Identifier: | oai:diposit.ub.edu:2445/127947 |
| Acceso en línea: | https://hdl.handle.net/2445/127947 http://hdl.handle.net/10803/665465 |
| Access Level: | acceso abierto |
| Palabra clave: | Neurocirurgia Encèfal Cirurgia mínimament invasiva Neurosurgery Encephalon Minimally invasive surgery |
| Sumario: | [eng] The brain ventral surface has been historically considered as a complex area to reach due to technical and operative difficulties when accessing it through 'classical' neurosurgical transcranial approaches. In recent years, 'ventral' approaches through the nose (endonasal) and very recently through the orbit (transorbital) performed with the aid of the endoscope, have been proposed as relatively safe and effective pathways to unlock anatomic structures located at the level of the ventral surface of the brain, in a minimally invasive manner. The hypothesis of the present thesis is that the new transorbital endoscopic approach, through the upper eyelid, could allow the visualization and manipulation of some anatomic structures located mainly in the lateral part of the ventral surface of the brain. Further, the combination with the endonasal path could exceed the limits of a single approach thus providing better manipulation angles, working distances, and visualization of target areas. Hence, the objective of this contribution would be to analyze, from a neuroanatomic fashion, the purely transorbital endoscopic approach and to combine it with the midline ventral route via the nose (endonasal route). Anatomic dissections will be performed. The purely endoscopic superior eyelid transorbital approach affords good visualization and surgical manipulation of structures in the anterior and middle cranial fossae. In particular, lateral orbital corridors to the superior and inferior orbital fissures permit the exposure of the most lateral portion of the middle or the anterior cranial fossa. Further, bone removal medially to the superior and inferior orbital fissures provides access to the optico-carotid region. On the other hand, the combination with the other ventral minimally invasive route provides a comprehensive management of specific anatomic targets. As a matter of fact, for example, used together, the endonasal and the transorbital paths allows a complete decompression of the optic nerve. In conclusion, this work may further extend the anatomic knowledge related to those ventral and endoscopic routes to the skull base, from a strictly neurosurgical point of view. Further studies and, eventually, surgical case series are mandatory to confirm the effectiveness of these approaches, thereby refining the proper indications for each of them. |
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