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“Unlocking the brain” - key concepts to accessing the anterolateral skull base made simple

  • Iype Cherian ,
  • Hira Burhan ,

Abstract

Background: The close relationships of skull base structures make it crucial to approach it in a fashion that provides wider exposure with minimal retraction. The concept of brain unlocking adds to the axial and sagittal views allowing access to the optico-carotid window with much ease as compared to the only sylvian dissection in an oblique plane. Another concept introduced is a modification of the Dolenc approach that prevents the bleeding from the cavernous sinuses and also protects the spanning nerves from paresis while operating within the cavernous sinus.

Methods: Unlocking the frontal and temporal lobes in sagittal and axial planes involves drilling the sphenoid bone and sharply dissecting the orbito-meningeal band, respectively. The peeling of the temporal lobe from the cavernous sinus is carried out while keeping the true cavernous membrane intact. This is a modification of the Dolenc approach.

Results: The outcomes of these maneuvers is clearly depicted in the cadaver and surgical dissections performed for skull base approaches. The immediate effects of brain unlocking can be seen as the brain flattens out completely at the fronto-temporal junction. This, followed by a modified Dolenc maintaining a pericavernous plane helps reduce the bleeding considerably. 

Conclusion: The use of brain unlocking maneuvers can be essential in providing a wider surgical corridor to approach deep structures in the middle fossa. Maintaining a pericavernous plane while peeling the temporal dura can help reduce cavernous bleeding and prevent nerve paresis in the region.

Keywords: anterolateral skull base; sphenoid; orbito-meningeal band; Dolenc; cavernous sinus; anterior clinoid; petrosectomy

References

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How to Cite

Cherian, I., & Burhan, H. (2020). “Unlocking the brain” - key concepts to accessing the anterolateral skull base made simple. Indonesian Journal of Neurosurgery, 3(3). https://doi.org/10.15562/ijn.v3i3.103

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