| VIDEO SECTION-OPERATIVE NUANCES: STEP BY STEP
|Year : 2021 | Volume
| Issue : 4 | Page : 829--832
Treading Toward Anterolateral Skull Base by Unlocking the Frontotemporal Dural Fold Along with Extradural Clinoidectomy: Translation from A Cadaver to Clinical Scenario
Arun K Srivastava1, Shashwat Mishra2, Ashutosh Kumar1, Bhavan Nangarwal1, Kuntal K Das1, Kamlesh S Bhaisora1, Pawan Verma1, Awadhesh K Jaiswal1, Sanjay Behari1
1 Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
2 Department of Neurosurgery, AIIMS, New Delhi, India
Background and Introduction: Unlocking of the frontotemporal dural fold (FTDF) and extradural removal of the anterior clinoid process (EACP) are challenging but mandatory skills for micro-neurosurgeons. Despite the presence of an extensive body of literature on this subject, the translation of this cadaveric and 3D simulation to a real patient turns out to be a very demanding and difficult task.
Objective: This video is aimed to address the surgical nuances and major adjustments necessary in the unlocking of the FTDF and extradural ACP removal in an actual case for an early-career neurosurgeon.
Surgical Technique: A 40-year lady presented with features of acromegaly with radiological evidence of significant component of the tumor in the right cavernous sinus along with sellar suprasellar component. To achieve a good hormonal control, a complete tumor excision was required, which was achieved with FTDF and EACP removal. The cavernous sinus was approached through the Parkinson's triangle.
Results: The patient had uneventful recovery and good hormonal control at the 3-month follow-up.
Conclusion: FTDF unlocking and EACP are elegant procedures and need to be learned by all neurosurgeons. This article will provide excellent teaching material for young neurosurgeons.
Dr. Arun K Srivastava
Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh
Source of Support: None, Conflict of Interest: None
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