Acceso minipterional interfascial simple y combinado, con peeling de fosa media y clinoidectomia anterior extradural. Serie clínica

Abstract

Introduction: In the last two decades, the classic pterional approach described by Yasargil has undergone important modificationsin search of access to the base of the skull, such as transcigomatic and orbitozygomatic approach; more recently, minimally invasive accesses, keyhole approaches. This is how minipterional access with interfascial dissection has been described, which has been combined with techniques of the base of the skull, anterior extradural clinoidectomy, middle fossa peeling and Kawase anterior petrosectomy, by the Vascular Neurosurgery team and the base of the Skull of the Institute of Neurosurgery (INCA), by Dr. Jorge Mura, managing to solve complex pathologies through a keyhole access. This work presentsa clinical, multicentric series, carried out by the same neurosurgeon, and whose objective is to demonstrate that simple and combined mini-pterional access is reproducible in other centers, with good clinical results. Materials and Methods: The author presents a clinical series of 56 patients, treated at the San Pablo of Coquimbo hospital and the Elqui clinic of La Serena, between April 2017 and August 2018, with a prospective follow-up of the clinical results, which were evaluated with the modified Rankin scale. Results: In a total of 56 cases, the female sex predominated (71%), the average age was 53 years and the aneurysmal pathology was the most frequent with 45 cases, of these 60% were ruptured aneurysms; 7% corresponded
to tumors of the base of the skull and 12.5% to non-communicating hydrocephalus resolved by the opening of the lamina
terminalis. In 9 cases, mini-pterional access was combined with extradural anterior clinoidectomy and in 3 cases a middle
fossa peeling was performed. The greater surgical time was associated with combined mini-pterional access, either due to
tumoral pathology or paraclinoid aneurysms. A favorable neurological result (ERm < 3) was obtained in 87.5% of the patients. Conclusion and Discussion: Currently the evidence has shown that the minipterional approach has advantages over other keyhole approaches, mainly due to the possibility of being able to combine it with skull base techniques, being able to resolve pathologies that previously could not be treated by minimally invasive approaches. The classical pterional approach, however, continues to be indicated in selected cases. On the other hand, this clinical series confirms that simple and combined minipterional approach is reproducible and that, using it with adequate microsurgical management, it achieves good results in complex pathologies.