Mini Temporal approach

Mental Skills Required

Automatism

Imagination

Strategy

Manual Skills Required

Automatism

Dexterity

Speed

Mental Skills Required

Automatism

Imagination

Strategy

Manual Skills Required

Automatism

Dexterity

Speed

Basic information

  • Gives access to:
    • large part of the lateral surface of the temporal lobe

Also used for minimally invasive sub-temporal routes

Keep in mind

  • Consider whether the patient / location of the lesion are suitable for this type of approach)
  • Study carefully available images (CT, MR) to be prepared for anatomical rarities, use different section and projection 
  • Try to find the best route to the lesion with an avoidance of the excessive exposure and the retraction of brain tissue, otherwise use a different approach to reach the pathology
  • Keep in mind the general anatomy (skin layers, temporal muscle, skull bones, brain surface)
  • Be aware of possible slight distortion of the anatomy (patient is in the supine position and the head is rotated – effect of the gravity)
  • Try to project the anatomy on the skin surface

Highlights

Surface of the temporal lobe, subtemporal route


Indications

Anatomy and important anatomical landmarks

  • Skull bones – the middle cranial fossa
  • Roof of the zygoma
  • Tragus
  • Temporal muscle, temporal muscle line
  • Superficial veins
  • Temporal lobe
  • Circle of Willis
  • Cranial nerves – n. III, n. IV.

Positioning

Body positioning: supine lateral (45°), lateral (90°)

Head positioning: contralateral rotation (0°), lateral tilt (12°), flexion (10°)

Red Flags

Head over the heart level. Avoid over rotation of the neck – elevate the ipsilateral shoulder or prefer lateral position based on the freedom of the neck motility.


Surgery

1. Skin incision N°22 scalpel blade

2. Initial dissection of the skin flap with elevator

3. Placement of hemostatic clips

4. Skin flap elevation with elevator

5. Incision and dissection of temporalis muscle

6. Burr hole with perforator

7. Preparation of the burr holes with dura separator

8. Craniotomy with high-speed drill

9. Edge drilling with high-speed drill

10. Dural tenting sutures

11. Dural incision with N°10 scalpel blade and scissors


Microexploration

BT: Basilar Tip

PCA: Posterior Cerebral Artery

CN IV: Cranial Nerve IV, Trochlear Nerve

BV: Basal Vein of Rosenthal

CN III: Cranial Nerve III, Oculomotor Nerve

CP: Cerebral Peduncle


Closure

1. Dura reconstruction

2. Bone fixation with microscrews

3. Muscle reconstruction

4. Subcutaneous/skin suture

Pterional Box: brain box for pteronial approach

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