Temporal_approach
PROCEDURES

Temporal approach

Mental Skills Required
icon_automatism
Automatism
icon_imagination
Imagination
icon_strategy
Strategy
Manual Skills Required
icon_automatism_manual
Automatism
icon_dexterity
Dexterity
icon_time
Speed
Temporal_approach
PROCEDURES

Temporal approach

Mental Skills Required
icon_automatism
Automatism
icon_imagination
Imagination
icon_strategy
Strategy

Manual Skills Required

icon_automatism_manual
Automatism
icon_dexterity
Imagination
icon_time
Strategy
PROCEDURES

Temporal approach

Temporal_approach
Mental Skills Required
icon_automatism
Automatism
icon_imagination
Imagination
icon_strategy
Strategy
Manual Skills Required
icon_automatism_manual
Automatism
icon_dexterity
Dexterity
icon_time
Speed
Needed for this topic

Tools involved:

Needed for this topic

Tools involved:
Needed for this topic
Tools involved:
icon_automatism_manual_white
icon_dexterity_white
BrainBox
icon_automatism_white
icon_imagination_white
Neurosurgery
icon_automatism_manual_white
icon_dexterity_white
BrainBox
icon_automatism_white
icon_imagination_white
Neurosurgery
icon_automatism_manual_white
icon_dexterity_white
BrainBox
icon_automatism_white
icon_imagination_white
Neurosurgery

Basic information

Gives access to:

 

  • large part of the lateral surface of the temporal lobe


Also facilitates sub-temporal route:

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
Basic information

Gives access to:

  • large part of the lateral surface of the temporal lobe

Also facilitates 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

Basic information

Gives access to:

  • large part of the lateral surface of the temporal lobe

Also facilitates 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
icon_positioning

Positioning

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

Academy_temporal_approach_body_positioning
Supine-lateral or lateral position

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

Academy_supine_lateral_left_head_0

Rotation: 90° rotation contralaterally; the midline must be parallel to the floor

Academy_supine_lateral_left_head_lateral_tilt

Extension: approximately 15° to facilitate temporal lobe retraction

Contralateral bending: this helps with the subtemporal surgical perspective

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.

icon_positioning
Positioning
Body positioning: supine lateral (45°), lateral (90°)
Academy_temporal_approach_body_positioning
Supine-lateral or lateral position
Head positioning contralateral rotation (0°), lateral tilt (12°), flexion (10°)
Academy_supine_lateral_left_head_0

Rotation: 90° rotation contralaterally; the midline must be parallel to the floor

Academy_supine_lateral_left_head_lateral_tilt

Extension: approximately 15° to facilitate temporal lobe retraction

Contralateral bending: this helps with the subtemporal surgical perspective

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.
icon_positioning

Positioning

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

Academy_temporal_approach_body_positioning
Supine-lateral or lateral position

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

Academy_supine_lateral_left_head_0

Rotation: 90° rotation contralaterally; the midline must be parallel to the floor

Academy_supine_lateral_left_head_lateral_tilt

Extension: approximately 15° to facilitate temporal lobe retraction

Contralateral bending: this helps with the subtemporal surgical perspective

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.
icon_surgery

Surgery

1. Skin incision N°22 scalpel blade

Temporal_01
The skin incision is performed in a “question mark” fashion. The inferior end starts anterior to the tragus, bends over the root of the pinna forming the question mark and terminates approximately over the temporal line.

2. Initial dissection of the skin flap with elevator

Temporal_02
Skin and subcutaneous layers are separated from the superficial temporal fascia.

3. Placement of hemostatic clips

Temporal_03
Avoiding an excessive cauterization of the subcutaneous layers mitigates the risk of impaired skin healing.

4. Skin flap elevation with elevator

Temporal_04
The same technique of subperiosteal detachment in one layer is applied during this stage to achieve a complete exposure of the bone.

5. Incision and dissection of temporalis muscle

Temporal_05
A “question mark” incision with monopolar cautery or scalpel and a subperiosteal dissection with periosteal elevator are performed on the temporalis muscle. Subsequently the muscle is retracted anteriorly with hooks.

6. Burr hole with perforator

Temporal_06
Burr hole can be placed on the temporal squama. One burr hole is often sufficient.

7. Preparation of the burr holes with dura separator

Temporal_07
This step helps to reduce the risk of tearing the dura mater during the craniotomy. The risk is higher in elderly patients because of the strong adherence between the inner table of the skull and dura.

8. Craniotomy with high-speed drill

Temporal_08
The resultant bone flap has a square shape.

9. Edge drilling with high-speed drill

Temporal_09
The cranial base must be drilled flat if a subtemporal route has been chosen. During drilling attention should be paid to the accidental opening of mastoid air cells. If this occurs, bone wax is used as a sealant.

10. Dural tenting sutures

Temporal_10
Transosseous stitches are used to suspend the dura and reduce extradural bleeding.

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

Temporal_11

Dura should be incised starting at the superior end of the craniotomy and reflected toward the cranial base.

icon_surgery
Surgery
1. Skin incision N°22 scalpel blade
Temporal_01
The skin incision is performed in a “question mark” fashion. The inferior end starts anterior to the tragus, bends over the root of the pinna forming the question mark and terminates approximately over the temporal line.
2. Initial dissection of the skin flap with elevator
Temporal_02
Skin and subcutaneous layers are separated from the superficial temporal fascia.
3. Placement of hemostatic clips
Temporal_03
Avoiding an excessive cauterization of the subcutaneous layers mitigates the risk of impaired skin healing.
4. Skin flap elevation with elevator
Temporal_04
The same technique of subperiosteal detachment in one layer is applied during this stage to achieve a complete exposure of the bone.
5. Incision and dissection of temporalis muscle
Temporal_05
A “question mark” incision with monopolar cautery or scalpel and a subperiosteal dissection with periosteal elevator are performed on the temporalis muscle. Subsequently the muscle is retracted anteriorly with hooks.
6. Burr hole with perforator
Temporal_06
Burr hole can be placed on the temporal squama. One burr hole is often sufficient.
7. Preparation of the burr holes with dura separator
Temporal_07
This step helps to reduce the risk of tearing the dura mater during the craniotomy. The risk is higher in elderly patients because of the strong adherence between the inner table of the skull and dura.
8. Craniotomy with high-speed drill
Temporal_08
The resultant bone flap has a square shape.
9. Edge drilling with high-speed drill
Temporal_09
The cranial base must be drilled flat if a subtemporal route has been chosen. During drilling attention should be paid to the accidental opening of mastoid air cells. If this occurs, bone wax is used as a sealant.
10. Dural tenting sutures
Temporal_10
Transosseous stitches are used to suspend the dura and reduce extradural bleeding.
11. Dural incision with N°10 scalpel blade and scissors
Temporal_11
Dura should be incised starting at the superior end of the craniotomy and reflected toward the cranial base.
icon_surgery

Surgery

1. Skin incision N°22 scalpel blade

Temporal_01
The skin incision is performed in a “question mark” fashion. The inferior end starts anterior to the tragus, bends over the root of the pinna forming the question mark and terminates approximately over the temporal line.

2. Initial dissection of the skin flap with elevator

Temporal_02
Skin and subcutaneous layers are separated from the superficial temporal fascia.

3. Placement of hemostatic clips

Temporal_03
Avoiding an excessive cauterization of the subcutaneous layers mitigates the risk of impaired skin healing.

4. Skin flap elevation with elevator

Temporal_04
The same technique of subperiosteal detachment in one layer is applied during this stage to achieve a complete exposure of the bone.

5. Incision and dissection of temporalis muscle

Temporal_05
A “question mark” incision with monopolar cautery or scalpel and a subperiosteal dissection with periosteal elevator are performed on the temporalis muscle. Subsequently the muscle is retracted anteriorly with hooks.

6. Burr hole with perforator

Temporal_06
Burr hole can be placed on the temporal squama. One burr hole is often sufficient.

7. Preparation of the burr holes with dura separator

Temporal_07
This step helps to reduce the risk of tearing the dura mater during the craniotomy. The risk is higher in elderly patients because of the strong adherence between the inner table of the skull and dura.

8. Craniotomy with high-speed drill

Temporal_08
The resultant bone flap has a square shape.

9. Edge drilling with high-speed drill

Temporal_09
The cranial base must be drilled flat if a subtemporal route has been chosen. During drilling attention should be paid to the accidental opening of mastoid air cells. If this occurs, bone wax is used as a sealant.

10. Dural tenting sutures

Temporal_10
Transosseous stitches are used to suspend the dura and reduce extradural bleeding.

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

Temporal_11
Dura should be incised starting at the superior end of the craniotomy and reflected toward the cranial base.

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

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

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

icon_surgery

Closure

1. Dura reconstruction

Temporal_12
A water-tight closure of the dura is always needed, particularly in cases of cisternal and ventricular opening. In case of dura retraction, several types of synthetic substitutes or a galea flap can be used to complete the approximation.

2. Bone fixation with microscrews

Temporal_13
At least 3 microplates are used to guarantee the immobility of the bone flap. Immobility is necessary for osteosynthesis. For bigger craniotomies, central dural suspensions are mandatory.

3. Muscle reconstruction

Temporal_14
Temporal muscle is sutured – this mitigates the risk of chewing problems postoperatively.

4. Subcutaneous/skin suture

Temporal_15
Aesthetic skin reconstruction is always mandatory.
icon_surgery
Closure
1. Dura reconstruction
Temporal_12
A water-tight closure of the dura is always needed, particularly in cases of cisternal and ventricular opening. In case of dura retraction, several types of synthetic substitutes or a galea flap can be used to complete the approximation.
2. Bone fixation with microscrews
Temporal_13
At least 3 microplates are used to guarantee the immobility of the bone flap. Immobility is necessary for osteosynthesis. For bigger craniotomies, central dural suspensions are mandatory.
3. Muscle reconstruction
Temporal_14
Temporal muscle is sutured – this mitigates the risk of chewing problems postoperatively.
4. Subcutaneous/skin suture
Temporal_15
Aesthetic skin reconstruction is always mandatory.
icon_surgery

Closure

1. Dura reconstruction

Temporal_12
A water-tight closure of the dura is always needed, particularly in cases of cisternal and ventricular opening. In case of dura retraction, several types of synthetic substitutes or a galea flap can be used to complete the approximation.

2. Bone fixation with microscrews

Temporal_13
At least 3 microplates are used to guarantee the immobility of the bone flap. Immobility is necessary for osteosynthesis. For bigger craniotomies, central dural suspensions are mandatory.

3. Muscle reconstruction

Temporal_14
Temporal muscle is sutured – this mitigates the risk of chewing problems postoperatively.

4. Subcutaneous/skin suture

Temporal_15
Aesthetic skin reconstruction is always mandatory.

Store
3D Apps, Physical Simulators, Augmented reality tools

The UpSurgeOn Store offers you a series of virtual and physical technologies to give you the best training experience EVER

Store
3D Apps, Physical simulators, Augmented reality tools

The UpSurgeOn Store offers you a series of virtual and physical technologies to give you the best training experience EVER

Store
3D Apps, Physical Simulators, Augmented reality tools

The UpSurgeOn Store offers you a series of virtual and physical technologies to give you the best training experience EVER

Supported by the European Union

This project has received funding from the Eropean Union's H2020 Research and Innovation Programme under grant agreement n.880895

Supported by the European Union

This project has received funding from the Eropean Union's H2020 Research and Innovation Programme under grant agreement n.880895

Supported by the European Union

This project has received funding from the Eropean Union’s H2020 Research and Innovation Programme under grant agreement n.880895

Join UpSurgeOn Community

Join our newsletter and stay up to date with the latest news!​

Join UpSurgeOn Community

Join our newsletter and stay up to date with the latest news!​

Join UpSurgeOn Community

Join our newsletter and stay up to date with the latest news!

  • This field is for validation purposes and should be left unchanged.