
Temporal approach
Mental Skills Required



Manual Skills Required




Temporal approach



Manual Skills Required



Temporal approach







Tools involved:
Needed for this topic
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
Gives access to:
- large part of the lateral surface of the temporal lobe
Also facilitates sub-temporal routes
- 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
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

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

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

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

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.



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

Extension: approximately 15° to facilitate temporal lobe retraction

Contralateral bending: this helps with the subtemporal surgical perspective

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

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

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

Extension: approximately 15° to facilitate temporal lobe retraction

Contralateral bending: this helps with the subtemporal surgical perspective
Red Flags

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

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













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
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

Closure
1. Dura reconstruction

2. Bone fixation with microscrews

3. Muscle reconstruction

4. Subcutaneous/skin suture







Closure
1. Dura reconstruction

2. Bone fixation with microscrews

3. Muscle reconstruction

4. Subcutaneous/skin suture


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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

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