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Peeters JB, Idriceanu T, El Hage G, Martin T, Salaud C, Champagne PO, Bojanowski MW. A comprehensive review of the vertebral artery anatomy. Neurochirurgie 2024; 70:101518. [PMID: 38277859 DOI: 10.1016/j.neuchi.2023.101518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 11/21/2023] [Indexed: 01/28/2024]
Abstract
BACKGROUND The vertebral arteries (VA) play a critical role by supplying nearly one-third of the brain's blood flow, predominantly contributing to the posterior circulation. These arteries may need to be exposed in a various cranial and cervical procedures and offers access to investigate or treat vascular lesions by endovascular means related to the posterior circulation. Given its complex anatomy, which is subject to numerous variations, and its role in supplying vital brain regions, a thorough understanding of the VA's anatomy is paramount for any related procedure. OBJECTIVE To provide a comprehensive overview of vertebral artery anatomy and its relevance in contemporary clinical practice. METHODS Dissection of the entire vertebral artery length using cadaveric specimen, combined with a comprehensive literature review. RESULTS The vertebral artery can be subdivided into four segments. Each of these segments has its own unique topographic anatomy with its variations, anastomoses, and significance in surgery. CONCLUSION As surgical and endovascular techniques continue to evolve with technological improvements, we are now more equipped than ever to manage complex lesions involving the VA. However, with its increasingly complexity comes the necessity for a deeper and more comprehensive understanding of the VA. Possessing the detailed knowledge of the VA is vital for the successful execution of any procedure involving it.
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Affiliation(s)
- Jean-Baptiste Peeters
- Division of Neurosurgery, Department of Surgery, University of Montreal Hospital Center, 1000, Rue St-Denis Montréal, QC H2X 0C, Canada
| | - Tania Idriceanu
- Division of Neurosurgery, Department of Surgery, University of Laval Quebec Hospital Center, 11 Côte du Palais, Québec, QC G1R 2J6, Canada
| | - Gilles El Hage
- Division of Neurosurgery, Department of Surgery, University of Montreal Hospital Center, 1000, Rue St-Denis Montréal, QC H2X 0C, Canada
| | - Tristan Martin
- Division of Neurosurgery, Department of Surgery, University of Montreal Hospital Center, 1000, Rue St-Denis Montréal, QC H2X 0C, Canada
| | - Céline Salaud
- Division of Neurosurgery, Department of Surgery, University of Nantes Hospital Center, 5 All. de l'Île Gloriette, 44000 Nantes, France
| | - Pierre-Olivier Champagne
- Division of Neurosurgery, Department of Surgery, University of Laval Quebec Hospital Center, 11 Côte du Palais, Québec, QC G1R 2J6, Canada
| | - Michel W Bojanowski
- Division of Neurosurgery, Department of Surgery, University of Montreal Hospital Center, 1000, Rue St-Denis Montréal, QC H2X 0C, Canada.
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Bresson D, Hudelist B, Gaudioso P, Moya-Plana A, Herman P, Idriceanu T, Nicolai P, Ferrari M. Side-door temporoparietal fascia flap: First experience with a novel technique for anterior skull base reconstruction. Head Neck 2024; 46:772-784. [PMID: 38192046 DOI: 10.1002/hed.27611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 11/16/2023] [Accepted: 12/12/2023] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND Modern achievements in transnasal endoscopic skull base (SB) surgery have led to complex resections that render reconstruction a challenge. Temporoparietal fascia flap (TPFF) is a suitable option for SB reconstruction. The side-door TPFF technique for anterior SB reconstruction is described here for the first time in a real-life surgical setting. METHODS Patients affected by a SB malignancy who underwent cranioendoscopic resection were included. For reconstruction, a multilayer reconstruction technique including side-door TPFF transposition was employed. RESULTS TPFF transposition was performed in five patients. The TPFF could be easily transposed via a side-door approach. It adequately covered the edges of the defect and supported optimal healing of the surgical site. During follow-up, vitality and integration of the TPFF were assessed endoscopically and radiologically. CONCLUSIONS The TPFF side-door transposition technique is a valuable option in anterior SB reconstruction that can provide fast and effective healing, especially in patients needing adjuvant radiotherapy.
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Affiliation(s)
- Damien Bresson
- Neurosurgery Department, Foch Hospital, Université Paris Saclay, Suresnes, France
| | - Benoit Hudelist
- Neurosurgery Department, AP-HP, Henri Mondor Hospital, Créteil, France
| | - Piergiorgio Gaudioso
- Section of Otorhinolaryngology-Head and Neck Surgery, Department of Neuroscience DNS, University of Padova, Padova, Italy
| | - Antoine Moya-Plana
- Head and Neck Oncology Department, Gustave Roussy Cancer Campus, Université Paris Saclay, Villejuif, France
| | - Philippe Herman
- Otorhinolaryngology and Skull Base Center, AP-HP, Hospital Lariboisière, Paris, France
| | - Tania Idriceanu
- Neurosurgery Department, AP-HP, Henri Mondor Hospital, Créteil, France
| | - Piero Nicolai
- Section of Otorhinolaryngology-Head and Neck Surgery, Department of Neuroscience DNS, University of Padova, Padova, Italy
| | - Marco Ferrari
- Section of Otorhinolaryngology-Head and Neck Surgery, Department of Neuroscience DNS, University of Padova, Padova, Italy
- Guided Therapeutics (GTx) Program International Scholarship, University Health Network (UHN), Toronto, Ontario, Canada
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Hudelist B, Idriceanu T, Moya-Plana A, Herman P, Bresson D. The "Gift Wrap" Technique - A Method that Simplifies the Placement of Fascia Lata in the Reconstruction of the Skull Base Following Endoscopic Endonasal Surgery: A Technical Note. World Neurosurg 2024; 183:41-44. [PMID: 38092352 DOI: 10.1016/j.wneu.2023.12.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 12/04/2023] [Accepted: 12/06/2023] [Indexed: 01/06/2024]
Abstract
BACKGROUND With the advancement of endoscopic endonasal surgery in the treatment of anterior skull base (ASB) pathologies, extended, watertight reconstructions are needed to prevent cerebrospinal fluid (CSF) leakage. This often involves the use of multilayers closure, with free fascia lata (FL) graft frequently used as an in- and/or outlay. However, positioning the FL properly can be challenging and time-consuming, particularly on wider defects. In this technical note, we present an easier and faster way to position FL using a silicone sheet. METHODS FL graft is harvested using a standard technique. The required dimensions are evaluated depending on the extent of the dural defect taking in consideration that FL graft should exceed the edges of the dural defect especially laterally. It is then wrapped around a semi rigid pattern (Silastic sheet) and secured with several monofilament 5/0 sutures. The "package" is transferred through the endonasal corridor to the defect. The sutures are divided and taken out; the fascia is unfolded, and its edges are inserted into the subdural space without any twisting or folding of the flap. Finally, the silicone sheet is withdrawn from the nasal cavity, leaving the FL well-stretched in perfect position. RESULTS We illustrate this technique in the management of a large anterior skull base chondrosarcoma, which necessitated significant bone and dural resection. CONCLUSIONS The "Gift wrap" technique offers an alternative approach for positioning the FL, which is less time-consuming compared to the traditional technique. Moreover, it enables improved placement of the FL, enhancing its efficacy.
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Affiliation(s)
- Benoit Hudelist
- Neurosurgery Department, GHU, Sainte-Anne Hospital, Paris, France.
| | - Tania Idriceanu
- Neurosurgery Department, AP-HP, Henri Mondor Hospital, Créteil, France
| | | | | | - Damien Bresson
- Neurosurgery Department, Foch Hospital, Suresnes, France
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Idriceanu T, Hudelist B, Moya-Plana A, Bresson D. How I do it: epidural transposition of the temporoparietal fascia flap for anterior skull base reconstruction. Acta Neurochir (Wien) 2023; 165:2327-2331. [PMID: 37103586 DOI: 10.1007/s00701-023-05602-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 04/16/2023] [Indexed: 04/28/2023]
Abstract
BACKGROUND Multilayer closures and the use of vascularized flaps have been showed to be very effective in the reconstruction of the anterior skull base (ASB) after extended endonasal approaches resulting in large bone and dural defects. In the case of unavailability of a local flap, regional ones like the temporoparietal fascia flap (TPFF), used until now via a transpterygoïd route (Bolzoni Villaret et al. in Eur Arch Otorhinolaryngol 270(4):1473-1479, 2023; Fortes et al. in Laryngoscope 117(6):970-976, 2017; Veyrat et al. in Acta Neurochir (Wien) 158(12):2291-2294, 2016), can be an effective alternative. METHOD We describe a step-by-step technique of TPFF transposition via an epidural supraorbital corridor for the reconstruction of a large midline ASB defect. CONCLUSION TPFF is a promising alternative for the reconstruction of the ASB defects.
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Affiliation(s)
- Tania Idriceanu
- Neurosurgery Department, AP-HP, Henri Mondor University Hospital, 51 avenue du Marechal de Lattre de Tassigny, 94000, Créteil, France.
| | - Benoit Hudelist
- Neurosurgery Department, AP-HP, Henri Mondor University Hospital, 51 avenue du Marechal de Lattre de Tassigny, 94000, Créteil, France
| | | | - Damien Bresson
- Neurosurgery Department, Foch University Hospital, 92150, Suresnes, France
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Idriceanu T, Beuriat PA, Di Rocco F, Szathmari A, Mottolese C. Recurrent tethering in conus lipomas: a late complication not to be ignored. World Neurosurg 2022; 168:e12-e18. [PMID: 35863646 DOI: 10.1016/j.wneu.2022.07.048] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 07/09/2022] [Accepted: 07/11/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUNDS Recurrent symptomatic tethered cord (RTC) is a long-term complication of spinal cord lipomas, responsible for progressive motor deficits, urologic dysfunction and aggravation of spinal deformities.We retrospectively analysed all cases of recurrent tethering after spinal cord lipoma surgery, the clinical and radiological features that led to the diagnosis, the surgical management and the neuro-orthopedic outcome at the last follow-up. METHODS The study was carried out over a period of 20 years on a total of 209 pediatric patients from a single institution, initially treated for a conus lipoma. RESULTS 9 patients (4,8 %) were surgically treated for a RTC. The age at retethering ranged from 2 to 12 years -median of 7, 4 years. The time before the first and the second surgical procedure, ranged from 19 to 140 months - median of 7 years and a half. The follow-up period after the second surgery ranged from 3 months to 13 years with a median of 50 months. Among symptoms, pain responded very well to surgery. Gait disturbances improved in 50 % after the surgery. One patient with bladder dysfunctions also improved. The rest of the patients maintained the pre-surgical status. CONCLUSIONS When RTC is confirmed, child should be referred to surgery as soon as possible, as we showed that the post- operative clinical outcome improved and surgery did not worsen patients. We stressed the fact that the follow-up should be as long as possible for these patients.
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Affiliation(s)
- T Idriceanu
- Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, 32 Avenue du Doyen Jean Lépine, 69677 Lyon Cedex, France
| | - P A Beuriat
- Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, 32 Avenue du Doyen Jean Lépine, 69677 Lyon Cedex, France
| | - F Di Rocco
- Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, 32 Avenue du Doyen Jean Lépine, 69677 Lyon Cedex, France
| | - A Szathmari
- Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, 32 Avenue du Doyen Jean Lépine, 69677 Lyon Cedex, France
| | - C Mottolese
- Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, 32 Avenue du Doyen Jean Lépine, 69677 Lyon Cedex, France.
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Gaicu E, Idriceanu T, Mihai M. [Multiple exostosis (Broca-Ombrédanne) associated with the Madelung deformity and congenital cardiopathy]. Pediatria (Bucur) 1969; 18:51-6. [PMID: 5305214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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