ORIGINAL
Introdução: O osso temporal é uma das principais avenidas para acessos profundos para a base do crânio. O sucesso nessa abordagem depende do estudo exaustivo do osso temporal em laboratório de microcirurgia. Objetivo: revisão do osso temporal e dos principais acessos cirúrgicos da região, desde o laboratório ao centro cirúrgico. Métodos: Dissecção de quinze ossos temporais e vinte cabeças nos laboratórios da Beneficência Portuguesa de São Paulo, Dianne and Gazy Yasargil Microsurgical Laboratory (UAMS), Little Rock, Arkansas e Departamento de Anatomia da UFRGS. Os casos cirúrgicos foram operados pelos autores. Resultados: O osso temporal pode ser dividido em partes escamosa, petrosa, timpânica, mastoidea e estiloide.. Cada porção do osso temporal possui inúmeras relações com estruturas nervosas e vasculares, além de importantes inserções musculares. A compreensão dessas relações são pré-requisito para abordagem à base do crânio. Os autores correlacionaram as peças dissecadas para ilustrar casos de pacientes reais nos acessos petroso anterior, translabiríntico, pré-sigmoide, retrosigmoide, subtemporal pré-auricular para fossa infratemporal e auricular posterior transtemporal. Conclusão: O domínio da anatomia do osso temporal adquirido em laboratório é imprescindível para tratamento de lesões primárias da região, assim como para acessos cirúrgicos complexos da base do crânio.
Introduction: The temporal bone is one of the main avenues for deep access to the skull base. The success of these approaches depends on exhaustive study of temporal bone in microsurgical laboratory. Objective: review of the temporal bone and the main surgical approaches in the region, from laboratory to operating room. Methods: Fifteen temporal bones and twenty heads were dissected at the laboratories of Beneficência Portuguesa de São Paulo, Dianne and Gazy Yasargil Microsurgical Laboratory, in Arkansas, and laboratory of anatomy at UFRGS. Surgical cases were operated on by the authors. Results: The temporal bone can be divided into five parts. Each portion has numerous relationships with nervous, vascular structure and muscular insertions. Understanding these relationships is a prerequisite for approaching the skull base. We used the dissected pieces to illustrate cases of real patients for the aproaches: Anterior Petrosectomy, Translabyrinthine, Presigmoid, Retrosigmoid, Subtemporal Preauricular for infratemporal fossa and Postauricular transtemporal. Conclusion: Mastering of temporal bone anatomy learned in the laboratory is essential for the treatment of primary lesions in the region, as well as for complex surgical approaches to the skull base.
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1 MD, Angelina Caron Hospital, Campina Grande do Sul, PR; Faculdade Evangélica Mackenzie do Paraná, Post-Graduation Program in Principles of Surgery and Microsurgery Lab, Curitiba, PR, Brazil.
2 MD, MSc, Angelina Caron Hospital, Campina Grande do Sul, PR, Brazil.
3 MD, PhD, Centro Avançado de Neurologia e Neurocirurgia (CEANNE), Porto Alegre, RS, Brazil.
4 MD, PHD, Centro Avançado de Neurologia e Neurocirurgia (CEANNE), Porto Alegre, RS; Federal University of Rio Grande do Sul (UFRGS), Department of Anatomy, Porto Alegre, RS, Brazil.
5 MD, PHD, Faculdade Evangélica Mackenzie do Paraná, Post-Graduation Program in Principles of Surgery and Microsurgery Lab, Curitiba, PR, Brazil.
6 MD, MSc, Centro Avançado de Neurologia e Neurocirurgia (CEANNE), Porto Alegre, RS; Faculdade Evangélica Mackenzie do Paraná, Post-Graduation Program in Principles of Surgery and
Microsurgery Lab, Curitiba, PR, Brazil.
7 MD, PhD, Centro Avançado de Neurologia e Neurocirurgia (CEANNE), Porto Alegre, RS; Faculdade Evangélica Mackenzie do Paraná, Post-Graduation Program in Principles of Surgery and
Microsurgery Lab, Curitiba, PR, Brazil.
Received Jan 2, 2023
Corrected Feb 15, 2023
Accepted Feb 16, 2023
