Endonasal and Transoral Approaches to the Craniovertebral Junction: A Quantitative Anatomical Study

Doglietto, Francesco; Belotti, Francesco; Qiu, Jimmy; Roca, Elena; Radovanović, Ivan; Agur, Anne; Kucharczyk, Walter; Schreiber, Alberto; Villaret, Andrea Bolzoni; Nicolai, Piero; Gentili, Fred; Fontanella, Marco Maria

doi:10.1007/978-3-319-62515-7_6

Cited by 10 publications

(6 citation statements)

References 15 publications

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“…Of note, the methods of this study were replicated from previous peer-reviewed anatomic studies both from our group and in the literature. 13,[34][35][36][37][38][39][40]…”

Section: Methodsmentioning

confidence: 99%

“…Intracranial arteries were injected with red silicone rubber. 13,[34][35][36][37][38][39][40] A computed tomography scan was performed on each specimen and, subsequently, uploaded to the neuronavigation software (GTx-Eyes II, University Health Network-University of Toronto, Toronto, Ontario, Canada) in Digital Imaging and Communications in Medicine format. [34][35][36][37][38][39][40][41][42][43]…”

Section: Preparation Of Specimens and Neuronavigationmentioning

confidence: 99%

“…13,[34][35][36][37][38][39][40] A computed tomography scan was performed on each specimen and, subsequently, uploaded to the neuronavigation software (GTx-Eyes II, University Health Network-University of Toronto, Toronto, Ontario, Canada) in Digital Imaging and Communications in Medicine format. [34][35][36][37][38][39][40][41][42][43]…”

Section: Preparation Of Specimens and Neuronavigationmentioning

confidence: 99%

“…Following the methods of previous studies, quantification of the surgical corridor was performed in a "noncrossing" and "crossing" modality with the aid of an optical neuronavigation system (Polaris Vicra; NDI), coupled with GTx-Eyes II, 13,[34][35][36][37][38][39][40] and data collection was repeated 3 times for each modality.…”

Section: Quantification Of Surgical Corridor and Areas Exposedmentioning

confidence: 99%

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Quantitative Anatomic Comparison of Endoscopic Transnasal and Microsurgical Transcranial Approaches to the Anterior Cranial Fossa

Agosti

Saraceno

Rampinelli

et al. 2022

Operative Neurosurgery

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BACKGROUND:Several microsurgical transcranial approaches (MTAs) and endoscopic transnasal approaches (EEAs) to the anterior cranial fossa (ACF) have been described.OBJECTIVE:To provide a preclinical, quantitative, anatomic, comparative analysis of surgical approaches to the ACF.METHODS:Five alcohol-fixed specimens underwent high-resolution computed tomography. The following approaches were performed on each specimen: EEAs (transcribriform, transtuberculum, and transplanum), anterior MTAs (transfrontal sinus interhemispheric, frontobasal interhemispheric, and subfrontal with unilateral and bilateral frontal craniotomy), and anterolateral MTAs (supraorbital, minipterional, pterional, and frontotemporal orbitozygomatic approach). An optic neuronavigation system and dedicated software (ApproachViewer, part of GTx-Eyes II—UHN) were used to quantify the working volume of each approach and extrapolate the exposure of different ACF regions. Mixed linear models with random intercepts were used for statistical analyses.RESULTS:EEAs offer a large and direct route to the midline region of ACF, whose most anterior structures (ie, crista galli, cribriform plate, and ethmoidal roof) are also well exposed by anterior MTAs, whereas deeper ones (ie, planum sphenoidale and tuberculum sellae) are also well exposed by anterolateral MTAs. The orbital roof region is exposed by both anterolateral and lateral MTAs. The posterolateral region (ie, sphenoid wing and optic canal) is well exposed by anterolateral MTAs.CONCLUSION:Anterior and anterolateral MTAs play a pivotal role in the exposure of most anterior and posterolateral ACF regions, respectively, whereas midline regions are well exposed by EEAs. Furthermore, certain anterolateral approaches may be most useful when involvement of the optic canal and nerves involvement are suspected.

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“…Of note, the methods of this study were replicated from previous peer-reviewed anatomic studies both from our group and in the literature. 13,[34][35][36][37][38][39][40]…”

Section: Methodsmentioning

confidence: 99%

Section: Preparation Of Specimens and Neuronavigationmentioning

confidence: 99%

Section: Preparation Of Specimens and Neuronavigationmentioning

confidence: 99%

Section: Quantification Of Surgical Corridor and Areas Exposedmentioning

confidence: 99%

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Quantitative Anatomic Comparison of Endoscopic Transnasal and Microsurgical Transcranial Approaches to the Anterior Cranial Fossa

Agosti

Saraceno

Rampinelli

et al. 2022

Operative Neurosurgery

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“…The aim of this study is to quantitatively compare, in a preclinical setting, [27][28][29][30][31][32][33][34][35][36] microsurgical transcranial approaches (MTAs), endonasal endoscopic transpterygoid approach (EEA), and endoscopic transorbital approaches (ETOAs) to the SOR, using a recently developed research method, already employed for the study of surgical approaches to other skull base regions. 27,28…”

mentioning

confidence: 99%

Quantitative Anatomic Comparison of Microsurgical Transcranial, Endoscopic Endonasal, and Transorbital Approaches to the Spheno-Orbital Region

Agosti¹,

Turri‐Zanoni²,

Saraceno³

et al. 2021

Operative Surg.

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BACKGROUND The spheno-orbital region (SOR) is a complex anatomic area that can be accessed with different surgical approaches. OBJECTIVE To quantitatively compare, in a preclinical setting, microsurgical transcranial approaches (MTAs), endoscopic endonasal transpterygoid approach (EEA), and endoscopic transorbital approaches (ETOAs) to the SOR. METHODS These approaches were performed in 5 specimens: EEA, ETOAs (superior eyelid and inferolateral), anterolateral MTAs (supraorbital, minipterional, pterional, pterional-transzygomatic, and frontotemporal-orbitozygomatic), and lateral MTAs (subtemporal and subtemporal transzygomatic). All specimens underwent high-resolution computed tomography; an optic neuronavigation system with dedicated software was used to quantify working volume and exposed area for each approach. Mixed linear models with random intercepts were used for statistical analyses. RESULTS Anterolateral MTAs offer a direct route to the greater wings (GWs) and lesser wings (LWs); only they guarantee exposure of the anterior clinoid. Lateral MTAs provide access to a large area corresponding to the GW, up to the superior orbital fissure (SOF) anteriorly and the foramen rotundum medially. ETOAs also access the GW, close to the lateral portion of SOF, but with a different angle of view as compared to lateral MTAs. Access to deep and medial structures, such as the lamina papyracea and the medial SOF, is offered only by EEA, which exposes the LW and GW only to a limited extent. CONCLUSION This is the first study that offers a quantitative comparison of the most used approaches to SOR. A detailed knowledge of their advantages and limitations is paramount to choose the ideal one, or their combination, in the clinical setting.

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The Nasopharyngo‐Septal Butterfly Flap: A Novel Adjunct for Reconstructing Large Skull Base Defects

Abouammo,

Narayanan,

Alsavaf

et al. 2024

OTO Open

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ObjectiveSkull base defects can be challenging to reconstruct. The nasoseptal flap (NSF) remains the first‐line option for reconstruction. However, it can be inadequate to cover wide defects or compromised by tumor invasion or prior surgery requiring additional reconstructive options. The goal of the study is to describe a novel flap for clival and craniovertebral junction (CVJ) reconstruction.Study DesignCadaveric study with an illustrative clinical case.SettingCadaver dissection laboratory and tertiary university hospital.MethodsEndoscopic endonasal dissection was performed in 15 cadavers. A modification of the inferior incision of the NSF was carried out. The inferior incision was performed at a more cranial location, sparing the mucosa of the posterior septum. Two lateral longitudinal incisions were carried out at the pterygo‐sphenoidal junction freeing the nasopharyngeal mucosa. A third incision was performed separating the rostral mucosa from the nasal floor. The resulting flap was rotated postero‐superiorly covering the clivus and CVJ.ResultsAn inferiorly based butterfly‐shaped nasopharyngo‐septal flap, consisting of nasopharyngeal and posterior septal mucosa and receiving blood supply from the bilateral ascending pharyngeal arteries, was formulated. The lower wings comprised nasopharyngeal mucosa while the upper wings comprised posterior septal mucosa. The mean surface area of the flap was 12.35 ± 0.21 cm2 covering the clivus and CVJ in all cadavers.ConclusionThe nasopharyngo‐septal flap is a novel vascularized flap that is well‐suited for reconstructing clival and CVJ defects where the NSF is insufficient and can also be used as a salvage flap in cases where the NSF is unobtainable.

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Endonasal and Transoral Approaches to the Craniovertebral Junction: A Quantitative Anatomical Study

Cited by 10 publications

References 15 publications

Quantitative Anatomic Comparison of Endoscopic Transnasal and Microsurgical Transcranial Approaches to the Anterior Cranial Fossa

Quantitative Anatomic Comparison of Endoscopic Transnasal and Microsurgical Transcranial Approaches to the Anterior Cranial Fossa

Quantitative Anatomic Comparison of Microsurgical Transcranial, Endoscopic Endonasal, and Transorbital Approaches to the Spheno-Orbital Region

The Nasopharyngo‐Septal Butterfly Flap: A Novel Adjunct for Reconstructing Large Skull Base Defects

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