Endonasal, transmaxillary, transpterygoid approach to the foramen ovale: radio-anatomical study of surgical feasibility

Abstract

With the increasing popularity of image guidance and assisted navigation in endoscopic surgery, these findings increase anatomico-radiological understanding of the surgical approach investigated.

Endoscope-assisted contralateral transmaxillary approach to the clivus and the hypoglossal canal: technical case report

“…The endoscopic endonasal approach to the clivus and hypoglossal canal has been previously described in many accounts, and its anatomy is well reported in the literature. 1,5,12,14,16,19,23,24,32,39,41,43 However, the anatomical description of the endoscopic transmaxillary route to the clivus and hypoglossal canal has been rarely reported, and, to our knowledge, this is the first non-cadaveric presentation of this specific approach in a patient. 32,43 Tumors in this location can alter the course of the ICA, making vascular injury one of the major concerns.…”

“…3B). 1,5,12,14,16,19,23,24,32,39,41,43 One of the relative contraindications for endonasal endoscopic approaches is when critical neurovascular structures are localized between the dissector and the targeted lesion. 25 Other alternatives for tumor resection at this location are combined approaches, such as a subtemporal-infratemporal-transpetrous apex approach that will give access to the entirety of the tumor.…”

Comprehensive review on rhino-neurosurgery

“…The distance of the foramen ovale to the anterior nasal spine amounts to around 8 cm. Beside the lateral process, the buccal nerve may serve as guideline for identifying the foramen ovale [ 36 ], [ 146 ], [ 257 ], [ 263 ], [ 264 ], [ 265 ], [ 266 ], [ 267 ], [ 268 ]. Dorsal of the foramen ovale, the internal carotid artery is found in a distance of about 5 mm in the middle part of its petrosal segment [ 269 ].…”

“…The dimension of the foramen ovale amounts to about 8×5 mm [ 270 ], the distance of the posterior edge of the lateral process is about 6 mm. The distance of the posterior wall of the maxillary sinus measures around 18–20 mm [ 268 ]. Behind the lateral pterygoid muscle, the tensor muscle and the levator veli palatini muscle are located medial in close neighborhood of the Eustachian tube [ 271 ].…”

Pushing the boundaries of surgery

“…Of particular importance is the preservation of the lip and bony piriform aperture. The surgical approach to this inaccessible area is a challenge, with endoscopic techniques also being feasible 3 and facilitated by image guidance technology. 4 Two articles in this issue of The Journal investigate additional areas of controversy.…”