Endoscopic Endonasal Transpterygoid Transmaxillary Approach to the Infratemporal and Upper Parapharyngeal Tumors

Battaglia, Paolo; Turri‐Zanoni, Mario; Dallan, Iacopo; Gallo, Stefania; Sica, Eleonora; Padoan, G.; Castelnuovo, Paolo

doi:10.1177/0194599813520290

Cited by 106 publications

(120 citation statements)

References 35 publications

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“…16 Battaglia et al reported 1 case of gross-total resection of a sinonasal chondrosarcoma through a transpterygoid transmaxillary approach, without complications. 2 We strongly believe that chondrosarcomas involving the posterior fossa and CPA are amenable to treatment with an EEA approach, with excellent results in terms of resection, while minimizing surgical morbidity, as evidenced by the current series. The main characteristic of the endonasal approach is its ability to reach the petroclival synchondrosis with little to no morbidity for the patient.…”

Section: 4mentioning

confidence: 57%

Endoscopic endonasal surgical management of chondrosarcomas with cerebellopontine angle extension

Filho

Prevedello

et al. 2014

FOC

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Object Skull base chondrosarcomas are slow-growing, locally invasive tumors that arise from the petroclival synchondrosis. These characteristics allow them to erode the clivus and petrous bone and slowly compress the contents of the posterior fossa progressively until the patient becomes symptomatic, typically from cranial neuropathies. Given the site of their genesis, surrounded by the petrous apex and the clival recess, these tumors can project to the middle fossa, cervical area, and posteriorly, toward the cerebellopontine angle (CPA). Expanded endoscopic endonasal approaches are versatile techniques that grant access to the petroclival synchondrosis, the core of these lesions. The ability to access multiple compartments, remove infiltrated bone, and achieve tumor resection without the need for neural retraction makes these techniques particularly appealing in the management of these complex lesions. Methods Analysis of the authors’ database yielded 19 cases of skull base chondrosarcomas; among these were 5 cases with predominant CPA involvement. The electronic medical records of the 5 patients were retrospectively reviewed for age, sex, presentation, pre- and postoperative imaging, surgical technique, pathology, and follow-up. These cases were used to illustrate the surgical nuances involved in the endonasal resection of CPA chondrosarcomas. Results The male/female ratio was 1:4, and the patients’ mean age was 55.2 ±11.2 years. All cases involved petrous bone and apex, with variable extensions to the posterior fossa and parapharyngeal space. The main clinical scenario was cranial nerve (CN) palsy, evidenced by diplopia (20%), ptosis (20%), CN VI palsy (20%), dysphagia (40%), impaired phonation (40%), hearing loss (20%), tinnitus (20%), and vertigo/dizziness (40%). Gross-total resection of the CPA component of the tumor was achieved in 4 cases (80%); near-total resection of the CPA component was performed in 1 case (20%). Two patients (40%) harbored high-grade chondrosarcomas. No patient experienced worsening neurological symptoms postoperatively. In 2 cases (40%), the symptoms were completely normalized after surgery. Conclusions Expanded endoscopic endonasal approaches appear to be safe and effective in the resection of select skull base chondrosarcomas; those with predominant CPA involvement seem particularly amenable to resection through this technique. Further studies with larger cohorts are necessary to test these preliminary impressions and to compare their effectiveness with the results obtained with open approaches.

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Section: 4mentioning

confidence: 57%

Endoscopic endonasal surgical management of chondrosarcomas with cerebellopontine angle extension

Filho

Prevedello

et al. 2014

FOC

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“…A criticism of this approach pertains to its relevance in the setting of expanded endoscopic approaches (including transpterygoid, trans-fovea ethmoidalis [28–31]). Certainly, access to the areas of the skull base afforded by expanded endonasal approaches and even supraorbital keyhole craniotomies can be obtained.…”

Section: Discussionmentioning

confidence: 99%

Transorbital neuroendoscopic surgery for the treatment of skull base lesions

Ramakrishna

Kim

Bly

et al. 2016

Journal of Clinical Neuroscience

113

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Transorbital neuroendoscopic surgery (TONES) is a relatively new technique that not only allows access to the contents of the orbit but also the intracranial compartment, including the anterior cranial fossa, middle fossa and lateral cavernous sinus. In this study, we aimed to retrospectively review the largest experience to our knowledge with regards to surgical outcomes of skull base pathologies treated with a TONES procedure. Forty patients (aged 3–89 years) underwent 45 TONES procedures between the years of 2006–2013. Pathologies were cerebrospinal fluid leak repair (n = 16), traumatic fracture (n = 8), tumor (n = 11), meningoencephalocele (n = 5), hematoma (n = 1), and infection (n = 4). Three patients had a persistent complication at 3 months, including a case each of enophthalmos (unnoticed by patient), epiphora (delayed presentation at 2 months requiring dacryocystorhinostomy), and ptosis (improved at 1 year). Surgical success was achieved in all patients. Of special import, there were no cases of visual decline, diplopia, or stroke. There was no mortality. To our knowledge this is the first study and largest experience of TONES (level 4 evidence) to detail outcomes with respect to skull base pathologies. Our results indicate that TONES procedures can be performed with minimal morbidity. Further studies are needed to assess equivalency with craniotomy based approaches though this initial report is encouraging.

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“…Endoscopic endonasal dissections of the sino-orbitocranial interface (11,12) and of the pterygopalatine and infratemporal fossa via a transpterygoid approach were performed as previously described (6). Extended exposure of the middle cranial fossa floor also was achieved through an endoscopic transnasal route, reaching the same areas previously exposed through the transorbital approach.…”

Section: Preclinical Studymentioning

confidence: 99%

Multiportal Combined Transorbital Transnasal Endoscopic Approach for the Management of Selected Skull Base Lesions: Preliminary Experience

et al. 2015

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Endoscopic Endonasal Transpterygoid Transmaxillary Approach to the Infratemporal and Upper Parapharyngeal Tumors

Abstract: The purely endoscopic endonasal technique may provide a minimally invasive and safe approach to radically resect selected tumors involving the ITF and UPS. Larger case series and longer follow-up are needed to validate the reproducibility and efficacy of this technique.

Cited by 106 publications

References 35 publications

Endoscopic endonasal surgical management of chondrosarcomas with cerebellopontine angle extension

Endoscopic endonasal surgical management of chondrosarcomas with cerebellopontine angle extension

Transorbital neuroendoscopic surgery for the treatment of skull base lesions

Multiportal Combined Transorbital Transnasal Endoscopic Approach for the Management of Selected Skull Base Lesions: Preliminary Experience

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