Abstract:Purpose Treatment of tumors arising in the upper parapharyngeal space (PPS) or the floor of the middle cranial fossa is challenging. This study aims to present anatomical landmarks for a combined endoscopic transnasal and anterior transmaxillary approach to the upper PPS and the floor of the middle cranial fossa and to further evaluate their clinical application. Methods Dissection of the upper PPS using a combined endoscopic endonasal transpterygoid and anterior transmaxillary approach was performed in six ca… Show more
“…Combined approaches might be a better treatment option for malignancy, which warrants the highest chances of achieving satisfactory tumor resection with a reduced risk of complications ( 38 ). Surgeons have adopted combined endoscopic transnasal and anterior transmaxillary approaches in the dissection of nasopharyngeal carcinoma that has extended to the upper PPS ( 39 ), and have used the transmaxillary approach in combination with the endonasal endoscopic approach for giant nasoangiofibromas and chondrosarcoma ( 40 ). The absolute contraindication of such an approach has rarely been reported although there are still severe complications, including skull base reconstruction failure and intraoperative vascular lesions ( 38 ).…”
The endoscopic transnasal maxillary sinus approach is usually performed in resecting tumors located in the pterygopalatine fossa and infratemporal fossa, but is rarely used in the resection of lesions in the middle cranial fossa. Because of the complicated anatomical structure of the middle cranial fossa, trigeminal schwannomas (TSs) located in this region are usually dissected through conventional craniotomy surgical approaches; however, the endoscopic transnasal maxillary sinus approach can be used in resection of middle cranial fossa TSs. The current study presented the case of a 59-year-old man who suffered intermittent headaches for 2 years without other notable medical history and neurological abnormalities. The patient was diagnosed with a middle cranial fossa TS. After imaging and assessment of anatomical features, the tumor was totally resected through the transnasal maxillary sinus approach. Following surgery, the symptoms were relieved and the patient returned to a normal life. Light numbness was complained of in the distribution area of the maxillary nerve of the right side of the face, but this was gradually relieved. Combined with a literature review, the present case indicated that the endoscopic transnasal maxillary sinus approach may provide a safer and more direct option for resecting middle cranial fossa lesions, which is worthy of increased clinical application.
“…Combined approaches might be a better treatment option for malignancy, which warrants the highest chances of achieving satisfactory tumor resection with a reduced risk of complications ( 38 ). Surgeons have adopted combined endoscopic transnasal and anterior transmaxillary approaches in the dissection of nasopharyngeal carcinoma that has extended to the upper PPS ( 39 ), and have used the transmaxillary approach in combination with the endonasal endoscopic approach for giant nasoangiofibromas and chondrosarcoma ( 40 ). The absolute contraindication of such an approach has rarely been reported although there are still severe complications, including skull base reconstruction failure and intraoperative vascular lesions ( 38 ).…”
The endoscopic transnasal maxillary sinus approach is usually performed in resecting tumors located in the pterygopalatine fossa and infratemporal fossa, but is rarely used in the resection of lesions in the middle cranial fossa. Because of the complicated anatomical structure of the middle cranial fossa, trigeminal schwannomas (TSs) located in this region are usually dissected through conventional craniotomy surgical approaches; however, the endoscopic transnasal maxillary sinus approach can be used in resection of middle cranial fossa TSs. The current study presented the case of a 59-year-old man who suffered intermittent headaches for 2 years without other notable medical history and neurological abnormalities. The patient was diagnosed with a middle cranial fossa TS. After imaging and assessment of anatomical features, the tumor was totally resected through the transnasal maxillary sinus approach. Following surgery, the symptoms were relieved and the patient returned to a normal life. Light numbness was complained of in the distribution area of the maxillary nerve of the right side of the face, but this was gradually relieved. Combined with a literature review, the present case indicated that the endoscopic transnasal maxillary sinus approach may provide a safer and more direct option for resecting middle cranial fossa lesions, which is worthy of increased clinical application.
“…[26][27][28] In general, EAs and non-EAs via natural cavities (oral or nasal) have been applied in patients via a strict screen and selection. 2,29,30 Among them, PPST resection via the transoral approach has become increasingly popular, especially along with the development of endoscopic techniques that guarantee a definite and magnified surgical view in natural cavities. 12,31 Hence, the EATA displays unique superiorities over other surgical approaches.…”
Section: Discussionmentioning
confidence: 99%
“…Optimized surgical methods to access and remove PPSTs are determined by lesion location, pathological nature of the tumor, and spatial neighborhood with adjacent anatomical structures, as well as the patient's personal cosmetic requirement 26–28 . In general, EAs and non‐ EAs via natural cavities (oral or nasal) have been applied in patients via a strict screen and selection 2,29,30 . Among them, PPST resection via the transoral approach has become increasingly popular, especially along with the development of endoscopic techniques that guarantee a definite and magnified surgical view in natural cavities 12,31 .…”
Objectives: By comparing the endoscopy-assisted transoral approach (EATA) with external approaches (EAs) for the resection of parapharyngeal space tumors (PPSTs), we determined whether the EATA has advantages in terms of operation time, intraoperative bleeding volume, postoperative hospitalization, drainage volume, and complications. At the same time, we summarized the surgical indications for the EATA.Methods: Systematic literature retrieval was performed in the PubMed, Web of Science, Embase, CNKI, Wanfang, and CQVIP databases up to February 2020. We calculated the mean difference (MD) with a 95% confidence interval (CI) for continuous outcomes and pooled odds ratio (OR) with 95% CI for dichotomous outcomes. The measured outcomes were operative time, bleeding volume, postoperative hospitalization, drainage volume, and complications.Results: Seven studies involving 318 patients were eligible. Of these patients, 145 patients underwent EATA and 173 patients underwent EA surgery. All the former tumors were benign and located medial or anteromedial to the carotid sheath except for the unrecorded tumors. Compared with EAs, the EATA significantly shortened the operation time (MD = −5.56 min, 95% CI: −9.58 to −1.55), shrank the bleeding volume (MD = −89.02 ml, 95% CI: −126.16 to −51.88), shortened the postoperative hospitalization (MD = −2.44 days, 95% CI: −3.37 to −1.51), reduced the drainage volume (MD = −32.97 ml, 95% CI: −36.24 to −29.70), and lowered the incidence of complications (OR = 0.30, 95% CI: 0.16 to 0.59).Conclusion: As for PPSTs, with an appropriate and precise patient selection, the EATA is a safe, effective, minimally invasive, and aesthetic surgical modality.
“…If the superior boundary of the mass was difficult to expose by the endoscopic transoral approach, the endoscopic transnasal transmaxillary approach to the upper parapharyngeal space could be used as well to facilitate exposure. 13 Fig. 2.Pre-operative enhanced magnetic resonance imaging scans in (a) axial and (b) coronal planes showing that the tumour was near the lateral pharyngeal wall; (c and d) endoscopic images showing the incision was made on the lateral pharyngeal wall to expose the tumour easily and to make a short corridor.Fig.…”
Objective
Surgical management is the mainstay of treatment for tumours in the parapharyngeal space. This study aimed to evaluate the indications, limits and technical nuances of the endoscopic transoral approach.
Method
Thirteen patients with parapharyngeal space tumours that were treated between May 2017 and November 2020 were included in this retrospective study.
Results
All patients underwent surgery for complete oncological resection except one patient who received treatment for diagnostic purposes. No major complications were reported, with excellent control of the vital structures of the parapharyngeal space.
Conclusion
The endoscopic transoral approach to the parapharyngeal space is a promising alternative approach for selected parapharyngeal space tumours with satisfactory outcomes.
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