Microsurgical anatomy of the dorsal clinoidal space: implications for endoscopic endonasal parasellar surgery

Xu, Yuanzhi; Núñez, Maximiliano; Mohyeldin, Ahmed; Vigo, Vera; Mao, Ying; Cohen-Gadol, Aaron; Fernández-Miranda, Juan C.

doi:10.3171/2021.12.jns211974

Cited by 8 publications

(7 citation statements)

References 20 publications

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“…As reported, ERBB receptor tyrosine kinases play a key role in both normal physiology and cancer. Many epithelial tumors contain mutations of ERBB2, and clinical studies indicate that they are correlated with tumor progression (Hynes and MacDonald, 2009;Xu et al, 2022). When cells are exposed to different stress signals, their p53 signaling pathway is activated, activating several transcriptional programs, including cell cycle arrest, senescence, DNA repair, and apoptosis, leading to tumor growth inhibition (Marei et al, 2021).…”

Section: Discussionmentioning

confidence: 99%

URB2 as an important marker for glioma prognosis and immunotherapy

et al. 2023

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Introduction: Glioma is the most common primary brain tumor and primary malignant tumor of the brain in clinical practice. Conventional treatment has not significantly altered the prognosis of patients with glioma. As research into immunotherapy continues, glioma immunotherapy has shown great potential.Methods: The clinical data were acquired from the Chinese Glioma Genome Atlas (CGGA) database and validated by the Gene Expression Omnibus (GEO) database, The Cancer Genome Atlas (TCGA) dataset, Clinical Proteomic Tumor Analysis Consortium (CPTAP) database, and Western blot (WB) analysis. By Cox regression analyses, we examined the association between different variables and overall survival (OS) and its potential as an independent prognostic factor. By constructing a nomogram that incorporates both clinicopathological variables and the expression of URB2, we provide a model for the prediction of prognosis. Moreover, we explored the relationship between immunity and URB2 and elucidated its underlying mechanism of action.Results: Our study shows that URB2 likely plays an oncogenic role in glioma and confirms that URB2 is a prognostic independent risk factor for glioma. Furthermore, we revealed a close relationship between immunity and URB2, which suggests a new approach for the immunotherapy of glioma.Conclusion: URB2 can be used for prognosis prediction and immunotherapy of glioma.

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Section: Discussionmentioning

confidence: 99%

URB2 as an important marker for glioma prognosis and immunotherapy

et al. 2023

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“…Although this technique has been previously proposed, [9][10][11] the current study provides a detailed anatomic analysis and step-by-step maneuvers, such as the sequential removal of the PPsb as the medial and posterior wall of the foramen lacerum and the lingual process as the lateral wall of the foramen lacerum. Freeing the superior anchor of the ICA involves incising the proximal dural ring and the caroticoclinoid ligament, 18 and is necessary to further mobilize the parasellar ICA.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic Endonasal Approach to the Ventral Petroclival Fissure: Anatomical Findings and Surgical Techniques

Mohyeldin

Lee³

et al. 2023

J Neurol Surg B Skull Base

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Objective: The endoscopic endonasal approach has emerged as an excellent option for the treatment of lesions involving the petroclival fissure (PCF), most commonly chordomas and chondrosarcomas. Here we investigate the surgical anatomy of the ventral PCF and its application in endoscopic endonasal surgery. Methods: Sixteen silicon-injected human head specimens were examined using endoscopy and microscopy. The anatomical features of PCF and relevant technical nuances in translacerum, extreme medial, and contralateral transmaxillary approaches were investigated. Two representative endoscopic endonasal surgery cases of pathologies involving the PCF were selected to illustrate the clinical application based on anatomical findings. Results: From the endoscopic endonasal view, the ventral PCF is presented as a lazy L sign, which is divided into 2 distinct segments: 1) upper (or petrosphenoidal) segment, which extends vertically from the foramen lacerum inferiorly to the junction of the petrosal process of sphenoid bone and petrous apex superiorly; 2) lower (or petroclival) segment, which extends inferolaterally from the foramen lacerum to the ventral jugular foramen. The paraclival internal carotid artery (ICA) is located anterior to the upper segment, whereas the lacerum and petrous ICA segments are located just above the lower segment. The abducens nerve courses just medial and superior to the upper segment as it enters the cavernous sinus, while the lower cranial nerves course posterior to the inferior end of the lower segment protected by the opening of the inferior petrosal sinus into the jugular foramen..... (revised shortened abstract to come)

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“…He underwent an endoscopic endonasal approach, and the pterygosphenoidal triangle was drilled out to expose the inferior-most aspect of the tumor residing near the foramen lacerum. Tumor was removed from the clinoidal space 11 as well as the medial wall and inferior and superior compartments of the cavernous sinus. Exposure of the foramen lacerum facilitated removal of tumor burden in the carotid canal toward the foramen lacerum.…”

Section: Illustrative Case 1: Application For Pituitary Adenomamentioning

confidence: 99%

The Pterygosphenoidal Triangle: Surgical Anatomy and Case Series in Endoscopic Endonasal Skull Base Surgery

Asmaro²,

Mohyeldin³

et al. 2023

Operative Neurosurgery

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BACKGROUND: Safe exposure of the lacerum segment of the carotid artery remains a challenge in endoscopic endonasal surgery. OBJECTIVE: To introduce the pterygosphenoidal triangle as a novel and reliable landmark for facilitating access to the foramen lacerum. METHODS: Fifteen colored silicone-injected anatomic specimens were dissected using an endoscopic endonasal approach to the foramen lacerum region in a stepwise manner. Twelve dried skulls were studied and 30 high-resolution computed tomography scans were analyzed to measure the borders and angles of the pterygosphenoidal triangle. Surgical cases incorporating the foramen lacerum exposure between July 2018 and December 2021 were reviewed to provide surgical outcomes of the proposed surgical technique. RESULTS: The pterygosphenoidal triangle is delineated by the pterygosphenoidal fissure medially and the vidian nerve laterally. The palatovaginal artery is located at the base of the triangle anteriorly, while the apex is formed by the pterygoid tubercle posteriorly, which leads to the anterior wall of the foramen lacerum and lacerum internal carotid artery. In the reviewed surgical cases, 39 patients underwent 46 foramen lacerum approaches for resection of pituitary adenoma (12 patients), meningioma (6 patients), chondrosarcoma (5 patients), chordoma (5 patients), or other lesions (11 patients). There were no carotid injuries or ischemic events. Near-total resection was achieved in 33 (85%) of 39 patients (gross-total in 20 [51%]). CONCLUSION: This study details the pterygosphenoidal triangle as a novel and practical anatomic surgical landmark for safe and effective exposure of the foramen lacerum in endoscopic endonasal surgery.

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Microsurgical anatomy of the dorsal clinoidal space: implications for endoscopic endonasal parasellar surgery

Cited by 8 publications

References 20 publications

URB2 as an important marker for glioma prognosis and immunotherapy

URB2 as an important marker for glioma prognosis and immunotherapy

Endoscopic Endonasal Approach to the Ventral Petroclival Fissure: Anatomical Findings and Surgical Techniques

The Pterygosphenoidal Triangle: Surgical Anatomy and Case Series in Endoscopic Endonasal Skull Base Surgery

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