The Endoscopic Endonasal Approach to the Lateral Recess of the Sphenoid Sinus Via the Pterygopalatine Fossa: Comparison Of Endoscopic and Radiological Landmarks

Magro, Francesco; Solari, Domenico; Cavallo, Luigi Maria; Samii, Amir; Cappabianca, Paolo; Paternó, Vincenzo; Lüdemann, Wolf; Divitiis, Enrico de; Samii, Madjid

doi:10.1227/01.neu.0000233977.79721.17

Cited by 16 publications

(22 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…However, these open procedures are extremely complex, traverse through major neuro-vascular structures requiring sometimes retraction of the brain with subsequent morbidity [5,6]. Recently transnasal endoscopic approaches have been reported for the resection of intra and extra-cranial lesions involving the midline skull base [1].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Anatomical landmarks for transnasal endoscopic skull base surgery

Sandu

Monnier

Pelletier

2011

Eur Arch Otorhinolaryngol

View full text Add to dashboard Cite

Resection of midline skull base lesions involve approaches needing extensive neurovascular manipulation. Transnasal endoscopic approach (TEA) is minimally invasive and ideal for certain selected lesions of the anterior skull base. A thorough knowledge of endonasal endoscopic anatomy is essential to be well versed with its surgical applications and this is possible only by dedicated cadaveric dissections. The goal in this study was to understand endoscopic anatomy of the orbital apex, petrous apex and the pterygopalatine fossa. Six cadaveric heads (3 injected and 3 non injected) and 12 sides, were dissected using a TEA outlining systematically, the steps of surgical dissection and the landmarks encountered. Dissection done by the "2 nostril, 4 hands" technique, allows better transnasal instrumentation with two surgeons working in unison with each other. The main surgical landmarks for the orbital apex are the carotid artery protuberance in the lateral sphenoid wall, optic nerve canal, lateral optico-carotid recess, optic strut and the V2 nerve. Orbital apex includes structures passing through the superior and inferior orbital Wssure and the optic nerve canal. Vidian nerve canal and the V2 are important landmarks for the petrous apex. IdentiWcation of the sphenopalatine artery, V2 and foramen rotundum are important during dissection of the pterygopalatine fossa. In conclusion, the major potential advantage of TEA to the skull base is that it provides a direct anatomical route to the lesion without traversing any major neurovascular structures, as against the open transcranial approaches which involve more neurovascular manipulation and brain retraction. Obviously, these approaches require close cooperation and collaboration between otorhinolaryngologists and neurosurgeons.

show abstract

Section: Discussionmentioning

confidence: 99%

“…Endoscopically (Fig. 12), the area medial to V2 is the PPF, and the area lateral to the V2 is the infratemporal fossa [2,5]. Not many veins are encountered in the PPF.…”

Section: Pterygopalatine Fossamentioning

confidence: 99%

Anatomical landmarks for transnasal endoscopic skull base surgery

Sandu

Monnier

Pelletier

2011

Eur Arch Otorhinolaryngol

View full text Add to dashboard Cite

show abstract

“…21) Pneumatization of the sphenoid bone and sphenoid sinus creates a natural corridor, allowing the surgeon to approach various neurovascular structures with minimal drilling or manipulation of intracranial structures. 22,23) Dural opening should start from the foramen rotundum and follow the V2 toward the Meckel’s cave in order to avoid injury to the abducens nerve, which runs superolaterally above the superior margin of the V2. 21) After opening the periosteal dura, the Gasserian ganglion and all trigeminal branches, as well as the cranial nerves (III, IV, VI) in the cavernous sinus, can be visualized (Fig.…”

Section: Methodsmentioning

confidence: 99%

Surgical Anatomy for the Endoscopic Endonasal Approach to the Ventrolateral Skull Base

Oyama

Tahara

Hirohata

et al. 2017

Neurol. Med. Chir.(Tokyo)

View full text Add to dashboard Cite

The authors describe the surgical anatomy for the endoscopic endonasal approach (EEA) to the ventrolateral skull base. The ventrolateral skull base can be divided into two segments: the upper lateral and lower lateral skull base. The upper lateral skull base includes the cavernous sinus and the orbit, while the lower lateral skull base includes the petrous apex, Meckel’s cave, parapharyngeal space, infratemporal fossa, etc. To gain access to the upper lateral skull base, a simple opening of the ethmoid sinus provides sufficient exposure of this area. To reach the lower lateral skull base, a transpterygoid approach, following ethmoidectomy, is a key procedure providing wide exposure of this area. Understanding of surgical anatomy is mandatory for treating ventrolateral skull base lesions via EEA. An appropriate, less-invasive approach should be applied depending on the size, location, and type of lesion.

show abstract

“…As the pterygopalatine fossa (PPF) contains a number of neurovascular structures in a narrow space, a careful dissection and access are required. A detailed understanding of the anatomy is vital and a number of recent papers have been published detailing the surgical anatomy [23 ] as well as radiological landmarks [24] that would be encountered in a dissection of the PPF.…”

Section: Transpterygoid Approachmentioning

confidence: 99%

“…Some describe the use of both nostrils for access of instruments and hence would need removal of the posterior nasal septum and middle turbinate for better access [24]. We describe the technique favoured by the senior author.…”

Section: Transpterygoid Approachmentioning

confidence: 99%