Transoral and endoscope-assisted transoral approaches to resecting benign tumours of the parapharyngeal space located in the medial portion of the carotid sheaths and extending toward the skull base: our experience

Y, Liu; Yu, Hong‐Jeng; Ht, Zhen

doi:10.1017/s0022215118001184

Cited by 14 publications

(24 citation statements)

References 13 publications

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“…The advent and development of minimally invasive endoscopic skull base surgery has provided a safe and effective alternative to open approaches with notably less complications. The Endoscopic endonasal nasopharyngectomy (EEN) has been extensively used for the management of nasopharyngeal pathology 1,3,4,13,17,27‐29 . The EEN has mainly been studied in the treatment of rNPC and has proven to be safe and effective, with comparable oncologic outcomes to open approaches and enhanced postoperative healing, shorter hospital stays, low risk of complications, and significantly less sequelae 17,29 …”

Section: Discussionmentioning

confidence: 99%

“…Additionally, in extensive tumors, view of the PPICA is obstructed, putting it at a higher risk of inadvertent injury. In light of this, lateral dissection in the PPS is restricted and unsafe, making an oncologically sound resection with negative margins challenging 17 . It was clear that an approach that provides adequate access to the PPS and adequate control of the PPICA in addition to a complete nasopharyngeal resection was necessary.…”

Section: Discussionmentioning

confidence: 99%

“…Despite its notable benefits, EEN still presents certain limitations, particularly when a tumor extends below the hard palate and laterally past the pterygoid musculature 3,6,13 . In large lesions such as these, visualization and access of the lateral and caudal aspects of the tumor becomes challenging, making necessary the use of an open approach 1,11,12,17,18 . In regard to management of rNPC with EEN; worse outcomes have been shown in the resection of rT2 tumors that involve the PPS 17,29 .…”

Section: Discussionmentioning

confidence: 99%

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Endoscopic transoral nasopharyngectomy

Soriano

Rindler

Helman³

et al. 2020

Head & Neck

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Background: A minimal access technique for the management of nasopharyngeal tumors extending below the palatal plane and laterally beyond the pterygoid musculature is yet to be developed. In this study we demonstrate the feasibility of endoscopic transoral nasopharyngectomy (ETON) for resection of large nasopharyngeal lesions as a natural orifice alternative to traditional approaches. Methods: ETON was completed in three latex-injected specimens. Surgical freedom (SF) and angles of attack (AoA) were calculated along the internal carotid artery (ICA). Results: An endoscopic transoral approach was successfully used to identify the parapharyngeal ICA and subsequently perform a complete nasopharyngeal resection. SF and AoA (sagittal) were found to be the greatest at the anterior genu of the ICA. Conclusions: ETON is feasible. It provides wide exposure of the skull base and proximal control of the ICA. It may be indicated for the management of nasopharyngeal tumors with inferolateral extension, involving the ICA.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Endoscopic transoral nasopharyngectomy

Soriano

Rindler

Helman³

et al. 2020

Head & Neck

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“…The styloid diaphragm divides the PPS into the retrostyloid compartment that includes the carotid sheath (CSh) and neurovascular structures embedded on it, and the prestyloid compartment that is filled with fat and lymphoid tissue. [1][2][3][4][5] Vertical subdivisions named the upper, middle, and lower portions of the PPSno are located between the skull base and the hard palate the hard palate, and the mandibular angle; and the mandibular angle and the hyoid bone respectively. 6 Tumors that arise from or extend into the PPS account for 0.5% of all head and neck tumors.…”

Section: Introductionmentioning

confidence: 99%

Keyhole Endoscopic-Assisted Transcervical Approach to the Upper and Middle Retrostyloid Parapharyngeal Space: An Anatomic Feasibility Study

Eguiluz‐Melendez

Torres-Bayona

Vega

et al. 2021

J Neurol Surg B Skull Base

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Objectives The aim of this study was to describe the anatomical nuances, feasibility, limitations, and surgical exposure of the parapharyngeal space (PPS) through a novel minimally invasive keyhole endoscopic-assisted transcervical approach (MIKET). Design Descriptive cadaveric study. Setting Microscopic and endoscopic high-quality images were taken comparing the MIKET approach with a conventional combined transmastoid infralabyrinthine transcervical approach. Participants Five colored latex-injected specimens (10 sides). Main Outcome Measures Qualitative anatomical descriptions in four surgical stages; quantitative and semiquantitative evaluation of relevant landmarks. Results A 5 cm long inverted hockey stick incision was designed to access a corridor posterior to the parotid gland after independent mobilization of nuchal and cervical muscles to expose the retrostyloid PPS. The digastric branch of the facial nerve, which runs 16.5 mm over the anteromedial part of the posterior belly of the digastric muscle before piercing the parotid fascia, was used as a landmark to identify the main trunk of the facial nerve. MIKET corridor was superior to the crossing of the accessory nerve over the internal jugular vein within 17.3 mm from the jugular process. Further exposure of the occipital condyle, vertebral artery, and the jugular bulb was achieved. Conclusion The novel MIKET approach provides in the cadaver straightforward access to the upper and middle retrostyloid PPS through a natural corridor without injuring important neurovascular structures. Our work sets the anatomical nuances and limitations that should guide future clinical studies to prove its efficacy and safety either as a stand-alone procedure or as an adjunct to other approaches, such as the endonasal endoscopic approach.

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“…In this study, Liu et al . investigated the feasibility of a transoral approach in the surgical management of benign posterior parapharyngeal space tumours located in the medial portion of the carotid sheaths and extending toward the skull base 5 . Their transoral approach safely allowed for en bloc resection of most benign tumours in the posterior parapharyngeal space with extracapsular dissection.…”

mentioning

confidence: 99%