105 research outputs found
Techniques and key points for endoscopic cranial base reconstruction/ Carlos Pinheiro-Neto, Maria Peris-Celda.
No full text"Due to close collaboration between otorhinolaryngologists and neurosurgeons, endoscopic endonasal brain surgery has become part of the surgical armamentarium for successful treatment of various cranial base pathologies. Today, it is considered the gold standard surgical technique for many types of skull base tumors. Techniques and Key Points for Endoscopic Cranial Base Reconstruction by pioneering otorhinolaryngologist Carlos D. Pinheiro-Neto and neurosurgeon Maria Peris-Celda, co-editor of Thieme's acclaimed Rhoton's Atlas of Head, Neck, and Brain, encompasses the most important endoscopic cranial base reconstruction techniques performed in the last two decades. The book features contributions from an impressive group of additional experts in this field."--Provided by publisher1 online resourc
Combined endoscopic endonasal transpterygoid and sublabial transmaxillary approaches for a large infratemporal fossa trigeminal schwannoma
No full textBackground Trigeminal schwannomas (TSs) with solitary extracranial location are rare, and surgical excision is challenging. In recent years, the endoscopic endonasal transmaxillary transpterygoid approach (EETPA) has been advocated as an effective strategy for TSs in the infratemporal fossa (ITF). Method We describe the steps of the EETPA combined with the sublabial transmaxillary approach for the surgical excision of a giant mandibular schwannoma of the ITF. Indications, advantages, and approach-specific complications are also discussed. The main surgical steps are shown in an operative video. Conclusion A combined EETPA and sublabial transmaxillary approach represents a safe and effective option for the surgical excision of extracranial TSs
Anatomical Step-by-Step Dissection of Complex Skull Base Approaches for Trainees: Surgical Anatomy of the Endoscopic Endonasal Clivectomy, Odontoidectomy, and Far Medial Approach
No full textLetter: Visual Field Defects in the Setting of Suprasellar Lesions: Could Vascularization Patterns of the Optic Chiasm Play a Role?
No full textPrecuneal Interhemispheric, Transtentorial Approach to a Dorsal Pontine Cavernous Malformation: 2-Dimensional Operative Video
No full textThe endonasal midline inferior intercavernous approach to the cavernous sinus: technical note, cadaveric step-by-step illustration, and case presentation
No full textPurpose Traditional endoscopic endonasal approaches to the cavernous sinus (CS) open the anterior CS wall just medial to the internal carotid artery (ICA), posing risk of vascular injury. This work describes a potentially safer midline cellar entry point for accessing the CS utilizing its connection with the inferior intercavernous sinus (IICS) when anatomically present.Methods The technique for the midline intercavernous dural access is described and depicted with cadaveric dissections and a clinical case.Results An endoscopic endonasal approach exposed the periosteal dural layer of anterior sella and CS. The IICS was opened sharply in midline through its periosteal layer. The feather knife was inserted and advanced laterally within the IICS toward the anterior CS wall, thereby gradually incising the periosteal layer of the IICS. The knife was turned superiorly then inferiorly in a vertical direction to open the anterior CS wall. This provided excellent access to the CS compartments, maintained the meningeal layer of the IICS and the medial CS wall, and avoided an initial dural incision immediately adjacent to the ICA.Conclusion The midline intercavernous dural access to the CS assisted by a 90 degrees dissector-blade is an effective modification to previously described techniques, with potentially lower risk to the ICA
Anatomical Step-by-Step Dissection of Complex Skull Base Approaches for Trainees: Surgical Anatomy of the Endoscopic Endonasal and Endoscopic-Assisted Transmaxillary Transpterygoid Approaches
No full textIntroduction The endoscopic endonasal transpterygoid approach (EETPA) with or without the addition of the endoscopic-assisted sublabial anterior transmaxillary approach (ESTA) has become increasingly utilized for lesions posterior to the pterygopalatine fossa (PPF), including infratemporal fossa (ITF), lateral recess of the sphenoid sinus, Meckel's cave, petrous apex, and parapharyngeal space. The main goal of this study is to develop an educational resource to learn the steps of the EETPA for trainees. Methods EETPA and ESTA were performed in 12 specimens by neurosurgery trainees, under supervision from the senior authors. One EETPA and one ESTA were performed on each specimen on opposite sides. Dissections were supplemented with representative cases. Results After a wide unilateral sphenoidotomy, ethmoidectomy, and partial medial maxillectomy, the anteromedial bone limits of the PPF were identified and drilled out. The pterygoid progress was modularly removed. By enlarging the opening of the posterior and lateral walls of the maxillary sinus through EETPA and ESTA, respectively, the neurovascular and muscular compartments of the PPF and ITF were better identified. The EETPA opens direct corridors to the PPF, medial ITF, middle cranial fossa, cavernous sinus, Meckel's cave, petrous apex, and internal carotid artery. If a more lateral exposure of the ITF is needed, the ESTA is an appropriate addition. Conclusion Despite the steep learning curve of the EETPA, granular knowledge of its surgical anatomy and basic surgical steps are vital for those advancing their learning in complex endoscopic approaches to the ventral skull base when expanding the approach laterally in the coronal plane
Endoscopic endonasal surgical anatomy of the optic canal: key anatomical relationships between the optic nerve and ophthalmic artery
No full textPurpose A detailed understanding of the neurovascular relationships between the optic nerve (ON) and the ophthalmic artery (OA) in the optic canal (OC) is paramount for safe surgery. We focused on the neurovascular anatomy of this area from both an endoscopic endonasal and transcranial trajectories to compare the surgical exposures and perspectives offered by these different views and provide recommendations to increase the intraoperative safety. Methods Twenty sides of ten formalin-fixed, latex-injected head specimens were utilized. The surgical anatomy and anatomical relationships of the OA in relationship to the ON along their intracranial and intracanalicular segments was studied from endoscopic endonasal and transcranial perspectives. Results Three types of OA-ON relationships at the origin of the OA were identified: inferomedial (type 1, 35%), inferior (type 2, 55%), and inferolateral (type 3, 10%). The endoscopic endonasal trajectory offers an inferomedial perspective of the ON-OA neurovascular complex, in which the OA, especially when located inferomedially, is first encountered. When comparing with the transcranial view, all OA were covered by the nerve, type 1 was located below the medial third, type 2 below the middle third, and type 3 below the lateral third of the OC. The mean extension of the intracanalicular portion of both OA and ON was 8.9 mm, while the intracranial portion of the OA and ON were 9.3 mm and 12.4 mm, respectively. The OA, endoscopically, is located within the inferior half of the OC, and occupies 39%, 43%, and 42% of the OC height at its origin, mid, and end points, respectively. The mean distance between the superior margin of the OC at its origin and superior margin of the OA is 1.4 mm. Conclusions Detailed anatomical understanding of the OC, and the ON and OA at their intracranial and intracanalicular segments is paramount to safe surgery. When opening the OC dura endoscopically, our results suggest that a medial incision along the superior third of the OC with a proximal to distal direction is recommended to avoid injury of the OA
Endoscopic endonasal surgical anatomy through the prechiasmatic sulcus: the key window to suprachiasmatic and infrachiasmatic corridors
No full textBackground Classically, the transtuberculum and transplanum approaches have been utilized to reach the suprachiasmatic and infrachiasmatic corridors. The aim of this study was to provide a better understanding of the key endoscopic endonasal anatomy of the suprachiasmatic and infrachiasmatic corridors provided through selective removal of the prechiasmatic sulcus (SRPS).Method A SRPS was performed in 16 sides of 8 alcohol-fixed head specimens. Twenty anatomical measurements were collected on the suprachiasmatic and infrachiasmatic corridors. The transplanum and transtuberculum approaches were also performed.Results In the suprachiasmatic corridor, the SRPS exposed the anterior communicating artery (AComm) and the post-communicating segment of the anterior cerebral arteries in all the cases, while the pre-communicating segment of the anterior cerebral arteries, recurrent arteries of Heubner, and fronto-orbital arteries were visualized in 75% (12/16), 31% (5/16), and 69% (11/16) of cases, respectively. In the infrachiasmatic corridor, the ophthalmic segment of the internal carotid artery and superior hypophyseal arteries were always visible through the SRPS. The mean width and height of the prechiasmatic sulcus were 13.2 mm and 9.6 mm, respectively. The mean distances from the midpoint of the AComm to the anterior margin of the optic chiasm (OCh) was 5.3 mm. The mean width of the infrachiasmatic corridor was 12 3 mm at the level of the proximal margin of the ophthalmic segment of the internal carotid artery. The mean distances from the posterior superior limit of the pituitary stalk to the basilar tip and oculomotor nerve were 9.7 mm and 12.3 mm, respectively.Conclusions The SRPS provides access to the main neurovascular and cisternal surgical landmarks of the suprachiasmatic and infrachiasmatic corridors. This anatomical area constitutes the key part of the approach to the suprasellar area. To afford adequate surgical maneuverability, the transplanum or transtuberculum approaches are usually a necessary extension
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