The Endoscopic Endonasal Approach to Craniovertebral Junction Pathologies: Surgical Skills and Anatomical Study

2019 ◽  
pp. 25-36 ◽  
Author(s):  
Paolo Pacca ◽  
Valentina Tardivo ◽  
Giancarlo Pecorari ◽  
Diego Garbossa ◽  
Alessandro Ducati ◽  
...  
Keyword(s):  
Anatomical Study ◽  
Craniovertebral Junction ◽  
Surgical Skills ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Endoscopic Endonasal

Endoscopic Endonasal Approaches to the Clivus with No Violation of the Nasopharynx: Surgical Anatomy and Clinical Illustration

2021 ◽  
Author(s):  
Carlos D. Pinheiro-Neto ◽  
Laura Salgado-Lopez ◽  
Luciano C.P.C. Leonel ◽  
Serdar O. Aydin ◽  
Maria Peris-Celda
Keyword(s):  
Posterior Fossa ◽  
Cerebrospinal Fluid Leak ◽  
Craniovertebral Junction ◽  
Foramen Magnum ◽  
Surgical Anatomy ◽  
Csf Leak ◽  
Surgical Approaches ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Endoscopic Endonasal

Abstract Background Despite the use of vascularized intranasal flaps, endoscopic endonasal posterior fossa defects remain surgically challenging with high rates of postoperative cerebrospinal fluid leak. Objective The aim of the study is to describe a novel surgical technique that allows complete drilling of the clivus and exposure of the craniovertebral junction with preservation of the nasopharynx. Methods Two formalin-fixed latex-injected anatomical specimens were used to confirm feasibility of the technique. Two surgical approaches were used: sole endoscopic endonasal approach and transnasion approach. The sole endonasal approach was used in a patient with a petroclival meningioma. Results In both anatomical dissections, the inferior clivectomy with exposure of the foramen magnum was achieved with a sole endoscopic endonasal approach. The addition of the transnasion approach helped to complete drilling of the inferior border of the foramen magnum and exposure of the arch of C1. Conclusion This study shows the anatomical feasibility of total clivectomy and exposure of the craniovertebral junction with preservation of the nasopharynx. A more favorable anatomical posterior fossa defect for the reconstruction is achieved with this technique. Further clinical studies are needed to assess if this change would impact the postoperative CSF leak rate.

Endoscopic Endonasal Approach for Craniovertebral Junction Pathologic Conditions: Myth and Truth in Clinical Series and Personal Experience

2017 ◽  
Vol 101 ◽  
pp. 122-129 ◽  
Author(s):  
Massimiliano Visocchi ◽  
Francesco Signorelli ◽  
Chenlong Liao ◽  
Mario Rigante ◽  
Gaetano Paludetti ◽  
...  
Keyword(s):  
Personal Experience ◽  
Craniovertebral Junction ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Endoscopic Endonasal ◽  
Clinical Series

Extended endoscopic endonasal approach to the pterygopalatine fossa: anatomical study and clinical considerations

2005 ◽  
Vol 19 (1) ◽  
pp. 1-7 ◽  
Author(s):  
Luigi M. Cavallo ◽  
Andrea Messina ◽  
Paul Gardner ◽  
Felice Esposito ◽  
Amin B. Kassam ◽  
...  
Keyword(s):  
Skull Base ◽  
Anatomical Study ◽  
Pterygopalatine Fossa ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Endoscopic Endonasal ◽  
Anatomical Dissection ◽  
Clinical Considerations ◽  
Functional Surgery ◽  
Safe Approach

Object The pterygopalatine fossa is an area located deep in the skull base. The microsurgical transmaxillary–transantral route is usually chosen to remove lesions in this region. The increasing use of the endoscope in sinonasal functional surgery has more recently led to the advent of the endoscope for the treatment of tumors located in the pterygopalatine fossa as well. Methods An anatomical dissection of three fresh cadaveric heads (six pterygopalatine fossas) and three dried skull base specimens was performed to evaluate the feasibility of the approach and to illustrate the surgical landmarks that are useful for operations in this complex region. The endoscopic endonasal approach allows a wide exposure of the pterygopalatine fossa. Furthermore, with the same access (that is, through the nostril) it is possible to expose regions contiguous with the pterygopalatine fossa, either to visualize more surgical landmarks or to accomplish a better lesion removal. Conclusions In this anatomical study the endoscopic endonasal approach to the pterygopalatine fossa has been found to be a safe approach for the removal of lesions in this region. The approach could be proposed as an alternative to the standard microsurgical transmaxillary–transantral route.

The extended endoscopic endonasal approach to the clivus and cranio-vertebral junction: anatomical study

2007 ◽  
Vol 23 (6) ◽  
pp. 665-671 ◽  
Author(s):  
L. M. Cavallo ◽  
P. Cappabianca ◽  
A. Messina ◽  
F. Esposito ◽  
L. Stella ◽  
...  
Keyword(s):  
Anatomical Study ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Endoscopic Endonasal

scholarly journals The Tough Fibrous Tissue of The Supracondylar Groove As A Useful Landmark Via The Endoscopic Endonasal Approach To The Lower Clivus

2021 ◽  
Author(s):  
Changchen Hu ◽  
Liyuan Zhou ◽  
Hongming Ji ◽  
Gangli Zhang ◽  
Shengli Chen ◽  
...  
Keyword(s):  
Connective Tissue ◽  
Fibrous Tissue ◽  
Craniovertebral Junction ◽  
Fibrous Connective Tissue ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Endoscopic Endonasal ◽  
External Orifice ◽  
Surgical Corridor ◽  
Lower Clivus

Abstract Background: The hypoglossal canal (HGC) is the most important structural landmark for the endoscopic endonasal approach to access the lower clivus (LC). We explored the feasibility of using the tough fibrous tissue covering the supracondylar groove (SCG) as a useful landmark to identify the location of the HGC. Methods: Four cadaveric specimens were dissected and analyzed. The craniovertebral junction (CVJ) region was accessed utilizing 4-mm endoscope with either 0° or 30° lenses. CVJ exposure and the surgical corridor areas were measured. The relationship between the tough fibrous tissue covering the SCG and the HGC was analyzed.Results: Tough fibrous connective tissue was tightly attached the SCG and ran superomedially to inferolaterally. The angle between the horizontal plane and the long axis of the SCG was 30°. Separating the tough tissue inferolaterally, we could locate the external orifice (EO) of the HGC to further accurately isolate the hypoglossal nerve. Conclusion: The tough fibrous connective tissue covered the SCG to the upper part of the HGC EO. The course of the tough fibrous connective tissue was superomedial to inferolateral. Using the tough fibrous connective tissue covering the SCG as a landmark, it was possible to accurately locate the HGC EO via the endoscopic endonasal approach to access the LC.

Anatomical study of the pterygopalatine fossa using an endoscopic endonasal approach: spatial relations and distances between surgical landmarks

2007 ◽  
Vol 106 (1) ◽  
pp. 157-163 ◽  
Author(s):  
Domenico Solari ◽  
Francesco Magro ◽  
Paolo Cappabianca ◽  
Luigi M. Cavallo ◽  
Amir Samii ◽  
...  
Keyword(s):  
Skull Base ◽  
Anatomical Study ◽  
Spatial Relations ◽  
Pterygopalatine Fossa ◽  
Direct Access ◽  
Anatomical Landmarks ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Endoscopic Endonasal ◽  
Invasive Approach

Object The pterygopalatine fossa is an area that lies deep within the skull base. The recent extensive use of the endoscopic endonasal approach has provided neurosurgeons with a method to reach various areas of the skull base through a less invasive approach than traditional transcranial or transfacial approaches. This study aims to provide neurosurgeons with new data concerning direct endoscopic measurements and precise anatomical topography features of the pterygopalatine fossa. Methods An anatomical dissection of six fixed cadaver heads (12 pterygopalatine fossae) was performed to analyze spatial relationships and distances between the most important neurovascular structures in this region, and to estimate the size of the endoscopic surgical field for operations in this area. The endoscopic endonasal approach offers direct access to the pterygopalatine fossa through its anteromedial walls. Conclusions Using an endoscopic endonasal approach makes it possible to identify all of the anatomical landmarks of the pterygopalatine fossa and almost all of the contiguous skull base areas.

Intracavernous branches of the internal carotid artery through an endoscopic endonasal approach: anatomical study and review of the literature

2021 ◽  
Author(s):  
Juan Ángel Aibar-Durán ◽  
Fernando Muñoz-Hernández ◽  
Carlos Asencio-Cortés ◽  
Joan Montserrat-Gili ◽  
Juan Ramón Gras-Cabrerizo ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Anatomical Study ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Review Of The Literature ◽  
Endoscopic Endonasal

Endoscopic Endonasal versus Transcranial Optic Canal Decompression: A Morphometric, Cadaveric Study

2021 ◽  
Author(s):  
Jun Kim ◽  
Aaron R Plitt ◽  
Awais Vance ◽  
Scott Connors ◽  
James Caruso ◽  
...  
Keyword(s):  
Anatomical Study ◽  
Contralateral Side ◽  
Lateral Approach ◽  
Ct Scans ◽  
Optic Canal ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Endoscopic Endonasal ◽  
Transcranial Approach ◽  
The Mean

Abstract Introduction Decompression of the optic nerve within the optic canal is indicated for compressive visual decline. The two most common approaches utilized for optic canal decompression are a medial approach with an endoscopic endonasal approach and a lateral approach with a craniotomy. Our study is a cadaveric anatomical study comparing the length and circumference of the orbit decompressed via an endoscopic endonasal approach versus a frontotemporal craniotomy. Methods Five cadaveric specimens were utilized. Predissection computed tomography (CT) scans were performed on each specimen. On each specimen, a standard frontotemporal craniotomy with anterior clinoidectomy and superolateral orbital decompression was performed on one side and an endoscopic endonasal approach with medial wall decompression was performed on the contralateral side. Post-dissection CT scans were performed. An independent radiologist provided measurements of the length (mm) and circumference (degrees) of optic canal decompression bilaterally. Results The mean length of optic canal decompression for open and endoscopic approach was 13 mm (range 12–15 mm) and 12.4 mm (range 10–16 mm), respectively. The mean circumference of decompression for open and endoscopic approaches was 252.8 degrees (range 205–280 degrees) and 124.6 degrees (range 100–163 degrees), respectively. Conclusion The endoscopic endonasal and the transcranial approaches provide a similar length of optic canal decompression, but the transcranial approach leads to greater circumferential decompression. The endoscopic endonasal approach has the benefit of being minimally invasive, though. Ultimately, the surgical approach decision should be based on the location of the pathology and the surgeon's comfort.

Endoscopic Endonasal Approach for Urgent Decompression of Craniovertebral Junction in Syringobulbia

2019 ◽  
Vol 130 ◽  
pp. 499-505
Author(s):  
Paolo Pacca ◽  
Nicola Marengo ◽  
Giuseppe Di Perna ◽  
Federica Penner ◽  
Marco Ajello ◽  
...  
Keyword(s):  
Craniovertebral Junction ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Endoscopic Endonasal
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