Combined biportal unilateral endoscopic endonasal and endoscopic anterior transmaxillary approach for resection of lesions involving the infratemporal fossa

Abstract OBJECTIVE The pterygopalatine fossa is a relatively small anatomic region. Because of its rich vasculonervous contents and its connections with several intracranial and extracranial compartments, it is of particular surgical interest. Because of its deep localization and despite its small size, however, it can require extensive anatomic approaches, especially for invasive cranial base lesions. We performed a cadaveric study through a minimally invasive endoscopic endonasal approach to the pterygopalatine fossa. METHODS We studied 16 pterygopalatine fossae in eight adult cadaveric heads in which the arteries and veins were injected with latex. For visualization, we used rod-lens endoscopes, 4 mm in diameter and 18 cm in length, with 0-, 30-, 45-, and 70-degree lenses. An endonasal middle meatal transpalatine approach, an endonasal middle meatal transantral approach, and an endonasal inferior turbinectomy transantral approach were used. RESULTS The middle meatal transpalatine approach allows for medial exposure of the pterygopalatine fossa contents, the middle meatal transantral approach allows a lateral view, and the inferior turbinectomy transantral approach allows the widest view and room for surgical maneuvering in the medial and lateral compartments of the pterygopalatine fossa and the infratemporal fossa. CONCLUSION Our anatomic study shows that this approach can be considered a valid minimally invasive option to approach pterygopalatine fossa lesions.

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The Infratemporal Retro-Eustachian Transposition of the Temporoparietal Fascial Flap for Clival Reconstruction After Endoscopic Endonasal Approach: An Anatomic Conceptual Technique

Operative Neurosurgery ◽

10.1093/ons/opab105 ◽

2021 ◽

Author(s):

Giulio Cecchini ◽

Huy Q Truong ◽

Francesco Di Biase ◽

Antonio Musio ◽

Juan C Fernandez Miranda

Keyword(s):

Infratemporal Fossa ◽

Surgical Techniques ◽

Pedicled Flap ◽

Reconstruction Technique ◽

Clinical Validation ◽

Endoscopic Endonasal Approach ◽

Endoscopic Endonasal ◽

Fascial Flap ◽

The Times ◽

Lower Clivus

Abstract BACKGROUND Reconstruction after endoscopic endonasal approaches is a key element. Lower clivus reconstruction is difficult and most of the times a pedicled flap is not available. As the complexity and the dimensions of the exposure increase, a reliable reconstruction technique becomes more and more important. OBJECTIVE To describe the anatomic and technical nuances of the transposition of the temporoparietal fascial flap for lower clivus reconstruction. METHODS A specific temporoparietal fascial flap (TPFF) design and tunneling technique has been studied using 4 head specimens, microscopic and endoscopic surgical techniques, and neuronavigation. RESULTS The L-shaped flap offers several advantages. It can be tunneled directly toward the lower clivus passing through the infratemporal fossa. CONCLUSION The infratemporal retro-eustachian transposition of an L-shaped TPFF provides a vascularized tissue virtually without dimension limits. This is the only technique that allows the flap to be tunneled directly in the lower clivus with the most vascular portion being at the bottom of the defect. Clinical validation is still required since more issues may become relevant in a real-surgery setting. Though, due to its possible complications, this methodology needs further testing and should not be attempted in less experienced hands.

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Endoscopic endonasal management of trigeminal schwannomas extending into the infratemporal fossa

Journal of Clinical Neuroscience ◽

10.1016/j.jocn.2011.09.023 ◽

2012 ◽

Vol 19 (6) ◽

pp. 862-865 ◽

Cited By ~ 17

Author(s):

Qiuhang Zhang ◽

Kong Feng ◽

Chen Ge ◽

Guo Hongchuan ◽

Li Mingchu

Keyword(s):

Infratemporal Fossa ◽

Endoscopic Endonasal

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Endoscopic endonasal approach to infratemporal fossa for V2 trigeminal schwannoma

European Journal of Oral and Maxillofacial Surgery ◽

10.23736/s2532-3466.20.00211-8 ◽

2021 ◽

Vol 5 (1) ◽

Author(s):

Evaristo BELLI ◽

Aleksandr KAPITONOV ◽

Marta ZAPPALÀ

Keyword(s):

Infratemporal Fossa ◽

Endoscopic Endonasal Approach ◽

Endonasal Approach ◽

Endoscopic Endonasal ◽

Trigeminal Schwannoma

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Comparison of Endoscopic Endonasal Approach and Lateral Microsurgical Infratemporal Fossa Approach to the Jugular Foramen: An Anatomical Study

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0041-1731034 ◽

2021 ◽

Author(s):

Jianfeng Liu ◽

Carlos D. Pinheiro-Neto ◽

Dazhang Yang ◽

Eric Wang ◽

Paul A. Gardner ◽

...

Keyword(s):

Facial Nerve ◽

Infratemporal Fossa ◽

Deep Understanding ◽

Type A ◽

Jugular Foramen ◽

Anatomical Landmarks ◽

Endoscopic Endonasal Approach ◽

Endonasal Approach ◽

Endoscopic Endonasal ◽

Complex Anatomy

Abstract Objective The jugular foramen is one of the most challenging surgical regions in skull base surgery. With the development of endoscopic techniques, the endoscopic endonasal approach (EEA) has been undertaken to treat some lesions in this area independently or combined with open approaches. The purpose of the current study is to describe the anatomical steps and landmarks for the EEA to the jugular foramen and to compare it with the degree of exposure obtained with the lateral infratemporal fossa approach. Materials and Methods A total of 15 osseous structures related to the jugular foramen were measured in 33 adult dry skulls. Three silicone-injected adult cadaveric heads (six sides) were dissected for EEA and three heads (six sides) were used for a lateral infratemporal fossa approach (Fisch type A). The jugular foramen was exposed, relevant landmarks were demonstrated, and the distances between relevant landmarks and the jugular foramen were obtained. High-quality pictures were obtained. Results The jugular foramen was accessed in all dissections by using either approach. Important anatomical landmarks for EEA include internal carotid artery (ICA), petroclival fissure, inferior petrosal sinus, jugular tubercle, and hypoglossal canal. The EEA exposed the anterior and medial parts of the jugular foramen, while the lateral infratemporal fossa approach (Fisch type A) exposed the lateral and posterior parts of the jugular foramen. With EEA, dissection and transposition of the facial nerve was avoided, but the upper parapharyngeal and paraclival ICA may need to be mobilized to adequately expose the jugular foramen. Conclusion The EEA to the jugular foramen is anatomically feasible but requires mobilization of the ICA to provide access to the anterior and medial aspects of the jugular foramen. The lateral infratemporal approach requires facial nerve transposition to provide access to the lateral and posterior parts of the jugular foramen. A deep understanding of the complex anatomy of this region is paramount for safe and effective surgery of the jugular foramen. Both techniques may be complementary considering the different regions of the jugular foramen accessed with each approach.

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Endoscopic Endonasal Craniofacial Surgery for Recurrent Skull Base Meningiomas Involving the Pterygopalatine Fossa, the Infratemporal Fossa, the Orbit, and the Paranasal Sinus

World Neurosurgery ◽

10.1016/j.wneu.2018.01.041 ◽

2018 ◽

Vol 112 ◽

pp. e302-e312 ◽

Cited By ~ 4

Author(s):

Masahiro Shin ◽

Masaaki Shojima ◽

Kenji Kondo ◽

Hirotaka Hasegawa ◽

Shunya Hanakita ◽

...

Keyword(s):

Skull Base ◽

Paranasal Sinus ◽

Infratemporal Fossa ◽

Pterygopalatine Fossa ◽

Craniofacial Surgery ◽

Endoscopic Endonasal ◽

Skull Base Meningiomas

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Quantitative analysis of endoscopic endonasal approaches to the infratemporal fossa

The Laryngoscope ◽

10.1002/lary.21863 ◽

2011 ◽

Vol 121 (8) ◽

pp. 1601-1605 ◽

Cited By ~ 29

Author(s):

J. Drew Prosser ◽

Ramon Figueroa ◽

Ricardo I. Carrau ◽

Yew Kwang Ong ◽

C. Arturo Solares

Keyword(s):

Quantitative Analysis ◽

Infratemporal Fossa ◽

Endoscopic Endonasal

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Endoscopic transorbital and endonasal approach for trigeminal schwannomas: a retrospective multicenter analysis (KOSEN-005)

Journal of Neurosurgery ◽

10.3171/2019.3.jns19492 ◽

2020 ◽

Vol 133 (2) ◽

pp. 467-476 ◽

Cited By ~ 3

Author(s):

Hun Ho Park ◽

Sang Duk Hong ◽

Yong Hwy Kim ◽

Chang-Ki Hong ◽

Kyung In Woo ◽

...

Keyword(s):

Endoscopic Surgery ◽

Infratemporal Fossa ◽

Endonasal Approach ◽

Middle Fossa ◽

Surgical Morbidity ◽

Total Resection ◽

Endoscopic Endonasal ◽

Preoperative Symptom ◽

Endoscopic Transorbital ◽

Multicenter Analysis

OBJECTIVETrigeminal schwannomas are rare neoplasms with an incidence of less than 1% that require a comprehensive surgical strategy. These tumors can occur anywhere along the path of the trigeminal nerve, capable of extending intradurally into the middle and posterior fossae, and extracranially into the orbital, pterygopalatine, and infratemporal fossa. Recent advancements in endoscopic surgery have suggested a more minimally invasive and direct route for tumors in and around Meckel’s cave, including the endoscopic endonasal approach (EEA) and endoscopic transorbital superior eyelid approach (ETOA). The authors assess the feasibility and outcomes of EEA and ETOA for trigeminal schwannomas.METHODSA retrospective multicenter analysis was performed on 25 patients who underwent endoscopic surgical treatment for trigeminal schwannomas between September 2011 and February 2019. Thirteen patients (52%) underwent EEA and 12 (48%) had ETOA, one of whom underwent a combined approach with retrosigmoid craniotomy. The extent of resection, clinical outcome, and surgical morbidity were analyzed to evaluate the feasibility and selection of surgical approach between EEA and ETOA based on predominant location of trigeminal schwannomas.RESULTSAccording to predominant tumor location, 9 patients (36%) had middle fossa tumors (Samii type A), 8 patients (32%) had dumbbell-shaped tumors located in the middle and posterior cranial fossae (Samii type C), and another 8 patients (32%) had extracranial tumors (Samii type D). Gross-total resection (GTR, n = 12) and near-total resection (NTR, n = 7) were achieved in 19 patients (76%). The GTR/NTR rates were 81.8% for ETOA and 69.2% for EEA. The GTR/NTR rates of ETOA and EEA according to the classifications were 100% and 50% for tumors confined to the middle cranial fossa, 75% and 33% for dumbbell-shaped tumors located in the middle and posterior cranial fossae, and 50% and 100% for extracranial tumors. There were no postoperative CSF leaks. The most common preoperative symptom was trigeminal sensory dysfunction, which improved in 15 of 21 patients (71.4%). Three patients experienced new postoperative complications such as vasospasm (n = 1), wound infection (n = 1), and medial gaze palsy (n = 1).CONCLUSIONSETOA provides adequate access and resectability for trigeminal schwannomas limited in the middle fossa or dumbbell-shaped tumors located in the middle and posterior fossae, as does EEA for extracranial tumors. Tumors predominantly involving the posterior fossa still remain a challenge in endoscopic surgery.

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