scholarly journals Anatomic Study of Endoscopic Transnasal Approach to Petrous Apex

2020 ◽  
Vol 218 ◽  
pp. 03016
Author(s):  
Wenyuan He ◽  
Qingying Qin ◽  
Guxian Wang
Keyword(s):  
Skull Base ◽  
Sphenoid Sinus ◽  
Lateral Wall ◽  
Anterior Wall ◽  
Surgical Anatomy ◽  
Petrous Apex ◽  
Transnasal Approach ◽  
Long Time ◽  
Endoscopic Transnasal Approach ◽  
Micro Drill

With the development of Neurosurgery technology, there has been a qualitative leap forward with the appearance of microanatomy, which makes the deep brain tumors which were hard to be achieved in the past, and effectively reduces the mortality of patients. Petrous apex is a cone-shaped part of the anteromedial part of the temporal bone, which is deep. It has been a challenging area for surgical anatomy for a long time. In this paper, fresh adult perfused cadaveric head specimens and dry adult cadaveric head specimens were taken as the experimental objects. The anterior wall of sphenoid sinus and the internal septum of sphenoid sinus were excised under neuroendoscope. The structures of the lateral wall of sphenoid sinus were identified and dissected. The lateral wall of sphenoid sinus and the bone of skull base were opened with micro drill, The meninges were exposed and cut open, and the related structures were dissected, observed and photographed. The experimental results show that it is relatively safe to operate in the range of less than 8mm, and the rock tip can be found accurately. The measurement of the bony structure of the skull base is helpful for the surgeon to judge the course of the internal carotid artery and its adjacent structure.

Ossifying fibromyxoid tumour of the sphenoid sinus

2009 ◽  
Vol 124 (4) ◽  
pp. 437-440
Author(s):  
S D Shetty ◽  
R J Salib ◽  
S B Nair ◽  
N Mathad ◽  
J Theaker
Keyword(s):  
Skull Base ◽  
Sphenoid Sinus ◽  
Neoplastic Disease ◽  
Clinical Effects ◽  
Soft Tissue Neoplasm ◽  
Transnasal Approach ◽  
Fibrous Stroma ◽  
Neuroectodermal Origin ◽  
Endoscopic Transnasal Approach

AbstractIntroduction:Ossifying fibromyxoid tumour is a recently described, rare but morphologically distinctive soft tissue neoplasm characterised by a combination of myxoid and/or fibrous stroma with areas of ossification. Although most authors postulate a neuroectodermal origin for this peculiar tumour, there is no agreement in the literature regarding its histopathogenesis. To our knowledge, this is the first reported case of ossifying fibromyxoid tumour involving the sphenoid sinus.Histological findings:Tumour of low cell density, composed of small, spindle-shaped or stellate cells with small, irregular nuclei set in a fibromyxoid stroma.Management:Following discussion at the skull base multidisciplinary team meeting, a combined surgical team including an otorhinolaryngologist and a neurosurgeon carried out resection of the lesion, using an endoscopic transnasal approach, followed by reconstruction of the defect.Conclusions:An awareness of the distinctive histopathological features of ossifying fibromyxoid tumour, and of its clinical effects, is crucial to establishing a definitive diagnosis and thereby instituting appropriate management. This case report also reinforces the evolving role of the endoscopic transnasal approach in the management of inflammatory and neoplastic disease involving the skull base. This is increasingly being made possible by close collaboration between multiple surgical specialties, including otorhinolaryngology and neurosurgery.

Surgical nuances for the endoscopic endonasal transpterygoid approach to lateral sphenoid sinus encephaloceles

2012 ◽  
Vol 32 (6) ◽  
pp. E5 ◽  
Author(s):  
Richard F. Schmidt ◽  
Osamah J. Choudhry ◽  
Joseph Raviv ◽  
Soly Baredes ◽  
Roy R. Casiano ◽  
...  
Keyword(s):  
Skull Base ◽  
Sphenoid Sinus ◽  
Skull Base Surgery ◽  
Surgical Anatomy ◽  
Endoscopic Endonasal ◽  
Csf Rhinorrhea ◽  
Lateral Recess ◽  
Sternberg Canal ◽  
Deep Location ◽  
Repair Techniques

Lateral sphenoid encephaloceles of the Sternberg canal are rare entities and usually present with spontaneous CSF rhinorrhea. Traditionally, these were treated via transcranial approaches, which can be challenging given the deep location of these lesions. However, with advancements in endoscopic skull base surgery, including improved surgical exposures, angled endoscopes and instruments, and novel repair techniques, these encephaloceles can be resected and successfully repaired with purely endoscopic endonasal approaches. In this report, the authors review the endoscopic endonasal transpterygoid approach to the lateral recess of the sphenoid sinus for repair of temporal lobe encephaloceles, including an overview of the surgical anatomy from an endoscopic perspective, and describe the technical operative nuances and surgical pearls for these cases. The authors also present 4 new cases of lateral sphenoid recess encephaloceles that were successfully treated using this approach.

scholarly journals Petrous Apex Granulomas: CT and MR Imaging

2002 ◽  
Vol 29 (2) ◽  
pp. 169-170 ◽  
Author(s):  
Stephen Hentschel ◽  
Felix Durity
Keyword(s):  
Sphenoid Sinus ◽  
Internal Carotid ◽  
Lateral Wall ◽  
Petrous Apex ◽  
High Signal ◽  
Horizontal Canal ◽  
Computed Tomography Scanning ◽  
History Of ◽  
Tomography Scanning ◽  
Sixth Nerve

A 29-year-old male complained of a four month history of horizontal, spontaneous, and nonprogressive diplopia. On examination he had a mild left sixth nerve palsy. The rest of his general and neurologic examinations were normal.Computed tomography scanning demonstrated a nonenhancing, well-circumscribed, lesion in the left petrous apex (Figure 1). The opposite apex was well pneumatized. The lesion abutted the medial wall of the horizontal canal of the internal carotid artery and pointed towards the lateral wall of the sphenoid sinus. Unfortunately, CT bone windows were not available for this case but would have been helpful in terms of the differential diagnosis. An MRI demonstrated a predominantly high signal mass on T1 and T2 sequences (Figure 2). The diagnosis was a petrous apex granuloma.

scholarly journals Endoscopic Transnasal Approach for Urgent Decompression of the Craniocervical Junction in Acute Skull Base Osteomyelitis

2015 ◽  
Vol 76 (01) ◽  
pp. e37-e42 ◽  
Author(s):  
Terry Burns ◽  
Stefan Mindea ◽  
Arjun Pendharkar ◽  
Nicolae Lapustea ◽  
Ioana Irime ◽  
...  
Keyword(s):  
Skull Base ◽  
Craniocervical Junction ◽  
Transnasal Approach ◽  
Skull Base Osteomyelitis ◽  
Endoscopic Transnasal Approach

Resection of a Pontine Cavernous Malformation via an Endoscopic Endonasal Approach

2012 ◽  
Vol 71 (suppl_1) ◽  
pp. onsE186-onsE194 ◽  
Author(s):  
Matthew M. Kimball ◽  
Stephen B. Lewis ◽  
John W. Werning ◽  
J D. Mocco
Keyword(s):  
Skull Base ◽  
Surgical Resection ◽  
Conservative Management ◽  
Cavernous Malformation ◽  
Gross Total Resection ◽  
Total Resection ◽  
Transnasal Approach ◽  
Acute Hemorrhage ◽  
Cavernous Malformations ◽  
Endoscopic Transnasal Approach

Abstract BACKGROUND AND IMPORTANCE: Cavernous malformations of the brainstem are a dilemma in terms of deciding when to operate, and they remain difficult to access surgically. We present a novel approach for the resection of a brainstem cavernous malformation CLINICAL PRESENTATION: A 59-year-old woman presented with a 1-month history of intermittent dysarthria, right facial weakness, and left arm and leg weakness. A magnetic resonance image revealed a 2-cm mass in the pons with blood products of differing ages, consistent with a cavernous malformation. We discussed with her the risks of surgical resection and conservative management. She decided to pursue conservative management. Two weeks later, she returned to the emergency room with diplopia and left-sided hemiplegia. Acute hemorrhage within the right pons was seen. She then chose to undergo surgical resection. CONCLUSION: The patient underwent an endoscopic transnasal approach for resection of a pontine cavernous malformation. Image guidance was used to identify key anatomic landmarks. A gross total resection was achieved without new neurological deficits. With physical and occupational therapy, the patient developed antigravity strength in her left upper and lower extremities before discharge. At her 4-week follow-up, she was ambulating independently with the assistance of a cane. We report the successful gross total resection of a pontine cavernous malformation via an endoscopic transnasal approach. This patient had improvement in neurological symptoms after surgical resection with minimal surgical morbidity. Technologic advances in endoscopic skull base approaches have provided access to lesions of the skull base previously requiring more invasive approaches.

scholarly journals Delayed Spontaneous Cerebrospinal Leak through Clival Recess: Emphasis on Technique of Repair

2017 ◽  
Vol 10 (1) ◽  
pp. 42-44
Author(s):  
Satyawati Mohindra ◽  
Sandeep Mohindra ◽  
Kiran Joshi ◽  
Harsimrat S Sodhi
Keyword(s):  
Magnetic Resonance ◽  
Sphenoid Sinus ◽  
Lateral Wall ◽  
Csf Leak ◽  
Nasal Discharge ◽  
Transnasal Approach ◽  
Csf Rhinorrhea ◽  
Repeat Magnetic Resonance Imaging ◽  
Computed Tomographic ◽  
General Physical

ABSTRACT Objective To report a rare case of delayed spontaneous cerebrospinal fluid (CSF) leak through clival region in the sphenoid sinus. Case report A 35-year-old female presented to our outdoor clinic with watery right nasal discharge for past 2 months, which increased on bending forward. Her medical history, general physical and neurological examinations were unremarkable. High-resolution computed tomographic scan and magnetic resonance cisternography were performed and suggestive of defect in right cribriform plate and right sphenoid sinus. Endoscopic repair was done but same symptoms occurred after 1 month. Repeat magnetic resonance imaging showed fistula in the lateral wall of right sphenoid sinus. Revision endoscopic transnasal CSF rhinorrhea repair was done. Lumbar subarachnoid drain was left in place for 5 days. No recurrence was noted at 12-week follow-up. Conclusion Endoscopic transnasal approach is the best modality of treatment for midline skull base defects. Delayed leaks can present from previously weak areas and all the doubtful areas must be examined during surgery. How to cite this article Mohindra S, Mohindra S, Joshi K, Sodhi HS. Delayed Spontaneous Cerebrospinal Leak through Clival Recess: Emphasis on Technique of Repair. Clin Rhinol An Int J 2017;10(1):42-44.

Endoscopic Transnasal Resection of Midline Skull Base Meningiomas: Tumor Consistency and Surgical Outcomes

2020 ◽  
Author(s):  
Hissah K. Al Abdulsalam ◽  
Aljohara K. Aldahish ◽  
Abdulrahman Albakr ◽  
Sajjad Hussain ◽  
Ahmad Alroqi ◽  
...  
Keyword(s):  
Skull Base ◽  
Surgical Outcomes ◽  
Transnasal Approach ◽  
Weighted Magnetic Resonance Imaging ◽  
Endoscopic Transnasal Approach ◽  
Cerebellar Peduncle ◽  
Magnetic Resonance Imaging Mri ◽  
Skull Base Meningiomas ◽  
Tumor Consistency ◽  
Traditional Approaches

Abstract Background The endoscopic transnasal approach (ETA) has proven to be of great value in the resection of midline skull base meningiomas when compared with traditional approaches. Our objective was to assess tumor consistency in relation to surgical outcomes for midline meningiomas (MMs) resected using ETA. Methods Radiological preoperative features, including the tumor to cerebellar peduncle T2-weighted magnetic resonance imaging (MRI) ratio (TCTI), were evaluated. The intraoperative consistency assessment was performed by the surgeon, which determined if the tumor was soft (resectable by suction) or firm (required a cavitation ultrasonic aspirator). Surgical resection and postoperative complications were evaluated in relation to tumor consistency. Results Twenty patients were evaluated; 6 were classified as firm and 14 were classified as soft. The mean TCTI ratio was 1.7 and the median was 1.7 (range: 1.3–2.4). Three firm tumors had a ratio of <1.6. All soft tumors had a ratio of ≥1.6 with three outliers. Additionally, 66.7% of patients with firm tumors had complications compared with 35.7% of patients with soft tumors. Only 33.3% of firm tumors underwent gross total resection (GTR) in comparison to 79.0% of tumors with a soft consistency. Conclusion In our analysis, we found that tumor consistency was significantly related to short-term surgical outcomes in MMs resected using the ETA. The TCTI ratio was found to be the most reliable predictor with a sensitivity of 76.9% and a specificity of 40.0%. Our findings suggest that traditional cranial approaches should be considered as the first surgical option for managing firm MMs.

Combined external and endoscopic transnasal approach with use of a diamond burr in the removal of a fishing harpoon hook traversing bilateral sphenoid sinuses in a 22-year-old man

2021 ◽  
Vol 14 (5) ◽  
pp. e239055
Author(s):  
Jan Alexeis Lacuata ◽  
Agnes Tirona - Remulla ◽  
Arsenio Claro Cabungcal ◽  
Romiena Mae Santos
Keyword(s):  
Visual Acuity ◽  
Sphenoid Sinus ◽  
Oral Antibiotics ◽  
Orbital Apex ◽  
Transnasal Approach ◽  
Endoscopic Transnasal Approach ◽  
Diamond Burr ◽  
The Right ◽  
Sphenoid Sinuses

A 22-year old construction worker was shot with a fishing harpoon gun on the left side of his face. He consulted at the emergency room 12 days postinjury, stable but with blurring of vision on the right. The shaft of the harpoon was protruding at the left preauricular area; the tip was neither visible nor palpable. Craniofacial CT scan and skull anteroposterolateral radiographs revealed the tip of the harpoon to be at the right orbital apex. A hook attached 1 cm from the tip was lodged in the sphenoid sinus. The hook was dismantled from the shaft via a combined external and endoscopic transnasal approach, enabling the shaft to be gently pulled. The hook, together with the tip, were removed endoscopically. The patient’s visual acuity improved. He was discharged after 2 days on oral antibiotics with no deficits on follow-up.

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