Endoscopic Endonasal Approaches to Infratemporal Fossa Tumors: A Classification System & Case Series

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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Commentary: Endoscopic Endonasal Versus Transoral Odontoidectomy for Non-Neoplastic Craniovertebral Junction Disease: A Case Series

Operative Neurosurgery ◽

10.1093/ons/opab322 ◽

2021 ◽

Author(s):

Kara A Parikh ◽

L Madison Michael

Keyword(s):

Case Series ◽

Craniovertebral Junction ◽

Endoscopic Endonasal ◽

Transoral Odontoidectomy

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Non endoscopic endonasal dacryocystorhinostomy versus external dacryocystorhinostomy

Kathmandu University Medical Journal ◽

10.3126/kumj.v6i4.1731 ◽

1970 ◽

Vol 6 (4) ◽

pp. 437-442 ◽

Cited By ~ 9

Author(s):

BR Sharma

Keyword(s):

Direct Method ◽

Case Series ◽

Nasolacrimal Duct ◽

Nasolacrimal Duct Obstruction ◽

Successful Outcome ◽

Success Rates ◽

Endoscopic Endonasal ◽

Duct Obstruction ◽

Surgical Success ◽

External Dacryocystorhinostomy

Aims and Objectives: To compare the success rates of non endoscopic endonasal dacryocystorhinostomy and conventional external dacryocystorhinostomy for the surgical management of primary acquired nasolacrimal duct obstruction. Materials and methods: A retrospective, nonrandomized, comparative interventional case series of 302 patients who underwent either endonasal or external dacryocystorhinostomy over a period of 2 years. All surgeries were performed by a single surgeon and patients with primary nasolacrimal duct obstruction with a minimum of 6 months post operative follow up were included in the study. While external dacryocystorhinostomy was performed using traditional technique, endonasal dacryocystorhinostomy was performed using direct method of nonendoscopic visualization. Results: Of the 302 cases included in the study 165 patients had endonasal dacryocystorhinostomy whereas 137 underwent external dacryocystorhinostomy. Success was defined by resolution of symptoms of tearing, a negative fluorescein dye disappearance test and patency of the canalicular system on lacrimal irrigation. In the external dacryocystorhinostomy group 124 (90.5%) patients had surgical success whereas 146 (88.5%) of the endonasal dacryocystorhinostomy patients had successful outcome. The overall success rate was 89.4%, and the difference of surgical success between the two groups was not statistically significant ( P=0.57). Conclusion: Non endoscopic endonasal dacryocystorhinostomy gives surgical results comparable to those of external dacryocystorhinostomy and is a viable alternative where dacryocystorhinostomy is indicated for primary acquired nasolacrimal duct obstruction. Key words: Endonasal Dacryocystorhinostomy (ENDCR), External Dacryocystorhinostomy (EXDCR), Primary acquired nasolacrimal duct obstruction (PANLDO) doi: 10.3126/kumj.v6i4.1731 Kathmandu University Medical Journal (2008), Vol. 6, No. 4, Issue 24, 437-442

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Transorbital approach to infratemporal fossa: novel technique

The Journal of Laryngology & Otology ◽

10.1017/s002221511100003x ◽

2011 ◽

Vol 125 (6) ◽

pp. 638-642 ◽

Cited By ~ 5

Author(s):

A Mishra

Keyword(s):

Infratemporal Fossa ◽

Case Series ◽

Cerebrospinal Fluid Leakage ◽

Malignant Tumours ◽

Operative Morbidity ◽

Diagnostic Uncertainty ◽

Medical College ◽

Case Series Report ◽

Cranial Nerve Injury ◽

Considerable Morbidity

AbstractObjective:To present a conservative surgical approach, via the transorbital route, for selected cases of infratemporal fossa involvement or inferolateral orbital tumours extending to the infratemporal fossa.Design:Case series report.Setting:Department of ENT, CSM Medical University (King George Medical College), Lucknow, India.Participants:One patient.Main outcome measures:Operative feasibility, intra-operative access, post-operative morbidity and cosmesis.Results:This novel and relatively conservative technique provides excellent exposure in selected cases of infratemporal fossa involvement and has minimal post-operative morbidity. Cosmesis is excellent, as osteotomy is not required and scarring is minimal. There is no risk of trismus, Vth or VIIth cranial nerve injury, or cerebrospinal fluid leakage, and haemostasis is easily achieved.Conclusion:Classical, open approaches to the infratemporal fossa involve considerable morbidity, while conservative approaches have their limitations. Diagnostic uncertainty over a small infratemporal fossa mass (perhaps an extension from an inferolateral orbital tumour) is an uncommon clinical challenge. The transorbital approach described is suited to benign and early malignant tumours, and has excellent results when combined with orbital exenteration (if needed). This paper discusses this approach's technical details and feasibility in different clinical situations, and compares it with other infratemporal fossa approaches.

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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 transoculomotor triangle approach for adenomas invading the parapeduncular space: surgical anatomy, technical nuances, and case series

Journal of Neurosurgery ◽

10.3171/2017.10.jns17779 ◽

2019 ◽

Vol 130 (4) ◽

pp. 1304-1314 ◽

Cited By ~ 7

Author(s):

Cristian Ferrareze Nunes ◽

Stefan Lieber ◽

Huy Q. Truong ◽

Georgios Zenonos ◽

Eric W. Wang ◽

...

Keyword(s):

Cavernous Sinus ◽

Case Series ◽

Surgical Anatomy ◽

Oculomotor Nerve ◽

Oculomotor Nerve Palsy ◽

Tumor Extension ◽

Endoscopic Endonasal ◽

Transcranial Approach ◽

Surgical Corridor ◽

Dural Opening

OBJECTIVEPituitary adenomas may extend into the parapeduncular space by invading through the roof of the cavernous sinus. Currently, a transcranial approach is the preferred choice, with or without the combination of an endonasal approach. In this paper the authors present a novel surgical approach that takes advantage of the natural corridor provided by the tumor to further open the oculomotor triangle and resect tumor extension into the parapeduncular space.METHODSSix injected specimens were used to demonstrate in detail the surgical anatomy related to the approach. Four cases in which the proposed approach was used were retrospectively reviewed.RESULTSFrom a technical perspective, the first step involves accessing the superior compartment of the cavernous sinus. The interclinoid ligament should be identified and the dura forming the oculomotor triangle exposed. The oculomotor dural opening may be then extended posteriorly toward the posterior petroclinoidal ligament and inferolaterally toward the anterior petroclinoidal ligament. The oculomotor nerve should then be identified; in this series it was displaced superomedially in all 4 cases. The posterior communicating artery should also be identified to avoid its injury. In all 4 cases, the tumor invading the parapeduncular space was completely removed. There were no vascular injuries and only 1 patient had a partial oculomotor nerve palsy that completely resolved in 2 weeks.CONCLUSIONSThe endoscopic endonasal transoculomotor approach is an original alternative for removal of tumor extension into the parapeduncular space in a single procedure. The surgical corridor is increased by opening the dura of the oculomotor triangle and by working below and lateral to the cisternal segment of the oculomotor nerve.

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