Landmarks to Identify Petrous Apex Through Endonasal Approach Without Transgression of Sinus

Objectives The use of nasopharyngeal landmarks to localize the petrous apex has not been previously described. We describe a purely endoscopic endonasal corridor to localize the petrous apex without transgressing any of the paranasal sinuses. Methods Anatomical dissections of four formalin preserved cadaveric heads (eight petrous apices) were performed to evaluate the feasibility of a nonsinus-based approach and illustrate the surgical landmarks and measurements that are useful for surgery in this area. Results The Eustachian tubes, fossa of Rosenmüller (FR), and posterior end of the middle and inferior turbinates are constant landmarks, which can be identified without opening any nasal sinuses. The petrous apex is located on an extended straight line connecting the upper end of the torus tubarius (TT) and the roof of the FR. The distance from upper end of TT to the roof of FR measured 9.875 (±0.99) mm, and the distance from roof of the FR to the petrous apex measured 9.75 (±1) mm. Conclusion With well-defined landmarks, the inferior, medial petrous apex can be reached using the endoscopic endonasal approach without crossing the sinus cavities.

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Endoscopic Endonasal Approach to Cholesterol Granulomas of the Petrous Apex: A Series of 17 Patients

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0032-1314262 ◽

2012 ◽

Vol 73 (S 02) ◽

Author(s):

A. Paluzzi ◽

M. Koutourousiou ◽

J. Fernandez-Miranda ◽

P. Gardner ◽

C. Snyderman

Keyword(s):

Petrous Apex ◽

Endoscopic Endonasal Approach ◽

Endonasal Approach ◽

Endoscopic Endonasal

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Endoscopic Endonasal Approach to the Petrous Apex: A Retrospective Study and Outcomes

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0035-1546538 ◽

2015 ◽

Vol 76 (S 01) ◽

Author(s):

Robert Miller ◽

Maria Koutourousiou ◽

Eric Wang ◽

Juan Fernandez-Miranda ◽

Carl Snyderman ◽

...

Keyword(s):

Retrospective Study ◽

Petrous Apex ◽

Endoscopic Endonasal Approach ◽

Endonasal Approach ◽

Endoscopic Endonasal

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Contralateral Transmaxillary Corridor as an Extension to the Endoscopic Endonasal Approach to the Petrous Apex

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0036-1579949 ◽

2016 ◽

Vol 77 (S 01) ◽

Cited By ~ 1

Author(s):

Chirag Patel ◽

Juan Fernandez-Miranda ◽

Eric Wang ◽

Paul Gardner ◽

Carl Snyderman

Keyword(s):

Petrous Apex ◽

Endoscopic Endonasal Approach ◽

Endonasal Approach ◽

Endoscopic Endonasal

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Endoscopic Endonasal Approach for Petrous Apex Cholesterol Granuloma: Cases Report and Review

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0034-1383939 ◽

2014 ◽

Vol 75 (S 02) ◽

Author(s):

Mohammad Samadian ◽

Nader Dilmaghani ◽

Habibollah Moghaddasi ◽

Mohsen Vazirnezami ◽

Reza Jabbari ◽

...

Keyword(s):

Petrous Apex ◽

Cholesterol Granuloma ◽

Endoscopic Endonasal Approach ◽

Endonasal Approach ◽

Endoscopic Endonasal

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Endoscopic endonasal approach for treatment of tumors in the nasal cavity and paranasal sinuses

Toukeibu Gan ◽

10.5981/jjhnc.43.349 ◽

2017 ◽

Vol 43 (3) ◽

pp. 349-351

Author(s):

Takayuki Nakagawa

Keyword(s):

Nasal Cavity ◽

Paranasal Sinuses ◽

Endoscopic Endonasal Approach ◽

Endonasal Approach ◽

Endoscopic Endonasal

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Comparative analysis of the anterior transpetrosal approach with the endoscopic endonasal approach to the petroclival region

Journal of Neurosurgery ◽

10.3171/2015.8.jns15302 ◽

2016 ◽

Vol 125 (5) ◽

pp. 1171-1186 ◽

Cited By ~ 16

Author(s):

Jun Muto ◽

Daniel M. Prevedello ◽

Leo F. S. Ditzel Filho ◽

Ing Ping Tang ◽

Kenichi Oyama ◽

...

Keyword(s):

Abducens Nerve ◽

Direct Access ◽

Petrous Apex ◽

Horizontal Line ◽

Endoscopic Endonasal Approach ◽

Endonasal Approach ◽

Endoscopic Endonasal ◽

Petroclival Region ◽

Advantages And Disadvantages ◽

Anterior Transpetrosal Approach

OBJECTIVE The endoscopic endonasal approach (EEA) offers direct access to midline skull base lesions, and the anterior transpetrosal approach (ATPA) stands out as a method for granting entry into the upper and middle clival areas. This study evaluated the feasibility of performing EEA for tumors located in the petroclival region in comparison with ATPA. METHODS On 8 embalmed cadaver heads, EEA to the petroclival region was performed utilizing a 4-mm endoscope with either 0° or 30° lenses, and an ATPA was performed under microscopic visualization. A comparison was executed based on measurements of 5 heads (10 sides). Case illustrations were utilized to demonstrate the advantages and disadvantages of EEA and ATPA when dealing with petroclival conditions. RESULTS Extradurally, EEA allows direct access to the medial petrous apex, which is limited by the petrous and paraclival internal carotid artery (ICA) segments laterally. The ATPA offers direct access to the petrous apex, which is blocked by the petrous ICA and abducens nerve inferiorly. Intradurally, the EEA allows a direct view of the areas medial to the cisternal segment of cranial nerve VI with limited lateral exposure. ATPA offers excellent access to the cistern between cranial nerves III and VIII. The quantitative analysis demonstrated that the EEA corridor could be expanded laterally with an angled drill up to 1.8 times wider than the bone window between both paraclival ICA segments. CONCLUSIONS The midline, horizontal line of the petrous ICA segment, paraclival ICA segment, and the abducens nerve are the main landmarks used to decide which approach to the petroclival region to select. The EEA is superior to the ATPA for accessing lesions medial or caudal to the abducens nerve, such as chordomas, chondrosarcomas, and midclival meningiomas. The ATPA is superior to lesions located posterior and/or lateral to the paraclival ICA segment and lesions with extension to the middle fossa and/or infratemporal fossa. The EEA and ATPA are complementary and can be used independently or in combination with each other in order to approach complex petroclival lesions.

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