scholarly journals Image-guided endonasal endoscopic excision of Meckel’s cave trigeminal schwannoma from cavernous and petrous carotid artery

2020 ◽  
Vol 2020 (9) ◽  
Author(s):  
Ali Almomen ◽  
Amal Alyousif ◽  
Zainab Ali ◽  
Ibrahim Al Yaeesh ◽  
Ahmed AlOmirin ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Infratemporal Fossa ◽  
Cranial Nerves ◽  
Endoscopic Removal ◽  
Anatomical Structures ◽  
Image Guided ◽  
Accurate Localization ◽  
Trigeminal Schwannoma ◽  
Cavernous Carotid Artery ◽  
Ct And Mri

Abstract Trigeminal schwannoma is the second most common schwannoma after vestibular schwannoma. Symptoms vary depending on the anatomical structures affected by the tumor, including facial pain, paresthesia, dizziness and ataxia. The primary goals are controlling the symptoms and the maintenance of cranial nerves’ integrity perioperatively. We report a 39-year-old lady who was complaining of mild right-sided headache, vision and hearing loss, right facial weakness and dysphagia. CT and MRI showed a large dumbbell-shaped tumor originating from the trigeminal fossa abutting the petrous and cavernous carotid artery and extending to the infratemporal fossa. An image-guided endonasal endoscopic removal was successfully done. Image-guided endonasal endoscopic removal of a trigeminal schwannoma abutting the petrous and cavernous carotid artery and extending to the infratemporal fossa is a safe, effective approach, as it offers excellent visualization, accurate localization and safe dissection of the tumor from the critical anatomical neurovascular structures surrounding it.

Zygomatic Approach to Cavernous Sinus Chordoma: 2-Dimensional Operative Video

2021 ◽  
Author(s):  
Antonio Aversa ◽  
Ossama Al-Mefty
Keyword(s):  
Carotid Artery ◽  
Cavernous Sinus ◽  
Infratemporal Fossa ◽  
Cranial Nerves ◽  
Radical Resection ◽  
High Rate ◽  
Petrous Apex ◽  
High Dose ◽  
Middle Fossa ◽  
Cavernous Carotid Artery

Abstract Chordoma is not a benign disease. It grows invasively, has a high rate of local recurrence, metastasizes, and seeds in the surgical field.1 Thus, chordoma should be treated aggressively with radical resection that includes the soft tissue mass and the involved surrounding bone that contains islands of chordoma.2–5 High-dose radiation, commonly by proton beam therapy, is administered after gross total resection for long-term control. About half of chordoma cases occupy the cavernous sinus space and resecting this extension is crucial to obtain radical resection. Fortunately, the cavernous sinus proper extension is the easier part to remove and pre-existing cranial nerves deficit has good chance of recovery. As chordomas originate and are always present extradurally (prior to invading the dura), an extradural access to chordomas is the natural way for radical resection without brain manipulation. The zygomatic approach is key to the middle fossa, cavernous sinus, petrous apex, and infratemporal fossa; it minimizes the depth of field and is highly advantageous in chordoma located mainly lateral to the cavernous carotid artery.6–12 This article demonstrates the advantages of this approach, including the mobilization of the zygomatic arch alleviating temporal lobe retraction, the peeling of the middle fossa dura for exposure of the cavernous sinus, the safe dissection of the trigeminal and oculomotor nerves, and total control of the petrous and cavernous carotid artery. Tumor extensions to the sphenoid sinus, sella, petrous apex, and clivus can be removed. The patient is a 30-yr-old who consented for surgery.

Microsurgical and Endoscopic Anatomy of the Extended Retrosigmoid Inframeatal Infratemporal Approach

2015 ◽  
Vol 11 (1) ◽  
pp. 181-189 ◽  
Author(s):  
Roberto Colasanti ◽  
Al-Rahim A Tailor ◽  
Mehrnoush Gorjian ◽  
Jun Zhang ◽  
Mario Ammirati
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Infratemporal Fossa ◽  
Cranial Nerves ◽  
Jugular Foramen ◽  
Sigmoid Sinus ◽  
Mean Width ◽  
Infratemporal Approach ◽  
Cervical Internal Carotid Artery

AbstractBACKGROUNDDifferent and often complex routes are available to deal with jugular foramen tumors with extracranial extension.OBJECTIVETo describe a novel extension of the retrosigmoid approach useful to expose the extracranial area abutting the posterior fossa skull base.METHODSA navigation-guided, endoscope-assisted retrosigmoid inframeatal approach was performed on 6 cadaveric heads in the semisitting position, displaying an area from the internal acoustic meatus to the lower cranial nerves and exposing the intrapetrous internal carotid artery. We then continued removing the temporal bone located between the sigmoid sinus and the hearing apparatus, reaching the infratemporal area just lateral to the jugular fossa. This drilling, which we refer to as posterolateral inframeatal drilling, has not previously been described. Drilling of the horizontal segment of the occipital squama allowed good visualization of the uppermost cervical internal carotid artery, internal jugular vein, and lower extracranial cranial nerves.RESULTSWe were able to provide excellent exposure of the inframeatal area and of the posterior infratemporal fossa from different operative angles, preserving the neurovascular structures and the labyrinth in all specimens. The intradural operative window on the extracranial compartment was limited by the venous sinuses and the hearing apparatus and presented a mean width of 8.52 mm. Sigmoid sinus transection led to better visualization of the lateral half of the jugular foramen and of the uppermost cervical internal carotid artery.CONCLUSIONThe navigation-guided endoscope-assisted extended retrosigmoid inframeatal infratemporal approach provides an efficient and versatile route for resection of jugular foramen tumors with extracranial extension.

scholarly journals Giant cavernous carotid aneurysm with spontaneous ipsilateral ICA occlusion: Report of 2 cases and review of literature

2013 ◽  
Vol 04 (S 01) ◽  
pp. S113-S116 ◽  
Author(s):  
Savitr BV Sastri ◽  
Nishanth Sadasiva ◽  
Paritosh Pandey
Keyword(s):  
Carotid Artery ◽  
Internal Carotid ◽  
Thrombus Formation ◽  
Treatment Options ◽  
Cranial Nerves ◽  
Review Of Literature ◽  
Giant Aneurysms ◽  
Cavernous Carotid Aneurysm ◽  
Cavernous Carotid Artery ◽  
Endovascular Devices

ABSTRACTGiant aneurysms of the cavernous carotid artery are rare entities which present predominantly with features of compression of the adjacent neural structures, most commonly the III, IV, VI and V cranial nerves. Historically, treatment options included occlusion of the feeding vessel, direct surgery on the aneurysm, bypass procedures and in recent times, the use of endovascular devices. While intramural thrombus formation is commonly seen in giant aneurysms, we present 2 cases of giant cavernous aneurysms which on evaluation were found to have spontaneous occlusion of the feeding internal carotid artery secondary to thrombus formation, and review the available literature regarding the same.

scholarly journals Unsuspected Paraganglioma—Infratemporal Fossa

2020 ◽  
Author(s):  
Nikhat Sultana J ◽  
Shekhar R. Gurrala ◽  
Lakshman K. Kommula ◽  
Gnana R. Boola
Keyword(s):  
Carotid Artery ◽  
Anesthetic Management ◽  
Infratemporal Fossa ◽  
Hemodynamic Instability ◽  
Morbidity And Mortality ◽  
Significant Morbidity ◽  
Close Proximity ◽  
Low Threshold ◽  
Ct And Mri

AbstractParaganglioma of the infratemporal fossa is exceedingly rare, with no more than a handful of documented cases. Undiagnosed paraganglioma poses a great challenge. We present a 39-year-old hypertensive female, who presented with giddiness and headache for 3 months and four episodes of syncope over 3 months. CT and MRI revealed an enhancing infratemporal region space-occupying mass close proximity to petrous carotid artery. Intraoperatively, the patient had hemodynamic instability (tachycardia and hypertension) when the mass was surgically manipulated. Diagnosis of paraganglioma was suspected, based on hemodynamic instability, which was later confirmed by histopathology. Undiagnosed paraganglioma pose a great challenge to the anesthetic management. Low-threshold of suspicion has to be there to avoid significant morbidity and mortality.

scholarly journals Confounding case of seromucinous hamartoma

2021 ◽  
Vol 14 (3) ◽  
pp. e240460
Author(s):  
Neal Rajan Godse ◽  
Giuseppe Vittorio Staltari ◽  
Katherine Doeden ◽  
Grant Shale Gillman
Keyword(s):  
Myasthenia Gravis ◽  
Vocal Fold ◽  
Cranial Nerves ◽  
Vocal Fold Paralysis ◽  
Seromucinous Hamartoma ◽  
Cranial Neuropathies ◽  
Receptor Antibodies ◽  
Bony Erosion ◽  
Ct And Mri ◽  
Anti Acetylcholine

A 67-year-old man presented with progressive diplopia. On evaluation, he was noted to have bilateral palsies of cranial nerves III, IV and VI as well as a unilateral right true vocal fold paralysis. CT and MRI studies demonstrated a T2-bright left ethmoid mass with no evidence of bony erosion. Direct visualisation demonstrated a polypoid appearing mass of the left sphenoethmoid recess. Operative biopsy was pursued with final pathology demonstrating benign seromucinous hamartoma. Subsequent blood work demonstrated high titres of anti-acetylcholine receptor antibodies consistent with myasthenia gravis. The patient was started on pyridostigmine with improvement in his ocular cranial neuropathies.

Retromandibular Fossa Approach to the High Cervical Internal Carotid Artery: An Anatomic Study

2008 ◽  
Vol 62 (suppl_5) ◽  
pp. ONS363-ONS370 ◽  
Author(s):  
Yusuf Izci ◽  
Roham Moftakhar ◽  
Mark Pyle ◽  
Mustafa K. Basşkaya
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Average Length ◽  
Cranial Nerves ◽  
External Carotid Artery ◽  
External Carotid ◽  
Digastric Muscle ◽  
High Cervical ◽  
Cervical Internal Carotid Artery

Abstract Objective: Access to the high cervical internal carotid artery (ICA) is technically challenging for the treatment of lesions in and around this region. The aims of this study were to analyze the efficacy of approaching the high cervical ICA through the retromandibular fossa and to compare preauricular and postauricular incisions. In addition, the relevant neural and vascular structures of this region are demonstrated in cadaveric dissections. Methods: The retromandibular fossa approach was performed in four arterial and venous latex-injected cadaveric heads and necks (eight sides) via preauricular and postauricular incisions. This approach included three steps: 1) sternocleidomastoid muscle dissection; 2) transparotid dissection; and 3) removal of the styloid apparatus and opening of the retromandibular fossa to expose the cervical ICA with the internal jugular vein along with Cranial Nerves X, XI, and XII. Results: The posterior belly of the digastric muscle and the styloid muscles were the main obstacles to reaching the high cervical ICA. The high cervical ICA was successfully exposed through the retromandibular fossa in all specimens. In all specimens, the cervical ICA exhibited an S-shaped curve in the retromandibular fossa. The external carotid artery was located more superficially than the ICA in all specimens. The average length of the ICA in the retromandibular fossa was 6.8 cm. Conclusion: The entire cervical ICA can be exposed via the retromandibular fossa approach without neural and vascular injury by use of meticulous dissection and good anatomic knowledge. Mandibulotomy is not necessary for adequate visualization of the high cervical ICA.

Intrasaccular Detachable Platinum Coil Embolization for Traumatic Pseudoaneurysm Treatment of a Cavernous Carotid Artery

2001 ◽  
Vol 124 (2) ◽  
pp. 230-231 ◽  
Author(s):  
Sung-Won Chae ◽  
Geon Choi ◽  
Heung-Man Lee ◽  
Jae-Jun Song ◽  
Jong-Ouck Choi ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Coil Embolization ◽  
Platinum Coil ◽  
Traumatic Pseudoaneurysm ◽  
Cavernous Carotid Artery

Custom-tailored transdural anterior transpetrosal approach to ventral pons and retroclival regions

2006 ◽  
Vol 104 (1) ◽  
pp. 38-46 ◽  
Author(s):  
Hans-Jakob Steiger ◽  
Daniel Hänggi ◽  
Walter Stummer ◽  
Peter A. Winkler
Keyword(s):  
Carotid Artery ◽  
Cranial Nerves ◽  
Extent Of Resection ◽  
Venous Congestion ◽  
Petrous Apex ◽  
Anterior Transpetrosal Approach ◽  
Target Field ◽  
Custom Made ◽  
Anterior Petrosectomy ◽  
Spinal Catheter

Object The extradural anterior petrosectomy approach to the pons and midbasilar artery (mid-BA) has the main disadvantage that the extent of resection of the petrous apex cannot be as minimal as desired given that the surgical target field is not visible during bone removal. Unnecessary or excessive drilling poses the risk of injury to the internal carotid artery, vestibulocochlear organ, and seventh and eighth cranial nerves. The use of a custom-tailored transdural anterior transpetrosal approach can potentially avoid these pitfalls. Methods A technique for a transdural anterior petrosectomy was developed in the operating theater and anatomy laboratory. Following a subtemporal craniotomy and basal opening of the dura mater, the vein of Labbé is first identified and protected. Cerebrospinal fluid ([CSF] 50–100 ml) is drained via a spinal catheter. The tent is incised behind the entrance of the trochlear nerve toward the superior petrosal sinus (SPS), which is coagulated and divided. The dura is stripped from the petrous pyramid. Drilling starts at the petrous ridge and proceeds laterally and ventrally. The trigeminal nerve is unroofed. The internal acoustic meatus is identified and drilling is continued laterally as needed. The bone of the Kawase triangle toward the clivus can be removed down to the inferior petrosal sinus if necessary. Anterior exposure can be extended to the carotid artery if required. It is only exceptionally necessary to follow the greater superior petrosal nerve toward the geniculate ganglion and to expose the length of the internal acoustic canal. The modified transdural anterior petrosectomy exposure has been used in nine patients—two with a mid-BA aneurysm, two with a dural arteriovenous fistula, one with a pontine glioma, three with a pontine cavernoma, and one with a pontine abscess. In one patient with a mid-BA aneurysm, subcutaneous CSF collection occurred during the postoperative period. No CSF fistula or approach-related cranial nerve deficit developed in any of these patients. There was no retraction injury or venous congestion of the temporal lobe nor any venous congestion due to the obliteration of the SPS or the petrosal vein. Conclusions The custom-made transdural anterior petrosectomy appears to be a feasible alternative to the formal extradural approach.

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