An Alternative Method of Endoscopic Intrasphenoidal Vidian Neurectomy

Objective To develop an easy surgical approach to facilitate clinical management. Study Design A novel transnasal endoscopic 3-step surgical method for vidian neurectomy was designed and tried in 91 cases with a mild-to-severe degree of allergic and nonallergic rhinitis refractory to routine medical therapy. Setting Endoscopic vidian neurectomy requires accurate localization of the vidian canal. However, it is not easy to localize during surgery because of its deep location and the complex anatomy of the pterygopalatine fossa. Subjects and Methods This technique consists of 3 steps, including transnasal endoscopic perforation of the anterior wall of the sphenoidal sinus as the first step and removal of the anterior wall until the exposure of the vidian canal in the junction between the anterior wall and the floor of the sphenoid sinus as the second step. The last step is the accurate resection and cauterization of the vidian nerve. In some cases in which the sphenoid sinus developed well with a big lateral space, an extended procedure of posterior ethmoidectomy was included to allow good exposure of the vidian canal. Results Using this technique, successful endoscopic vidian neurectomy in this series of patients was confirmed by both histology and Schirmer test, showing its distinct advantages of easy localization of the vidian canal and less risk of injury to the nerve and vessel bundles within the pterygopalatine fossa. Conclusion Taken together, this novel 3-step procedure of endoscopic vidian neurectomy plus an extended procedure guarantees good exposure of the vidian canal and therefore accurate vidian neurectomy.

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MICROSURGICAL AND ENDOSCOPIC ANATOMY OF THE VIDIAN CANAL

Operative Neurosurgery ◽

10.1227/01.neu.0000338945.54863.d9 ◽

2009 ◽

Vol 64 (suppl_5) ◽

pp. ons385-ons412 ◽

Cited By ~ 15

Author(s):

Shigeyuki Osawa ◽

Albert L. Rhoton ◽

Askin Seker ◽

Satoru Shimizu ◽

Kiyotaka Fujii ◽

...

Keyword(s):

Cavernous Sinus ◽

Sphenoid Sinus ◽

Posterior Part ◽

Pterygopalatine Fossa ◽

Sphenoid Bone ◽

Petrous Apex ◽

Maxillary Artery ◽

Medial Part ◽

Vidian Nerve ◽

Vidian Canal

Abstract OBJECTIVE The vidian canal, the conduit through the sphenoid bone for the vidian nerve and artery, has become an important landmark in surgical approaches to the cranial base. The objective of this study was to examine the anatomic features of the vidian canal, nerve, and artery, as well as the clinical implications of our findings. METHODS Ten adult cadaveric specimens and 10 dried skulls provided 40 vidian canals for examination with ×3 to ×20 magnification and the endoscope. RESULTS The paired vidian canals are located in the skull base along the line of fusion of the pterygoid process and body of the sphenoid bone. The canal opens anteriorly into the medial part of the pterygopalatine fossa and posteriorly at the upper part of the anterolateral edge of the foramen lacerum. The vidian nerve, when followed posteriorly, reaches the lateral surface of the anterior genu of the petrous carotid and the anteromedial part of the cavernous sinus where the nerve is continuous with the greater petrosal nerve. The bone surrounding the upper part of 12 of 20 vidian canals protruded into the floor of the sphenoid sinus and one canal had a bony dehiscence that exposed its contents under the sinus mucosa. Nine petrous carotid arteries (45%) gave rise to a vidian artery, all of which anastomosed with the vidian branch of the maxillary artery in the vidian canal or pterygopalatine fossa. The vidian canal can be exposed by opening the floor of the sphenoid sinus, the posterior wall of the maxillary, the posterior part of the lateral wall of the nasal cavity, and the medial part of the floor of the middle fossa. CONCLUSION The vidian canal and nerve are important landmarks in accessing the anterior genu of the petrous carotid, anteromedial part of the cavernous sinus, and petrous apex.

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The Anterior Wall of the Sphenoid Sinus

Ear Nose & Throat Journal ◽

10.1177/014556139407300705 ◽

1994 ◽

Vol 73 (7) ◽

pp. 446-448 ◽

Cited By ~ 4

Author(s):

Gady Har-El

Keyword(s):

Sphenoid Sinus ◽

Anterior Wall

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A Case of Adult T-cell Leukemia-lymphoma (Acute Type) Occurring from the Pterygopalatine Fossa to the Sphenoid Sinus

Practica Oto-Rhino-Laryngologica ◽

10.5631/jibirin.108.775 ◽

2015 ◽

Vol 108 (10) ◽

pp. 775-781

Author(s):

Hiromi Nagano ◽

Yumi Miyamoto ◽

Tomohiro Jimura ◽

Hiroyuki Iuchi ◽

Yuichi Kurono

Keyword(s):

T Cell ◽

Sphenoid Sinus ◽

Pterygopalatine Fossa ◽

Acute Type ◽

T Cell Leukemia ◽

Cell Leukemia ◽

Adult T Cell Leukemia

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Sublabial rhinoseptoplastic technique for transsphenoidal pituitary surgery by a hinged-septum method

Journal of Neurosurgery ◽

10.3171/jns.1980.52.6.0867 ◽

1980 ◽

Vol 52 (6) ◽

pp. 867-870 ◽

Cited By ~ 22

Author(s):

Takanori Fukushima ◽

Keiji Sano

Keyword(s):

Sphenoid Sinus ◽

Sella Turcica ◽

Pituitary Surgery ◽

Anterior Wall ◽

Surgical Instruments ◽

En Bloc ◽

Content Type ◽

Anterior Nasal Spine ◽

Transsphenoidal Pituitary Surgery ◽

Mucosal Perforation

✓ A new modification of the transseptal, transsphenoidal approach to the sella turcica is described. The procedure consists of unilateral dissection of the septal mucosa through a sublabial route, and retraction of the entire nasal septum with its upper attachment as a hinge. For mobilization of the septum, an L-shaped osteotomy is made along the base of the septum and along the anterior wall of the sphenoid sinus. It provides adequate exposure of the sphenoid sinus while preserving the septal structures. The anterior nasal spine and the edges of the nares are also left intact. The anterior wall of the sphenoid sinus is resected en bloc and is used as a bone splint for the reconstruction of the sellar floor. This approach has been performed in 45 cases of pituitary adenoma, one of craniopharyngioma, and one with sphenoid mucocele. There was no instance of complications such as mucosal perforation, septal deformity, or infection. Modifications of the surgical instruments used are described.

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A Case Report of Inflammatory Myofibroblastic Tumor of the Sphenoidal Sinus

Ear Nose & Throat Journal ◽

10.1177/01455613211065990 ◽

2021 ◽

pp. 014556132110659

Author(s):

Shuo Wu ◽

Feitong Jian

Keyword(s):

Radiation Therapy ◽

Sphenoid Sinus ◽

Rare Case ◽

Inflammatory Myofibroblastic Tumor ◽

Soft Tissues ◽

Complete Resection ◽

Sphenoidal Sinus ◽

Molecular Targeted Drug ◽

Primary Origin ◽

Targeted Drug

Inflammatory myofibroblastic tumor (IMT) is a tumor composed of differentiated myofibroblastic spindle-shaped cells. It occurs in the soft tissues of the abdomen and lungs, and is very rare in the sphenoid sinus. The diagnosis depends on histopathology and immunohistochemistry, and is easily misdiagnosed. Although metastasis is rare, the recurrence rate is high. Surgical resection is the treatment of choice, and where complete resection is difficult, radiation therapy, hormonal therapy, or molecular targeted drug therapy can be administered. We report a rare case of IMT with a primary origin in the sphenoid sinus, which was entirely resected by nasal endoscopy and confirmed by histological examination.

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Reconstruction of the Anterior Wall of the Sphenoid Sinus with a Composite Osteomucosal Middle Turbinate Pedicled Flap

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0034-1370575 ◽

2014 ◽

Vol 75 (S 01) ◽

Author(s):

Mark Toma ◽

Robert Engle ◽

Maria Peris-Celda ◽

Tyler Kenning ◽

Carlos Pinheiro-Neto

Keyword(s):

Sphenoid Sinus ◽

Middle Turbinate ◽

Anterior Wall ◽

Pedicled Flap

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New Endoscopic Instruments for Paranasal Sinus Surgery

Otolaryngology ◽

10.1016/j.otohns.2005.05.046 ◽

2005 ◽

Vol 133 (3) ◽

pp. 444-449 ◽

Cited By ~ 9

Author(s):

Klaus Bumm ◽

Jochen Wurm ◽

Christopher Bohr ◽

Johannes Zenk ◽

Heinrich Iro

Keyword(s):

Paranasal Sinus ◽

Sphenoid Sinus ◽

Computer Navigation ◽

Anterior Wall ◽

Visual Surveillance ◽

Sinus Surgery ◽

Multiple Features ◽

Paranasal Sinus Surgery ◽

Drill Holes ◽

New Instruments

BACKGROUND: Minimally invasive endoscopic and microscopic procedures represent state of the art paranasal sinus surgery techniques in both diagnostic and surgical fields. To combine favorable aspects of both techniques, we evaluated the clinical applicability and effectiveness of multifunctional microendoscopes, providing multiple features to ensure highest accuracy and surveillance when performing crucial steps in paranasal sinus surgery. METHODS: The study included both anatomic experiments on cadaveric heads and clinical tests on patients undergoing routine paranasal surgery. The systems applicability was evaluated in procedures approaching the frontal and sphenoid sinus. Three different endoscopes, 2 straight and the other 1 with a 90° angle, were tested. They integrate canals for flushing and suction and a working canal for either drilling or obtaining biopsies with a miniaturized forceps. For stereotactic feedback, the applicability in combination with a computer-navigation system was evaluated. RESULTS: Anatomic tests were performed to optimize illumination and to test drilling features and forceps biopsies. In all cases, the frontal sinus ostium and the sphenoid sinus anterior wall was easily identified and enlarged by drilling under visual and stereotactic control. Continuous suction and irrigation ensured a constant visual surveillance by removing drilling debris and blood. Best suited for multifunctional endoscopic surgery were drill heads with a cylinder shape, for placing bore holes along the Z axis, and spherical drill heads, for furbishing and enlarging drill holes. CONCLUSION: These new instruments have proven their applicability in paranasal sinus surgery. Multifunctional endoscopic procedures were deemed best suited for maneuvers requiring highest precision, such as the surgery of the frontal and sphenoid sinus.

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25 Sphenopalatine Foramen, Pterygopalatine Fossa, and Vidian Canal

Endoscopic Sinonasal Dissection Guide ◽

10.1055/b-0037-145188 ◽

2017 ◽

Keyword(s):

Pterygopalatine Fossa ◽

Sphenopalatine Foramen ◽

Vidian Canal

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Unilateral hemiplegia: a unique complication of septoplasty

The Journal of Laryngology & Otology ◽

10.1017/s0022215113001436 ◽

2013 ◽

Vol 127 (8) ◽

pp. 809-810 ◽

Cited By ~ 3

Author(s):

L D'Ascanio ◽

L Cappiello ◽

F Piazza

Keyword(s):

Informed Consent ◽

Surgical Technique ◽

Sphenoid Sinus ◽

Simple Procedure ◽

Anterior Wall ◽

Informed Consent Process ◽

Consent Process ◽

Partial Recovery ◽

Nasal Airway ◽

Wide Range

AbstractBackground:Septoplasty is one of the most common otolaryngological operations. It is often dismissed as a simple procedure, despite the wide range of potential complications. We describe the first reported case of unilateral hemiplegia as a complication of septoplasty.Methods and results:A 51-year-old man presented with right hemiplegia following a septoplasty and turbinoplasty procedure carried out elsewhere. Cranial imaging showed a breakthrough fracture of the left sphenoid sinus anterior wall and clivus, with a haemorrhagic area in the left paramedian pons, which was responsible for the patient's right hemiplegia. Despite neurological and physiotherapeutic rehabilitation, the patient gained only partial recovery from his right hemiplegia.Conclusion:Good intra-operative visualisation and appropriate surgical technique are essential to prevent complications and achieve a functional nasal airway. The importance of the presented case to the pre-operative informed consent process is underlined.

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