The Course of the Lesser Petrosal Nerve on the Middle Cranial Fossa

2007 ◽  
Vol 61 (suppl_3) ◽  
pp. ONS-15-ONS-23 ◽  
Author(s):  
Yukinari Kakizawa ◽  
Hiroshi Abe ◽  
Yutaka Fukushima ◽  
Kazuhiro Hongo ◽  
Hatem El-Khouly ◽  
...  
Keyword(s):  
Skull Base ◽  
Middle Cranial Fossa ◽  
Surgical Approaches ◽  
Geniculate Ganglion ◽  
Middle Fossa ◽  
Greater Petrosal Nerve ◽  
Three Bundles ◽  
Thin Bone ◽  
Cranial Fossa

Abstract Objective: The course of the lesser petrosal nerve is not well understood and may be confused with the course of the greater petrosal nerve during middle fossa surgery. The objective was to examine the course of the lesser petrosal nerve along the floor of the middle cranial fossa from the region of the geniculate ganglion to its outlet from the skull base. There are no studies focused on the course of this nerve in relationship to the floor of the middle cranial fossa. Methods: Twenty middle fossae from adult cadaveric specimens were examined using 3 to 40× magnification. Results: The lesser petrosal nerve was partially exposed on the floor of the middle fossa without drilling in 75% of the middle fossae and totally covered by thin bone in 25%. It crossed the floor anterior to the greater petrosal nerve and exited the middle fossa through the canaliculus innominatus in 14 cases, foramen spinosum in 3 cases, and the sphenopetrosal suture in 3 cases. The course of the lesser petrosal nerve has been shown in textbooks to be parallel to the greater petrosal nerve. However, the lesser and greater petrosal nerves diverged in the area medial to the geniculate ganglion in 90% of middle fossae with the angle of divergence averaging 11.6 degrees. The course of the lesser petrosal nerve was divided into three patterns based on the site of confluence of the three bundles of fibers forming the nerve. Conclusion: The relationships of the lesser petrosal nerve in the middle cranial fossa have been described. An understanding of these relationships will reduce the likelihood of it being confused with the greater petrosal nerve during surgical approaches to the middle fossa.

Blood Supply of the Facial Nerve in the Middle Fossa: The Petrosal Artery

2008 ◽  
Vol 62 (suppl_5) ◽  
pp. ONS297-ONS304 ◽  
Author(s):  
Hatem El-Khouly ◽  
Juan Fernandez-Miranda ◽  
Albert L. Rhoton
Keyword(s):  
Facial Nerve ◽  
Middle Cranial Fossa ◽  
Middle Meningeal Artery ◽  
Sole Source ◽  
Geniculate Ganglion ◽  
Nerve Supply ◽  
Middle Fossa ◽  
Greater Petrosal Nerve ◽  
Cranial Fossa ◽  
Meningeal Artery

Abstract Objective: To define the arterial supply to the facial nerve that crosses the floor of the middle cranial fossa. Methods: Twenty-five middle fossae from adult cadaveric-injected specimens were examined under 3 to 40× magnification. Results: The petrosal branch of the middle meningeal artery is the sole source of supply that crossed the floor of the middle fossa to irrigate the facial nerve. The petrosal artery usually arises from the first 10-mm segment of the middle meningeal artery after it passes through the foramen spinosum, but it can arise within or just below the foramen spinosum. The petrosal artery is commonly partially or completely hidden in the bone below the middle fossa floor. It most commonly reaches the facial nerve by passing through the bone enclosing the geniculate ganglion and tympanic segment of the nerve and less commonly by passing through the hiatus of the greater petrosal nerve. The petrosal artery frequently gives rise to a branch to the trigeminal nerve. The middle meningeal artery was absent in one of the 25 middle fossae, and a petrosal artery could not be identified in four middle fossae. The petrosal arteries were divided into three types based on their pattern of supply to the facial nerve. Conclusion: The petrosal artery is at risk of being damaged during procedures in which the dura is elevated from the floor of the middle fossa, the middle fossa floor is drilled, or the middle meningeal artery is embolized or sacrificed. Several recommendations are offered to avoid damaging the facial nerve supply while performing such interventions.

scholarly journals Temporal Lobe Encephalocele Appearing as a Lytic Lesion of the Skull Base and Pterygoid Process

2003 ◽  
Vol 82 (4) ◽  
pp. 269-275 ◽  
Author(s):  
William E. Bolger ◽  
Christine Reger
Keyword(s):  
Skull Base ◽  
Brain Tissue ◽  
Unusual Case ◽  
Middle Cranial Fossa ◽  
Ethmoid Sinus ◽  
Lytic Lesion ◽  
Middle Fossa ◽  
Pterygoid Process ◽  
Cranial Fossa ◽  
Uncommon Condition

Meningoencephalocele is an uncommon condition in which brain tissue, meninges, or both protrude through a defect in the anterior cranial fossa and into the ethmoid sinus or nasal cavity. Much less often, brain tissue, meninges, or both protrude through a defect in the middle cranial fossa and into the sphenoid sinus. We report an unusual case of a middle fossa encephalocele that appeared as a lytic lesion of the skull base. The patient was treated successfully via a unique endoscopic transpterygoid approach—that is, an endoscopic approach through the maxillary sinus and pterygopalatine fossa and into the pterygoid process.

scholarly journals Pediatric multicompartmental trigeminal schwannoma: illustrative case

2021 ◽  
Vol 1 (20) ◽  
Author(s):  
Alexander P. Landry ◽  
Vincent C. Ye ◽  
Kerry A. Vaughan ◽  
James M. Drake ◽  
Peter B. Dirks ◽  
...  
Keyword(s):  
Skull Base ◽  
Infratemporal Fossa ◽  
Middle Cranial Fossa ◽  
Surgical Approaches ◽  
Illustrative Case ◽  
Trigeminal Schwannoma ◽  
Skull Base Lesions ◽  
Cranial Fossa ◽  
Extradural Approach

BACKGROUND Trigeminal schwannoma (TS) is an uncommon and histologically benign intracranial lesion that can involve any segment of the fifth cranial nerve. Given its often impressive size at diagnosis and frequent involvement of critical neurovascular structures of the skull base, it represents a challenging entity to treat. Pediatric TS is particularly rare and presents unique challenges. Similarly, tumors with extension into multiple compartments (e.g., middle cranial fossa, posterior cranial fossa, extracranial spaces) are notoriously difficult to treat surgically. Combined or staged surgical approaches are typically required to address them, with radiosurgical treatment as an adjunct. OBSERVATIONS The authors presented the unusual case of a 9-year-old boy with a large, recurrent multicompartmental TS involving Meckel’s cave, the cerebellopontine angle, and the infratemporal fossa. Near-total resection was achieved using a frontotemporal-orbitozygomatic craniotomy with a combined interdural and extradural approach. LESSONS The case report adds to the current literature on multicompartmental TSs in children and their management. The authors also provided a simplified classification of TS that can be generalized to other skull base tumors. Given a lack of precedent, the authors intended to add to the discussion regarding surgical management of these rare and challenging skull base lesions.

Outcomes of Transzygomatic Middle Cranial Fossa Approach for Resection of Skull Base Tumors

2019 ◽  
Author(s):  
Nauman Manzoor ◽  
Silky Chotai ◽  
Robert Yawn ◽  
Reid Thompson ◽  
Alejandro Rivas
Keyword(s):  
Skull Base ◽  
Middle Cranial Fossa ◽  
Skull Base Tumors ◽  
Middle Cranial Fossa Approach ◽  
Cranial Fossa

scholarly journals The orbitopterygoid corridor as a deep keyhole for endoscopic access to the paranasal sinuses and clivus

2020 ◽  
pp. 1-10
Author(s):  
Kenichi Oyama ◽  
Kentaro Watanabe ◽  
Shunya Hanakita ◽  
Pierre-Olivier Champagne ◽  
Thibault Passeri ◽  
...  
Keyword(s):  
Nasal Cavity ◽  
Skull Base ◽  
Paranasal Sinuses ◽  
Middle Cranial Fossa ◽  
The Body ◽  
Middle Fossa Approach ◽  
Alternative Approach ◽  
Endoscopic Assistance ◽  
Skull Base Lesions ◽  
Cranial Fossa

OBJECTIVEThe anteromedial triangle (AMT) is the triangle formed by the ophthalmic (V1) and maxillary (V2) nerves. Opening of this bony space offers a limited access to the sphenoid sinus (SphS). This study aims to demonstrate the utility of the orbitopterygopalatine corridor (OPC), obtained by enlarging the AMT and transposing the contents of the pterygopalatine fossa (PPF) and V2, as an entrance to the SphS, maxillary sinus (MaxS), and nasal cavity.METHODSFive formalin-injected cadaveric specimens were used for this study (10 approaches). A classic pterional approach was performed. An OPC was created through the inferior orbital fissure, between the orbit and the PPF, by transposing the PPF inferiorly. The extent of the OPC was measured using neuronavigation and manual measurements. Two illustrative cases using the OPC to access skull base tumors are presented in the body of the article.RESULTSVia the OPC, the SphS, MaxS, ethmoid sinus (EthS), and nasal cavity could be accessed. The use of endoscopic assistance through the OPC achieved better visualization of the EthS, SphS, MaxS, clivus, and nasal cavity. A significant gain in the area of exposure could be achieved using the OPC compared to the AMT (22.4 mm2 vs 504.1 mm2).CONCLUSIONSOpening of the AMT and transposition of V2 and the contents of the PPF creates the OPC, a potentially useful deep keyhole to access the paranasal sinuses and clival region through a middle fossa approach. It is a valuable alternative approach to reach deep-seated skull base lesions infiltrating the cavernous sinus and middle cranial fossa and extending into the paranasal sinus.

scholarly journals Skull Base Trauma: Clinical Considerations in Evaluation and Diagnosis and Review of Management Techniques and Surgical Approaches

2017 ◽  
Vol 31 (04) ◽  
pp. 177-188 ◽  
Author(s):  
Soroush Farnoosh ◽  
Robert Kellman ◽  
Sherard Tatum ◽  
Jacob Feldman
Keyword(s):  
Skull Base ◽  
Surgical Approaches ◽  
Trauma Patients ◽  
Traumatic Injuries ◽  
Surgical Access ◽  
Radiographic Testing ◽  
Cranial Nerve Injury ◽  
Cranial Fossa ◽  
Skull Base Anatomy ◽  
Neurovascular Structures

AbstractTraumatic injuries to the skull base can involve critical neurovascular structures and present with symptoms and signs that must be recognized by physicians tasked with management of trauma patients. This article provides a review of skull base anatomy and outlines demographic features in skull base trauma. The manifestations of various skull base injuries, including CSF leaks, facial paralysis, anosmia, and cranial nerve injury, are discussed, as are appropriate diagnostic and radiographic testing in patients with such injuries. While conservative management is sometimes appropriate in skull base trauma, surgical access to the skull base for reconstruction of traumatic injuries may be required. A variety of specific surgical approaches to the anterior cranial fossa are discussed, including the classic anterior craniofacial approach as well as less invasive and newer endoscope-assisted approaches to the traumatized skull base.

Cribriform Adenocarcinoma of the Minor Salivary Gland (CAMSG); A Separate and Malignant Entity

2020 ◽  
Vol 154 (Supplement_1) ◽  
pp. S24-S24
Author(s):  
H Laharwani ◽  
T Woods ◽  
J Jackson ◽  
V Manucha ◽  
I Velasco
Keyword(s):  
Salivary Gland ◽  
Cell Carcinoma ◽  
Skull Base ◽  
Minor Salivary Gland ◽  
Middle Cranial Fossa ◽  
Salivary Gland Neoplasm ◽  
Left Neck ◽  
S 100 ◽  
The Face ◽  
Cranial Fossa

Abstract Introduction/Objective Cribriform adenocarcinoma of the minor salivary gland (CAMSG) is a recently described salivary gland neoplasm (SGN) that WHO includes under the polymorphous adenocarcinoma (PAC) subheading. CAMSG is reported to occur mostly in the base of the tongue and lingual tonsils. Methods We present a case of CAMSG of buccal mucosa in a 48-year old woman who presented with pain and swelling on the left side of the face that started after tooth extraction. Imaging revealed a large expansile mass (5.8 x 4.3 x 6.1 cm) originating in the left mandibular angle extending into masticator space, maxillary sinus, pterygopalatine fossa, sphenoid, middle cranial fossa, orbit and skull base. Ameloblastoma, primary intraosseous carcinoma, and squamous cell carcinoma were considered. Incisional biopsy revealed a tumor comprised of round to ovoid cells with clear to vesicular nuclei (ground-glass appearance) and occasional mitosis present in irregular solid, cribriform, and microcystic patterns in a hyalinized stroma with the presence of abundant mucin within lobules and stroma. Results Differential diagnosis of secretory carcinoma, hyalinizing clear cell carcinoma, and less likely PAC and mucoepidermoid carcinoma were considered, all inconsistent with the imaging findings. The tumor cells were positive for S100 and negative for CD117, ki67, p63, CD117, and TTF-1. Based on a prominent cribriform pattern, vesicular nuclei, and S-100 expression, a diagnosis of cribriform adenocarcinoma of minor salivary gland origin was rendered. The patient subsequently underwent left partial maxillectomy, left partial mandibulectomy, and resection of the skull base and left neck dissection and was staged as pT4bN0, with negative margins and vascular invasion. The patient underwent radiation therapy and at 6- month follow up was alive and healthy. Clinically and histologically CAMSG overlaps with tumors of both salivary and non-salivary gland origin. Conclusion Recognition of CAMSG as a distinct entity will help in accurate diagnosis and categorization in the WHO classification of SGNs.

scholarly journals Occurrence of the Foramen of Vesalius and Its Morphometry Relevant to Clinical Consideration

2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
Author(s):  
Vipavadee Chaisuksunt ◽  
Lanaprai Kwathai ◽  
Kritsana Namonta ◽  
Thanaporn Rungruang ◽  
Wandee Apinhasmit ◽  
...  
Keyword(s):  
Skull Base ◽  
Surgical Approach ◽  
Middle Cranial Fossa ◽  
Maximum Diameter ◽  
Foramen Ovale ◽  
Clinical Consideration ◽  
Cranial Fossa ◽  
Foramen Of Vesalius

All 377 dry skulls were examined for the occurrence and morphometry of the foramen of Vesalius (FV) both in the middle cranial fossa and at the extracranial view of the skull base. There were 25.9% and 10.9% of FV found at the extracranial view of the skull base and in the middle cranial fossa, respectively. Total patent FV were 16.1% (11.9% unilaterally and 4.2% bilaterally). Most FV were found in male and on the left side. Comparatively, FV at the extracranial view of the skull base had a larger maximum diameter. The distance between FV and the foramen ovale (FO) was as short as2.05±1.09 mm measured at the extracranial view of the skull base. In conclusion, although the existence of FV is inconstant, its occurrence could not be negligible. The proximity of FV to FO should remind neurosurgeons to be cautious when performing the surgical approach through FO.

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