MICROSURGICAL AND ENDOSCOPIC ANATOMY OF THE VIDIAN CANAL

2009 ◽  
Vol 64 (suppl_5) ◽  
pp. ons385-ons412 ◽  
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.

The endoscopic, endonasal, transmaxillary transpterygoid approach to the pterygopalatine fossa, infratemporal fossa, petrous apex, and the Meckel cave

2010 ◽  
Vol 113 (5) ◽  
pp. 967-974 ◽  
Author(s):  
Christoph P. Hofstetter ◽  
Ameet Singh ◽  
Vijay K. Anand ◽  
Ashutosh Kacker ◽  
Theodore H. Schwartz
Keyword(s):  
Skull Base ◽  
Sphenoid Sinus ◽  
Infratemporal Fossa ◽  
Pterygopalatine Fossa ◽  
Csf Leak ◽  
Petrous Apex ◽  
Subtotal Resection ◽  
Endoscopic Endonasal ◽  
Lateral Skull Base ◽  
Neural Origin

Object In this paper the authors' goal was to present their clinical experience with lesions of the pterygopalatine fossa, infratemporal fossa, lateral sphenoid sinus, cavernous sinus, petrous apex, and Meckel cave using simple and extended endoscopic transpterygoid approaches to the lateral skull base. Methods Simple and expanded endoscopic transpterygoid approaches were performed in a series of 13 patients with varying pathology that included lateral sphenoid sinus encephaloceles, benign and malignant sinonasal tumors, and lesions of neural origin. Results A gross-total resection was achieved in 5 of 9 patients, while a subtotal resection for tissue diagnosis and cytoreduction prior to further adjuvant treatment was performed in the remaining patients. Sphenoid sinus encephaloceles were successfully repaired via a transpterygoid approach in all 4 patients. The skull base defect was reconstructed using a multilayered closure. One patient developed a postoperative CSF leak, which was successfully treated conservatively. The mean follow-up time was 16 months. Five patients complained of recurrent sinusitis. One patient experienced xerophthalmia and palate numbness. Three patients had died by the time of this report. Two patients died of unrelated causes. The third patient died of progression of an aggressive pterygopalatine osteosarcoma despite undergoing cytoreductive surgery and adjuvant chemotherapy. Conclusions An endoscopic transpterygoid approach is a minimally invasive endoscopic approach for lesions located or extending to the pterygopalatine fossa, infratemporal fossa, petrous apex, Meckel cave, and other regions of the paramedian skull base.

Simplifying Access to the Lateral Sphenoid Recess: A Modification of the Transpterygoid Approach

2021 ◽  
pp. 194589242110038
Author(s):  
Satyan B. Sreenath ◽  
Dennis M. Tang ◽  
João Paulo De Almeida ◽  
Pranay Soni ◽  
Troy D. Woodard ◽  
...  
Keyword(s):  
Skull Base ◽  
Sphenoid Sinus ◽  
Postoperative Morbidity ◽  
Pterygopalatine Fossa ◽  
Benign Lesions ◽  
Lateral Recess ◽  
Less Invasive ◽  
Vidian Nerve ◽  
The Face ◽  
Skull Base Defect

Background Meningoencephaloceles originating in the lateral recess of the sphenoid sinus can be difficult to access. Historically, the endoscopic transpterygoid approach was advocated, which carries additional morbidity given the dissection of the pterygopalatine fossa (PPF) contents to provide a direct line approach to the defect. Given our increased facility with angled endoscopes and instrumentation, we now approach this region in a less invasive manner. Methods We describe the endoscopic modified transpterygoid approach (MTPA), a quicker approach to the lateral sphenoid recess which preserves the PPF contents through a single nostril corridor. Results In the MTPA, the face of the sphenoid and anterior junction of the pterygoid plates are removed, allowing for mobilization of the PPF contents with the periosteum intact. Angled instrumentation is then used to resect the meningoencephalocele and repair the skull base defect in the lateral recess. If increased exposure is needed, this can be gained by sacrificing the sphenopalatine artery and even the vidian nerve, although this is rarely required. Conclusions The MTPA obviates the need for PPF dissection and simplifies access to the lateral sphenoid recess while minimizing postoperative morbidity. This approach should be considered for accessing meningoencephaloceles and other benign lesions in this challenging location.

Endoscopic Anatomy of the Pterygopalatine Fossa

2007 ◽  
Vol 21 (5) ◽  
pp. 644-647 ◽  
Author(s):  
Seth J. Isaacs ◽  
Parul Goyal
Keyword(s):  
Pterygopalatine Fossa ◽  
Maxillary Artery ◽  
Internal Maxillary Artery ◽  
Sphenopalatine Foramen ◽  
Neoplastic Processes ◽  
Patient Morbidity ◽  
Infraorbital Canal ◽  
Vidian Canal ◽  
Foramen Rotundum ◽  
Neurovascular Structures

Background The pterygopalatine fossa can be involved with a variety of infectious and neoplastic processes. This region can be entered endoscopically, but endoscopic landmarks to localize the neurovascular structures in the pterygopalatine fossa have not yet been reported. Objectives The purpose of this study is to describe the location of the neurovascular structures in the pterygopalatine fossa in relation to consistent intranasal landmarks. Methods Endoscopic dissections of cadaveric heads were performed. The locations of neurovascular structures in the region were defined. Results The sphenopalatine foramen (SPF) served as the primary intranasal landmark to the pterygopalatine fossa (PPF). Mean distances from the SPF were measured with the following results: SPF to sphenopalatine ganglion (SPG), 4 mm medially and 6 mm laterally; SPF to foramen rotundum (FR), 7 mm; and SPF to vidian canal (VC), 2 mm. The internal maxillary artery followed an irregular and inconsistent course, making it difficult to define a reliable landmark for its location in the fossa. Conclusion Entering the PPF inferior to the horizontal plane of the SPF along a vertical line drawn inferiorly from the infraorbital canal will avoid injury to the major neural structures in the fossa. Because of the inconsistent course and location of the internal maxillary artery, this structure may be at risk no matter where the fossa is entered. These landmarks will allow the surgeon to enter the PPF with more accuracy and less patient morbidity.

Vidian Canal as a Transcranial Landmark: Anatomy, Technique, and Illustrative Cases

2021 ◽  
Author(s):  
Xiaochun Zhao ◽  
Daniel M. McKenzie ◽  
Panayiotis E. Pelargos ◽  
Ali H. Palejwala ◽  
Ian F. Dunn
Keyword(s):  
Outcome Measures ◽  
Surgical Approach ◽  
Sphenoid Sinus ◽  
Tumor Resection ◽  
The Other ◽  
Cadaver Dissection ◽  
Cadaveric Dissection ◽  
Vidian Nerve ◽  
Tumor Delivery ◽  
Vidian Canal

Abstract Objective The vidian nerve can be accessed in transcranial approaches in carefully selected patients to ensure its preservation and to serve as a landmark for sphenoid sinus entry. This report is to review a technique, evaluate it in laboratory settings, and present two illustrative cases. Design The study involves cadaveric dissection and illustrative cases. Setting The study conducted in a cadaveric dissection laboratory. Participants The object of the study is one cadaveric head and two illustrative clinical cases. Main Outcome Measures Two cases using this approach were illustrated, and a cadaver dissection was performed in a step-by-step fashion. Results: The vidian canal can be accessed by drilling the anterolateral triangle. Two illustrated cases were presented; in one, the vidian nerve was used as part of a corridor to access the sphenoid sinus for tumor delivery, and in the other, the technique was used to find and preserve the vidian nerve during transcranial resection. Conclusion Careful identification of the vidian canal in transcranial surgery is a beneficial technique in carefully selected cases which allows identification of the nerve both for its preservation in selected cases and to create the vidian–maxillary corridor for tumor resection. Knowing the anatomy and pneumatization variants is important in the surgical approach.

scholarly journals An Alternative Method of Endoscopic Intrasphenoidal Vidian Neurectomy

OTO Open ◽  
2018 ◽  
Vol 2 (1) ◽  
pp. 2473974X1876486
Author(s):  
Changqing Zhao ◽  
Yongjin Ji ◽  
Yunfang An ◽  
Jinmei Xue ◽  
Qingfeng Li ◽  
...  
Keyword(s):  
Sphenoid Sinus ◽  
Anterior Wall ◽  
Pterygopalatine Fossa ◽  
Sphenoidal Sinus ◽  
Accurate Localization ◽  
Vidian Neurectomy ◽  
Complex Anatomy ◽  
Vidian Canal ◽  
Severe Degree ◽  
Good Exposure

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.

scholarly journals Transcavernous Approach for Gross Total Resection of a Dumbbell-Shaped Giant Trigeminal Schwannoma

2021 ◽  
Author(s):  
Sima Sayyahmelli ◽  
Emel Avci ◽  
Burak Ozaydin ◽  
Mustafa K. Başkaya
Keyword(s):  
Skull Base ◽  
Cavernous Sinus ◽  
Tumor Resection ◽  
Mass Effect ◽  
World Health ◽  
Gross Total Resection ◽  
Petrous Apex ◽  
Total Resection ◽  
Who Grade ◽  
Trigeminal Schwannoma

AbstractTrigeminal schwannomas are rare nerve sheet tumors that represent the second most common intracranial site of occurrence after vestibular nerve origins. Microsurgical resection of giant dumbbell-shaped trigeminal schwannomas often requires complex skull base approaches. The extradural transcavernous approach is effective for the resection of these giant tumors involving the cavernous sinus.The patient is a 72-year-old man with headache, dizziness, imbalance, and cognitive decline. Neurological examination revealed left-sided sixth nerve palsy, a diminished corneal reflex, and wasting of temporalis muscle. Magnetic resonance imaging (MRI) showed a giant homogeneously enhancing dumbbell-shaped extra-axial mass centered within the left cavernous sinus, Meckel's cave, and the petrous apex, with extension to the cerebellopontine angle. There was a significant mass effect on the brain stem causing hydrocephalus. Computed tomography (CT) scan showed erosion of the petrous apex resulting in partial anterior autopetrosectomy (Figs. 1 and 2).The decision was made to proceed with tumor resection using a transcavernous approach. Gross total resection was achieved. The surgery and postoperative course were uneventful, and the patient woke up the same as in the preoperative period. MRI confirmed gross total resection of the tumor. The histopathology was a trigeminal schwannoma, World Health Organization (WHO) grade I. The patient continues to do well without any recurrence at 15-month follow-up.This video demonstrates important steps of the microsurgical skull base techniques for resection of these challenging tumors.The link to the video can be found at https://youtu.be/TMK5363836M

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.

scholarly journals Case Report: Petrous Apicitis and Otogenic Thrombosis of the Cavernous Sinus in a 10-Year-Old Boy

2021 ◽  
Vol 8 ◽  
Author(s):  
Patrick Bergsma ◽  
Seraina Kunz ◽  
Anna-Lena Kienle ◽  
Yves Brand
Keyword(s):  
Otitis Media ◽  
Cavernous Sinus ◽  
Sinus Thrombosis ◽  
Acute Otitis Media ◽  
Petrous Apex ◽  
Cavernous Sinus Thrombosis ◽  
Petrous Apicitis ◽  
Air Cells ◽  
Ct And Mri

Background: Petrous apicitis and cavernous sinus thrombosis are exceedingly rare complications of acute otitis media with only few reported cases in the post-antibiotic era. Especially in children, the appropriate management is a subject of controversy.Case Presentation: We report the case of a 10-year-old boy who presented to the emergency department with left-sided otalgia, otorrhea, and hearing loss, accompanied by somnolence and high spiking fevers. CT and MRI revealed partially obstructed mastoid air cells including a pneumatized petrous apex. Furthermore, thrombosis of the cavernous sinus and vasculitis of the internal carotid artery on the left side were present. The patient was treated with antibiotics for 6 weeks and anticoagulant therapy for 3 months. Follow-up carried out 3 months post-admission showed complete recanalization of the cavernous sinus on MRI and fatigue as the only remaining symptom.Conclusion: A complicated otitis media with petrous apicitis and cavernous sinus thrombosis in a child can in some cases be managed without a surgical intervention.

scholarly journals Petrous Apex Granulomas: CT and MR Imaging

2002 ◽  
Vol 29 (2) ◽  
pp. 169-170 ◽  
Author(s):  
Stephen Hentschel ◽  
Felix Durity
Keyword(s):  
Sphenoid Sinus ◽  
Internal Carotid ◽  
Lateral Wall ◽  
Petrous Apex ◽  
High Signal ◽  
Horizontal Canal ◽  
Computed Tomography Scanning ◽  
History Of ◽  
Tomography Scanning ◽  
Sixth Nerve

A 29-year-old male complained of a four month history of horizontal, spontaneous, and nonprogressive diplopia. On examination he had a mild left sixth nerve palsy. The rest of his general and neurologic examinations were normal.Computed tomography scanning demonstrated a nonenhancing, well-circumscribed, lesion in the left petrous apex (Figure 1). The opposite apex was well pneumatized. The lesion abutted the medial wall of the horizontal canal of the internal carotid artery and pointed towards the lateral wall of the sphenoid sinus. Unfortunately, CT bone windows were not available for this case but would have been helpful in terms of the differential diagnosis. An MRI demonstrated a predominantly high signal mass on T1 and T2 sequences (Figure 2). The diagnosis was a petrous apex granuloma.

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