scholarly journals Endoscopic endonasal translacerum approach to the inferior petrous apex

2016 ◽  
Vol 124 (4) ◽  
pp. 1032-1038 ◽  
Author(s):  
Masaaki Taniguchi ◽  
Nobuyuki Akutsu ◽  
Katsu Mizukawa ◽  
Masaaki Kohta ◽  
Hidehito Kimura ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Surgical Simulation ◽  
Internal Auditory Canal ◽  
Jugular Foramen ◽  
Petrous Apex ◽  
Partial Removal ◽  
Endoscopic Endonasal ◽  
Anatomical Features ◽  
Petrous Portion ◽  
Sufficient Space

OBJECT The surgical approach to lesions involving the inferior petrous apex (IPA) is still challenging. The purpose of this study is to demonstrate the anatomical features of the IPA and to assess the applicability of an endoscopic endonasal approach through the foramen lacerum (translacerum approach) to the IPA. METHODS The surgical simulation of the endoscopic endonasal translacerum approach was conducted in 3 cadaver heads. The same technique was applied in 4 patients harboring tumors involving the IPA (3 chordomas and 1 chondro-sarcoma). RESULTS By removing the fibrocartilaginous component of the foramen lacerum, a triangular space was created between the anterior genu of the petrous portion of the carotid artery and the eustachian tube, through which the IPA could be approached. The range of the surgical maneuver reached laterally up to the internal auditory canal, jugular foramen, and posterior vertical segment of the petrous portion of the carotid artery. In clinical application, the translacerum approach provided sufficient space to handle tumors at the IPA. Gross-total and partial removal was achieved in 3 and 1 cases, respectively, without permanent surgery-related morbidity and mortality. CONCLUSIONS The endoscopic endonasal translacerum approach provides reliable access to the IPA. It is indicated alone for lesions confined to the IPA and in combination with other approaches for more extensive lesions.

Combined Endoscopic Endonasal and Contralateral Transmaxillary Approach for Petrous Cholesteatoma: 2-Dimensional Operative Video

2021 ◽  
Author(s):  
Wei-Hsin Wang ◽  
Ming-Ying Lan ◽  
Carl H Snyderman ◽  
Paul A Gardner
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Hearing Impairment ◽  
Internal Carotid ◽  
Video Recording ◽  
Internal Auditory Canal ◽  
Petrous Apex ◽  
Endoscopic Endonasal ◽  
The Right ◽  
Key Steps

Abstract This 59-yr-old man presented with headache, dizziness, diplopia, and right-side hearing impairment for years. The objective degree of hearing impairment was not available. Magnetic resonance imaging (MRI) showed a right petrous apex lesion centered behind the right petrous internal carotid artery and extending lateral to the medial aspect of the right internal auditory canal. A combined endoscopic endonasal and left contralateral transmaxillary (CTM) approach was performed, and gross-total resection was achieved. Peeling the cyst wall from the dura resulted in minor weeping. It was covered with a left-sided, vascularized nasoseptal flap. His dizziness and diplopia improved immediately after the surgery. Histopathology revealed an epidermoid cyst. In this surgical video, we demonstrate the key steps of the CTM approach for access to the petrous apex posterior to the petrous internal carotid artery (ICA).  The patient gave informed consent for surgery and video recording.

Microsurgical Anatomy of the Endoscopy-Assisted Retrosigmoid Intradural Suprameatal Approach to the Meckel's Cave

2021 ◽  
Author(s):  
Yuanzhi Xu ◽  
Benjamin K Hendricks ◽  
Maximiliano Alberto Nunez ◽  
Ahmed Mohyeldin ◽  
Juan C Fernandez-Miranda ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Internal Auditory Canal ◽  
Semicircular Canals ◽  
Petrous Apex ◽  
Microsurgical Anatomy ◽  
Meckel’S Cave ◽  
Meckel's Cave ◽  
Trigeminal Root

Abstract BACKGROUND Understanding the microsurgical anatomical features of the endoscopy-assisted retrosigmoid intradural suprameatal approach (RISA) is critical for surgeons treating petroclival tumors or lesions in the cerebellopontine region that extend into Meckel's cave. OBJECTIVE To evaluate increased exposure for Meckel's cave in the RISA and assess the surgical landmarks for this approach. METHODS A standard retrosigmoid craniotomy to the cerebellopontine region was performed in 4 cadaveric specimens (8 hemispheres) with microscope-assisted endoscopy. The length and depth of the drilling region from the suprameatal tubercle to the petrous apex were analyzed. After opening Meckel's cave and mobilizing the trigeminal root completely, the landmarks for this approach were investigated. RESULTS The endoscopy-assisted RISA facilitates mobilization of the trigeminal root and enhances surgical exposure in the region of Meckel's cave and the petrous apex with increases of 10.1 ± 1.3 mm in depth, 21.4 ± 3.2 mm in length, and 6.4 ± 0.6 mm in height. The posterior and superior semicircular canals, internal auditory canal, superior petrous sinus, and internal carotid artery (petrous segment) served as important landmarks for this approach. One case illustration is presented to describe the application of this approach. CONCLUSION The RISA is suitable mainly for lesions in the posterior fossa that extend into Meckel's cave. The endoscopy-assisted reach optimizes accessibility to the petrous apex region, obviates the need for extensive drilling, and decreases the risk of internal carotid artery injury. Better realization and recognition of microsurgical landmarks and parameters of this approach are crucial for successful outcomes.

Paratrigeminal, Paraclival, Precavernous, or All of the Above? A Circumferential Anatomical Study of the C3-C4 Transitional Segment of the Internal Carotid Artery

2017 ◽  
Vol 14 (4) ◽  
pp. 432-440 ◽  
Author(s):  
Eleonora Marcati ◽  
Norberto Andaluz ◽  
Sebastien C Froelich ◽  
Lee A Zimmer ◽  
James L Leach ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Cavernous Sinus ◽  
Internal Carotid ◽  
Anatomical Study ◽  
Posterior Longitudinal Ligament ◽  
Petrous Apex ◽  
Meckel’S Cave ◽  
Endoscopic Endonasal ◽  
Meckel's Cave

Abstract BACKGROUND Although the term paraclival carotid pervades recent skull base literature, no clear consensus exists regarding boundaries or anatomical segments. OBJECTIVE To reconcile various internal carotid artery (ICA) nomenclatures for transcranial and endoscopic-endonasal perspectives, we reexamined the transition between lacerum (C3) and cavernous (C4) segments using a C1-C7 segments schema. In this cadaveric study, we obtained a 360°-circumferential view integrating histological, microsurgical, endoscopic, and neuroradiological analyses of this C3-C4 region and identified a distinct transitional segment. METHODS In 13 adult, silicone-injected, formalin-fixed cadaveric heads (26 sides), transcranial-extradural-subtemporal and endoscopic-endonasal CT­guided dissections were performed. A quadrilateral area was noted medial to Meckel's cave between cranial nerve VI, anterolateral and posterolateral borders of the lateral-paratrigeminal aspect of the precavernous ICA, and posterior longitudinal ligament. Endoscopically, a medial-paraclival aspect was defined. Anatomical correlations were made with histological and neuroradiological slides. RESULTS We identified a distinct precavernous C3-C4 transitional segment. In 18 (69%) specimens, venous channels were absent at the quadrilateral area, on the paratrigeminal border of the precavernous ICA. A trigeminal membrane, seen consistently on the superior border of V2, defined the lateral aspect of the cavernous sinus floor. The medial aspect of the precavernous ICA corresponded with the paraclival ICA. CONCLUSION Our study revealing the juncture of 2 complementary borders of the ICA, endoscopic endonasal (paraclival) and transcranial (paratrigeminal), reconciles various nomenclature. A precavernous segment may clarify controversies about the paraclival ICA and support the concept of a “safe door” for lesions involving Meckel's cave, cavernous sinus, and petrous apex.

Three-dimensional Computed Tomographic Cranial Base Measurements for Improvement of Surgical Approaches to the Petrous Carotid Artery and Apex Regions

Neurosurgery ◽  
2001 ◽  
Vol 49 (2) ◽  
pp. 342-353 ◽  
Author(s):  
Alan T. Villavicencio ◽  
Jean-Christophe Leveque ◽  
Ketan R. Bulsara ◽  
Allan H. Friedman ◽  
Linda Gray
Keyword(s):  
Computed Tomography ◽  
Carotid Artery ◽  
Three Dimensional ◽  
Internal Auditory Canal ◽  
Cranial Base ◽  
Petrous Apex ◽  
Surgical Approaches ◽  
Tomographic Images ◽  
Computed Tomographic ◽  
Preoperative Information

Abstract OBJECTIVE The bony and vascular anatomic features in the region of the petrous apex can vary significantly. These variations affect the operative view obtained via extended subtemporal or anterior transpetrosal approaches to cranial base lesions for individual patients. The goal of this study was to evaluate three-dimensional computed tomography as a means of obtaining detailed preoperative anatomic information regarding bony and vascular landmarks and spatial relationships in the region of the petrous carotid artery and petrous apex. METHODS We radiographically studied 15 patients (30 sides), using 0.8- to 1-mm-thick, reconstructed, computed tomographic images. Special attention was given to the course of the petrous carotid artery. RESULTS The petrous carotid artery was located lateral to the trigeminal impression. The size of the petrous apex medial to the horizontal petrous carotid artery was observed to be variable. The width of bone from the trigeminal impression to the wall of the internal auditory canal averaged 9.6 mm (range, 5.2–16.1 mm). A variable amount of bone overlying the internal auditory canal (4.5 mm) was also present. Multiple other relationships among key landmarks were quantified. CONCLUSION There is significant variability in the anatomic features of the petrous apex among patients. For each patient, detailed preoperative information regarding the amount of bone to be removed during a cranial base procedure can be obtained using three-dimensional computed tomography. This information may be critical for determination of the amount of extra exposure that can be achieved via an anterior petrosectomy for each patient.

Anterior inferior petrosectomy: defining the role of endonasal endoscopic techniques for petrous apex approaches

2014 ◽  
Vol 120 (6) ◽  
pp. 1321-1325 ◽  
Author(s):  
Jamie J. Van Gompel ◽  
Puya Alikhani ◽  
Mark H. Tabor ◽  
Harry R. van Loveren ◽  
Sivero Agazzi ◽  
...  
Keyword(s):  
3D Modeling ◽  
Jugular Foramen ◽  
Contralateral Side ◽  
Petrous Apex ◽  
Endoscopic Endonasal ◽  
Endoscopic Techniques ◽  
Inferior Portion ◽  
Anterior Petrosectomy ◽  
Superior Portion

Object Historically, surgery to the petrous apex has been addressed via craniotomy and open microscopic anterior petrosectomy (OAP). However, with the popularization of endoscopic approaches, the petrous apex can further be approached endonasally by way of an endoscopic endonasal anterior petrosectomy (EAP). Endonasal anterior petrosectomy is a relatively new procedure and has not been compared anatomically with OAP. The authors hypothesized that the EAP and OAP techniques approach different portions of the petrous apex and therefore may have different applications. Methods Four cadaveric heads were used. An OAP was performed on one side and an EAP was performed on the contralateral side; the limits of bony resection were defined. The extent of bony resection was then evaluated using predissection and postdissection thin-slice CT scans. The comparative resection was then reconstructed using 3D modeling on Brainlab workstations. Results The average resection volumes for EAP and OAP were 0.297 cm3 and 0.649 cm3, respectively, representing a comparative percentage of 46% (EAP/OAP). An EAP and OAP achieved resection of 29% and 64% of the total petrous apex volume, respectively. Indeed, EAP addressed the inferior portion of the petrous apex located adjacent to the petroclival suture more completely than OAP, where 45% of the bone overlying the petroclival suture (petroclival angle to the jugular foramen) was resected with the EAP, while 0% was resected with the OAP. Conclusions In anatomically normal cadavers, OAP achieved nearly a 50% larger volumetric resection than EAP. Furthermore, while OAP appears to completely address the superior portion of the petrous apex, EAP appears to have a niche in approaches to lesions in the inferior petrous apex. Given these results, the authors propose that OAP be redefined as the “superior anterior petrosectomy,” while EAP be referred to as the “inferior anterior petrosectomy,” which more clearly defines the role of each approach in anterior petrosectomy.

scholarly journals Modified classification of infralabyrinthie cholesteatoma and scale of cholesteatoma extention

2020 ◽  
pp. 86-94
Author(s):  
K. M. Diab ◽  
O. S. Panina ◽  
O. A. Pashchinina
Keyword(s):  
Temporal Bone ◽  
Surgical Approach ◽  
Internal Auditory Canal ◽  
Petrous Bone ◽  
Jugular Foramen ◽  
Petrous Apex ◽  
Occipital Condyle ◽  
Epidermal Cyst ◽  
Scientific Center

Introduction. Petrous temporal bone (PTB) cholesteatoma is an epidermal cyst, which is the result of uncontrolled growth of keratinizing squamous epithelium in the petrous part of the temporal bone. Cholesteatoma is classified into congenital, acquired, and iatrogenic.Objective. To discuss the classification of infralabyrinthine petrous bone cholesteatoma (PBC), add modified classificationand to propose adequate differential surgical management.Methods. The setting was a National Medical Scientific Center of Otorhinolaryngology FMBA (Russia). The data of 14 patients who underwent surgery for different variations of infralabyrinthine PBC from 2017 till 2020 were analyzed and included into the study (with respect to localization type of the approach used, complications, recurrences and outcome). The follow-up period ranged from 6 to 34 months with a median of 18 months.Results. Based on preoperative CT scans and intraoperative findings a Scale of Cholesteatoma extension CLIF(APO) and Modified classification of infralabyrinthine cholesteatoma (in relation to mastoid segment of the facial nerve) are proposed. The scale includes the main anatomical structures of the temporal bone and the adjacent parts of the occipital and sphenoid bones, which may be involved in the cholesteatoma process: cochlea, vestibule and semicircular canals, internal auditory canal, jugular foramen, bony chanal of the internal carotid artery, petrous apex, occipital condyle. Based on the modified classification and scale we present an algorithm for decision making and surgical approach choosing.Conclusion. The implementation of the Scale of Cholesteatoma Extension in Otology and Radiology practice will allow to preoperatively diagnose the extension of PBC, unify the data of the localization of cholesteatoma; allows standardization in reporting and continuity at all stages of treatment. The modified classification proposed by us in this article facilitate the algorithm for selecting the type of surgical approach and determine whether to perform less aggressive combined microscopic approaches with endoscopic control.

scholarly journals Microsurgical Resection of Multiple Giant Glomus Tumors

2019 ◽  
Vol 80 (S 04) ◽  
pp. S385-S388
Author(s):  
Guilherme H. W. Ceccato ◽  
Marcio S. Rassi ◽  
Luis A. B. Borba
Keyword(s):  
Carotid Artery ◽  
Facial Paralysis ◽  
Voice Quality ◽  
Cranial Nerves ◽  
Internal Auditory Canal ◽  
Mass Effect ◽  
Jugular Foramen ◽  
Surgical Approaches ◽  
Glomus Tumors ◽  
Complex Anatomy

AbstractGlomus tumors, also called paragangliomas, are challenging lesions, demanding accurate knowledge of complex anatomy and pertinent approaches. We present the case of a 39-year-old male presenting with headache, vertigo, tinnitus, hearing loss, and hoarseness. Neurological assessment showed facial paralysis House–Brackmann IV and lower cranial nerves deficits. Preoperative magnetic resonance imaging (MRI) demonstrated two large lesions, suggestive of a glomus jugulare, and carotid body paragangliomas. Considering worsening of the symptoms and the important mass effect of both lesions over the neurovascular structures, microsurgical excision was offered, after preoperative tumor embolization. We preferred to approach both lesions in the same operation, starting by the cervical tumor. Initially there was not an easily identifiable dissection plane between the tumor and the carotid artery, but it was achieved after performing a subadventitial dissection, being possible to resect the entire lesion. The jugular foramen lesion was approached through a postauricular transtemporal approach, skeletonizing the sigmoid sinus, jugular bulb, and facial nerve, following a complete mastoidectomy. The tumor, extending to the intradural compartment, middle ear, internal auditory canal, petrous internal carotid artery, and internal jugular vein was completely removed. Postoperative MRI demonstrated complete resection of both lesions, and pathology confirmed to be paragangliomas. In the immediate postoperative period, the facial paralysis evolved to House–Brackmann grade VI, improving to grade III during follow-up. The patient underwent a vocal cord medialization in order to improve voice quality and swallowing. These are challenging lesions and extensive laboratory training is mandatory to be familiarized with the regional anatomy and its various surgical approaches.The link to the video can be found at: https://youtu.be/gA_ckwFq_9c.

Analysis of the petrous portion of the internal carotid artery: Landmarks for an endoscopic endonasal approach

2014 ◽  
Vol 124 (9) ◽  
pp. 1988-1994 ◽  
Author(s):  
Eric Mason ◽  
Jose Gurrola ◽  
Camilo Reyes ◽  
Jimmy J. Brown ◽  
Ramon Figueroa ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Endoscopic Endonasal ◽  
Petrous Portion

The investigation and management of petrous apex ersion

1985 ◽  
Vol 99 (5) ◽  
pp. 439-450 ◽  
Author(s):  
L. M. Flood ◽  
J. L. Kemink ◽  
M. D. Graham
Keyword(s):  
Temporal Bone ◽  
Cranial Nerves ◽  
Internal Auditory Canal ◽  
Jugular Foramen ◽  
Petrous Apex ◽  
Unique Challenge ◽  
Anterior Extension ◽  
Facial Numbness ◽  
Lower Cranial Nerves ◽  
Ear Effusion

AbstractDisease of the apex of the petrous temporal bone, while rarely encountered, can present a unique challenge to the otologist. Lesions tend to be advanced at presentation, as massive bony erosion can remain asymptomatic. When symptoms occur, they reflect involvement of the neurovascular contents of the temporal bone. The earliest clinical features, such as headache, facial numbness and middle-ear effusion, do not immediately suggest the site or gravity of the underlying pathology. Anterior extension of disease may produce ophthalmoplegia and diplopia whilst posterior spread involves the lower cranial nerves, within the internal auditory canal, jugular foramen and hypoglossal canal.

Sign in / Sign up

Export Citation Format

Share Document