Endoscopic endonasal approach for resection of pediatric chordoma with brainstem invasion

2019 ◽  
Vol 1 (2) ◽  
pp. V20
Author(s):  
Kumar Abhinav ◽  
David Hong ◽  
Carol H. Yan ◽  
Peter Hwang ◽  
Juan C. Fernandez-Miranda ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid ◽  
Abducens Nerve ◽  
Complete Resection ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Endoscopic Endonasal ◽  
Surveillance Imaging ◽  
Pontine Lesion ◽  
Postoperative Diagnosis

A 14-year-old boy had undergone an orbitozygomatic craniotomy for a pontine lesion. There was growth on surveillance imaging with involvement of posterior clinoids, clivus, and left pons suggestive of chordoma (Fernandez-Miranda et al., 2014b). An endoscopic endonasal approach was undertaken involving full upper and midclival exposure including bilateral posterior clinoidectomy (Fernandez-Miranda et al., 2014a; Truong et al., 2019a, 2019b). The internal carotid artery was skeletonized to maximize exposure and facilitate safe resection. The tumor was removed from between the dural layers of the midclivus while preserving the interdural abducens nerve (Barges-Coll et al., 2010). The brainstem component was resected while preserving the pontine perforators. Postoperative diagnosis was chordoma with MRI demonstrating complete resection. The patient was intact postoperatively.The video can be found here: https://youtu.be/g6SQ5JVK0Ko.

Assessment of Internal Carotid Artery Invasion With the Endoscopic Endonasal Approach

2020 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Huankang Zhang ◽  
Xicai Sun ◽  
Huapeng Yu ◽  
Weidong Zhao ◽  
Keqing Zhao ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Endoscopic Endonasal

Direct Repair of Iatrogenic Internal Carotid Artery Injury During Endoscopic Endonasal Approach Surgery With Temporary Endovascular Balloon-Assisted Occlusion: Technical Case Report

2015 ◽  
Vol 11 (3) ◽  
pp. E483-E487 ◽  
Author(s):  
Mary In-Ping Huang Cobb ◽  
Shahid Nimjee ◽  
L Fernando Gonzalez ◽  
David Woojin Jang ◽  
Ali Zomorodi
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Endovascular Procedures ◽  
Internal Carotid ◽  
High Morbidity ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Endoscopic Endonasal ◽  
Safe Technique ◽  
Internal Carotid Artery Injury

Abstract BACKGROUND AND IMPORTANCE Iatrogenic internal carotid artery (ICA) injuries during endoscopic endonasal approach (EEA) surgeries are associated with a high morbidity and mortality, with few acceptable methods described for repair. CLINICAL PRESENTATION A 13-year-old girl with a large anterior and central skull base osteoblastoma incurred an iatrogenic cavernous ICA injury during a staged EEA approach. Intraoperative angiogram was performed with balloon-assisted EEA primary microsurgical repair of the lacerated ICA. CONCLUSION By integrating current techniques commonly used in open aneurysm surgeries and in endovascular procedures, we developed a rapid, safe technique to repair an EEA-associated iatrogenic ICA injury.

Intracavernous branches of the internal carotid artery through an endoscopic endonasal approach: anatomical study and review of the literature

2021 ◽  
Author(s):  
Juan Ángel Aibar-Durán ◽  
Fernando Muñoz-Hernández ◽  
Carlos Asencio-Cortés ◽  
Joan Montserrat-Gili ◽  
Juan Ramón Gras-Cabrerizo ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Anatomical Study ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Review Of The Literature ◽  
Endoscopic Endonasal

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

scholarly journals The pterygoclival ligament: a novel landmark for localization of the internal carotid artery during the endoscopic endonasal approach

2019 ◽  
Vol 130 (5) ◽  
pp. 1699-1709 ◽  
Author(s):  
Ali Tayebi Meybodi ◽  
Andrew S. Little ◽  
Vera Vigo ◽  
Arnau Benet ◽  
Sofia Kakaizada ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Fibrous Tissue ◽  
Petrous Apex ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Endoscopic Endonasal ◽  
Pterygoid Process ◽  
The Mean

OBJECTIVEThe transpterygoid extension of the endoscopic endonasal approach provides exposure of the petrous apex, Meckel’s cave, paraclival area, and the infratemporal fossa. Safe and efficient localization of the lacerum segment of the internal carotid artery (ICA) is a crucial part of such exposure. The aim of this study is to introduce a novel landmark for localization of the lacerum ICA.METHODSTen cadaveric heads were prepared for transnasal endoscopic dissection. The floor of the sphenoid sinus was drilled to expose an extension of the pharyngobasilar fascia between the sphenoid floor and the pterygoid process (the pterygoclival ligament). Several features of the pterygoclival ligament were assessed. In addition, 31 dry skulls were studied to assess features of the bony groove harboring the pterygoclival ligament.RESULTSThe pterygoclival ligament was identified bilaterally during drilling of the sphenoid floor in all specimens. The ligament started a few millimeters posterior to the posterior end of the vomer alae and invariably extended posterolaterally and superiorly to blend into the fibrous tissue around the lacerum ICA. The mean length of the ligament was 10.5 ± 1.7 mm. The mean distance between the anterior end of the ligament and midline was 5.2 ± 1.2 mm. The mean distance between the posterior end of the ligament and midline was 12.3 ± 1.4 mm. The bony pterygoclival groove was identified at the confluence of the vomer, pterygoid process of the sphenoid, and basilar part of the occipital bone, running from posterolateral to anteromedial. The mean length of the groove was 7.7 ± 1.8 mm. Its posterolateral end faced the anteromedial aspect of the foramen lacerum medial to the posterior end of the vidian canal. A clinical case illustration is also provided.CONCLUSIONSThe pterygoclival ligament is a consistent landmark for localization of the lacerum ICA. It may be used as an adjunct or alternative to the vidian nerve to localize the ICA during endoscopic endonasal surgery.

Comparative analysis of the anterior transpetrosal approach with the endoscopic endonasal approach to the petroclival region

2016 ◽  
Vol 125 (5) ◽  
pp. 1171-1186 ◽  
Author(s):  
Jun Muto ◽  
Daniel M. Prevedello ◽  
Leo F. S. Ditzel Filho ◽  
Ing Ping Tang ◽  
Kenichi Oyama ◽  
...  
Keyword(s):  
Abducens Nerve ◽  
Direct Access ◽  
Petrous Apex ◽  
Horizontal Line ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Endoscopic Endonasal ◽  
Petroclival Region ◽  
Advantages And Disadvantages ◽  
Anterior Transpetrosal Approach

OBJECTIVE The endoscopic endonasal approach (EEA) offers direct access to midline skull base lesions, and the anterior transpetrosal approach (ATPA) stands out as a method for granting entry into the upper and middle clival areas. This study evaluated the feasibility of performing EEA for tumors located in the petroclival region in comparison with ATPA. METHODS On 8 embalmed cadaver heads, EEA to the petroclival region was performed utilizing a 4-mm endoscope with either 0° or 30° lenses, and an ATPA was performed under microscopic visualization. A comparison was executed based on measurements of 5 heads (10 sides). Case illustrations were utilized to demonstrate the advantages and disadvantages of EEA and ATPA when dealing with petroclival conditions. RESULTS Extradurally, EEA allows direct access to the medial petrous apex, which is limited by the petrous and paraclival internal carotid artery (ICA) segments laterally. The ATPA offers direct access to the petrous apex, which is blocked by the petrous ICA and abducens nerve inferiorly. Intradurally, the EEA allows a direct view of the areas medial to the cisternal segment of cranial nerve VI with limited lateral exposure. ATPA offers excellent access to the cistern between cranial nerves III and VIII. The quantitative analysis demonstrated that the EEA corridor could be expanded laterally with an angled drill up to 1.8 times wider than the bone window between both paraclival ICA segments. CONCLUSIONS The midline, horizontal line of the petrous ICA segment, paraclival ICA segment, and the abducens nerve are the main landmarks used to decide which approach to the petroclival region to select. The EEA is superior to the ATPA for accessing lesions medial or caudal to the abducens nerve, such as chordomas, chondrosarcomas, and midclival meningiomas. The ATPA is superior to lesions located posterior and/or lateral to the paraclival ICA segment and lesions with extension to the middle fossa and/or infratemporal fossa. The EEA and ATPA are complementary and can be used independently or in combination with each other in order to approach complex petroclival lesions.

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