scholarly journals Combined and simultaneous endoscopic endonasal and transorbital surgery for a Meckel’s cave schwannoma: technical nuances of a mini-invasive, multiportal approach

2020 ◽  
pp. 1-10
Author(s):  
Alberto Di Somma ◽  
Cristobal Langdon ◽  
Matteo de Notaris ◽  
Luis Reyes ◽  
Santiago Ortiz-Perez ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Skull Base ◽  
Cavernous Sinus ◽  
Lateral Wall ◽  
Neurological Deficits ◽  
Meckel’S Cave ◽  
Endoscopic Endonasal ◽  
Endoscopic Transorbital ◽  
Meckel's Cave ◽  
Surgical Teams

OBJECTIVEOver the years, Meckel’s cave pathologies have been judged off-limits because of high rates of morbidity. Even though several studies have defined various surgical routes with tolerable morbidity and mortality rates, controversies related to the optimal avenue to treat different categories of Meckel’s cave and cavernous sinus neoplasms persist.With unceasing energy to cultivate minimally invasive neurosurgical approaches, the endoscopic endonasal route has been tested, and the approach effectively performed, to provide a valid surgical window to these areas. In this dynamic and challenging scenario, another ventral endoscopic minimally invasive route—that is, the superior eyelid endoscopic transorbital approach—has been very recently proposed, and used in selected cases, to access the cavernous sinus and Meckel’s cave regions.METHODSThe authors report the technical nuances of a combined and simultaneous endoscopic endonasal and transorbital surgical treatment of a patient with a Meckel’s cave schwannoma. The operation involved collaboration among neurosurgery, otorhinolaryngology, and ophthalmology (oculoplastic surgery). The patient recovered well, had no neurological deficits, and was discharged to home 3 days after surgery.RESULTSThe multiportal combined route was proposed for the following reasons. The endonasal approach, considered to be more familiar to our skull base team, could allow control of possible damage of the internal carotid artery. From the endonasal perspective, the most inferior and medial portion of the tumor could be properly managed. Finally, the transorbital route, by means of opening the lateral wall of the cavernous sinus via the meningoorbital band, could allow control of the superolateral part of the tumor and, most importantly, could permit removal of the portion entering the posterior cranial fossa via the trigeminal pore. Simultaneous surgery with two surgical teams working together was planned in order to reduce operative time, hospital stay, and patient stress and discomfort, and to ensure “one-shot” complete tumor removal, with minimal or no complications.CONCLUSIONSThis study represents the translation into the real surgical setting of recent anatomical contributions related to the novel endoscopic transorbital approach and its simultaneous integration with the endoscopic endonasal pathway. Accordingly, it may pave the way for future applications related to minimally invasive, multiportal endoscopic surgery for skull base tumors.

scholarly journals Endoscopic-Assisted Microsurgical Resection of Right Recurrent Meckel's Cave Meningioma Extended to Cavernous Sinus

2021 ◽  
Author(s):  
Arianna Fava ◽  
Paolo di Russo ◽  
Lorenzo Giammattei ◽  
Sébastien Froelich
Keyword(s):  
Skull Base ◽  
Cavernous Sinus ◽  
Infratemporal Fossa ◽  
Tumor Resection ◽  
Lateral Wall ◽  
Complete Removal ◽  
Meckel’S Cave ◽  
Large Tumor ◽  
Postoperative Mri ◽  
Meckel's Cave

Abstract Objective This study was aimed to present the complete removal of a large recurrent Meckel's cave meningioma. Design This study is a case report. Setting The study was conducted at Department of Neurosurgery and Skull Base Laboratory at Lariboisiére Hospital, Paris. Participant A 53-year-old male was presented with a severe V1, V2, and V3 hypoesthesia and pain. He was operated 7 years ago for a right Meckel's cave meningioma with postoperative V1–V2 hypoesthesia. Magnetic resonance imaging (MRI) showed a large tumor recurrence extending into the cavernous sinus (CS), posterior fossa (PF), sphenoid sinus (SS), pterygopalatine (PPF), and infratemporal fossa (ITF; Fig. 1). Main Outcome Measures Radiological results and postoperative course were assessed for this study. Results The previous right frontotemporal approach was used. The lateral wall of the orbit, the middle fossa floor and the anterior temporal base were drilled to expose the orbit, PPF, and ITF. Foramen ovale (FO), foramen rotondum (FR), and superior orbital fissure (SOF) were opened. The meningoorbital band was cut and the lateral wall of CS was elevated (Fig. 2). The inferior orbital fissure was opened and tumor removed into the ITF, PPF, and orbit. After entering Meckel's cave from above, tumor was removed from PF. After microsurgical tumor removal, a 45-degree endoscope was used to remove tumor remnant and mucosa into SS. A watertight dural closure with pericranium was performed, reinforced with autologous fat and fibrin glue. Postoperative MRI showed complete tumor resection (Fig. 1). The patient experienced a right-side keratitis that resolved within 10 days and a V3 hypoesthesia that improved at 2 months. Conclusion This surgical case shows how the anatomical knowledge is mandatory in skull base surgery and how the integration of microsurgical and endoscopic-assisted techniques allows to obtain optimal results.The link to the video can be found at: https://youtu.be/qxt_389AdWU.

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.

scholarly journals Minimally Invasive Approaches to the Lateral Cavernous Sinus and Meckel's Cave: Comparison of Transorbital and Subtemporal Endoscopic Techniques

2017 ◽  
Vol 78 (S 01) ◽  
pp. S1-S156
Author(s):  
Lucas Lima ◽  
Diego Servian ◽  
Matias Gomez ◽  
Alaa Montaser ◽  
Victor Vasconcelos ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Cavernous Sinus ◽  
Meckel’S Cave ◽  
Endoscopic Techniques ◽  
Meckel's Cave

Isolated Meckel's Cave and Cavernous Sinus Amyloidomas Mimicking Central Skull Base Tumors

2012 ◽  
Vol 73 (S 01) ◽  
Author(s):  
W.W. Chang ◽  
M. E. Jentoft ◽  
J. J. Van Gompel ◽  
J. E. Hammack ◽  
T. J. Sebo ◽  
...  
Keyword(s):  
Skull Base ◽  
Cavernous Sinus ◽  
Skull Base Tumors ◽  
Meckel’S Cave ◽  
Meckel's Cave

Minimally Invasive Approaches to the Lateral Cavernous Sinus and Meckel's Cave: Comparison of Transorbital and Subtemporal Endoscopic Techniques

2020 ◽  
Vol 141 ◽  
pp. e86-e96
Author(s):  
Lucas Ramos Lima ◽  
Andre Beer-Furlan ◽  
Daniel M. Prevedello ◽  
Ricardo L. Carrau ◽  
Diego Armando Servián-Duarte ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Cavernous Sinus ◽  
Meckel’S Cave ◽  
Endoscopic Techniques ◽  
Meckel's Cave

scholarly journals Transcavernous Approach to the Upper Basilar and Retroclival Area—Cadaveric Surgical Simulation Video: 2-Dimensional Operative Video

2019 ◽  
Vol 17 (6) ◽  
pp. E251-E251 ◽  
Author(s):  
Ali Tayebi Meybodi ◽  
Leandro Borba Moreira ◽  
Xiaochun Zhao ◽  
Michael T Lawton ◽  
Mark C Preul
Keyword(s):  
Skull Base ◽  
Cavernous Sinus ◽  
Surgical Simulation ◽  
Lateral Aspect ◽  
Meckel’S Cave ◽  
Quantitative Studies ◽  
Lateral Skull Base ◽  
Meckel's Cave ◽  
Vascular Structures ◽  
Neurovascular Structures

Abstract The transcavernous approach (TcA) is an extension of the pterional approach that widens access to the central and lateral skull base regions. Through working between the nerves and vascular structures within the cavernous sinus, the TcA enables enhanced exposure of areas and structures including but not limited to the retrosellar area, Meckel's cave, and the basilar trunk. When the basilar apex and retrosellar regions are targeted, the TcA offers a valuable solution to the problem of the restricted space between the neurovascular structures of the central skull base through opening and widening the 2 major triangles of the cavernous sinus roof: the clinoidal and oculomotor triangles. Mastery of this approach requires careful review of the anatomy and much time spent in the cadaver lab. Although many quantitative studies and illustrative papers exist on the technical nuances of the TcA to the basilar apex region, the TcA is still difficult to understand, learn, and undertake. This cadaveric surgical simulation attempts to facilitate this objective. Of note, we have demonstrated and discussed the specific variant of the TcA that aims to reach the basilar apex area, and this video does not include the full TcA that also involves complete exposure of the lateral aspect of the cavernous sinus and the Meckel's cave.

scholarly journals Endoscopic transorbital surgery for Meckel’s cave and middle cranial fossa tumors: surgical technique and early results

2019 ◽  
Vol 131 (4) ◽  
pp. 1126-1135 ◽  
Author(s):  
Chiman Jeon ◽  
Chang-Ki Hong ◽  
Kyung In Woo ◽  
Sang Duk Hong ◽  
Do-Hyun Nam ◽  
...  
Keyword(s):  
Surgical Techniques ◽  
Middle Cranial Fossa ◽  
Csf Leak ◽  
Meckel’S Cave ◽  
Endoscopic Endonasal ◽  
Working Space ◽  
Early Results ◽  
Endoscopic Transorbital ◽  
Meckel's Cave ◽  
Cranial Fossa

OBJECTIVETumors involving Meckel’s cave remain extremely challenging because of the surrounding complex neurovascular structures and deep-seated location. The authors investigated a new minimal-access technique using the endoscopic transorbital approach (eTOA) through the superior eyelid crease to Meckel’s cave and middle cranial fossa lesions and reviewed the most useful surgical procedures and pitfalls of this approach.METHODSBetween September 2016 and January 2018, the authors performed eTOA in 9 patients with tumors involving Meckel’s cave and the middle cranial fossa. The lesions included trigeminal schwannoma in 4 patients, meningioma in 2 patients, metastatic brain tumor in 1 patient, chondrosarcoma in 1 patient, and dermoid cyst in 1 patient. In 7 of the 9 patients, eTOA alone was performed, while the other 2 patients underwent a combined eTOA and endoscopic endonasal approach or retrosigmoid craniotomy. Data including details of surgical techniques and clinical outcomes were recorded.RESULTSGross-total resection was performed in 7 of the 9 patients (77.8%). Four patients underwent extended eTOA (with lateral orbital rim osteotomy). Drilling of the trapezoid sphenoid floor, a middle fossa “peeling” technique, and full visualization of Meckel’s cave were applied to approach the lesions. Tumors were exposed and removed extradurally in 3 patients and intradurally in 6 patients. There was no postoperative CSF leak.CONCLUSIONSThe eTOA affords a direct route to access Meckel’s cave and middle cranial fossa lesions. With experience, this novel approach can be successfully applied to selected skull base lesions. To achieve successful removal of the tumor, emphasis should be placed on the importance of adequately removing the greater sphenoid wing and vertical crest. However, because of limited working space eTOA may not be an ideal approach for posterior fossa lesions.

Limits of endoscopic endonasal transpterygoid approach to cavernous sinus and Meckel's cave

2018 ◽  
Vol 62 (3) ◽  
Author(s):  
Douglas A. Hardesty ◽  
Alaa S. Montaser ◽  
Ricardo L. Carrau ◽  
Daniel M. Prevedello
Keyword(s):  
Cavernous Sinus ◽  
Meckel’S Cave ◽  
Endoscopic Endonasal ◽  
Meckel's Cave
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