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Daniele Starnoni, Roy Thomas Daniel, Mercy George, Mahmoud Messerer
BACKGROUND: Spontaneous meningoencephaloceles of the lateral sphenoid sinus are rare entities and their peculiar location represent a surgical challenge due to the importance of a wide exposure and skull base reconstruction. They are thought to arise from congenital base defect of the lateral sphenoid or in some cases have been postulated to represent a rare manifestation of altered CSF dynamics. We report the first case in literature of a Chiari malformation type I and a lateral sphenoid encephaloceles revising the theoretical etiology and surgical technique of endoscopic repair...
October 8, 2016: World Neurosurgery
Hussam Abou-Al-Shaar, Ari M Blitz, Fausto J Rodriguez, Masaru Ishii, Gary L Gallia
BACKGROUND: Craniopharyngiomas are uncommon benign locally aggressive epithelial tumors mostly located in the sellar and suprasellar regions. An infrasellar origin of these tumors is rare. CASE DESCRIPTION: The authors report a 22-year-old male patient with a purely infrasellar adamantinomatous craniopharyngioma centered in the nasopharynx with extension into the posterior nasal septum, sphenoid sinus, and clivus. Gross total resection was achieved using an expanded endonasal endoscopic transethmoidal, transsphenoidal, transpterygoid, and transclival approach...
August 20, 2016: World Neurosurgery
Jacob L Freeman, Raghuram Sampath, Michael A Casey, Steven Craig Quattlebaum, Vijay R Ramakrishnan, A Samy Youssef
BACKGROUND: Fixed retraction of the internal carotid artery (ICA) has previously been described for use during transcranial microscopic surgery. We report the novel use of a self-retaining microvascular retractor for static repositioning and protection of the ICA during expanded endonasal endoscopic approaches to the paramedian skull base. METHODS: The transmaxillary, transpterygoid approach was performed in five cadaver heads (ten sides). The self-retaining microvascular retractor was used to laterally reposition the pterygopalatine fossa contents during exposure of the pterygoid base/plates and the paraclival ICA to expose the petrous apex...
August 2016: Acta Neurochirurgica
Nikita Chapurin, Adam Honeybrook, Sean Johnson, Cynthia Wang, David W Jang
BACKGROUND: The retroantral ethmoid cell (RAEC) is defined as a posterior ethmoid cell that pneumatizes inferolaterally behind the posterior wall of the maxillary sinus. The RAEC can present a challenge to otolaryngologists during endoscopic ethmoidectomy due to its concealed location. It is also encountered during the endoscopic transpterygoid approach to the skull base, which requires dissection behind the posterior wall of the maxillary sinus. Because the RAEC is not described in the literature, this study aims to better characterize this anatomic variant...
June 21, 2016: International Forum of Allergy & Rhinology
Xuejian Wang, Xiaobiao Zhang, Fan Hu, Yong Yu, Ye Gu, Tao Xie, Junqi Ge
The aim of this report was to summarize our preliminary experience on the resection of tumors located in Meckel's cave via the endoscopic endonasal transmaxillary transpterygoid approach with image-guided system and to investigate the feasibility and efficacy of this approach. Two patients who had tumors in left Meckel's cave underwent surgical treatment using the image-guided endoscopic endonasal transmaxillary transpterygoid approach. This particular technique has advantages of no brain retraction, direct vision of tumor resection and protection of surrounding neurovascular structures...
2016: Turkish Neurosurgery
Jianfeng Liu, Jun Han, Dazhang Yang, Dandan Liu, Rui Li, Yanbing Yu, Qiuhang Zhang, Juan C Fernandez Miranda, Paul A Gardner, Carl H Snyderman
OBJECTIVE: To identify the landmarks of transpterygoid approach and to report its application in a series of cases. METHODS: Two silicon-injected adult cadaveric heads(4 sides) were dissected by performing an endoscopic endonasal transpterygoid approach after CT scanning for imaging guidance. High-quality pictures were obtained. This approach was used to treat twelve patients with skull base lesions including 3 spontaneous cerebrospinal fluid (CSF) leaks in the lateral recess of the sphenoid sinus, 2 neurofibromas and 2 Schwannomas involving the pterygopalatine fossa and infratemporal fossa, 1 dermoid cyst involving the middle fossa and infratemporal fossa, 1 invasive fungal sinusitis invading the middle fossa base, 1 basal cell adenoma in the upper parapharyngeal space, 1 chondrosarcoma in the parasellar region and 1 adenoid cystic carcinoma...
November 2015: Zhonghua Er Bi Yan Hou Tou Jing Wai Ke za Zhi, Chinese Journal of Otorhinolaryngology Head and Neck Surgery
Koichiro Wasano, Sayuri Yamamoto, Shuta Tomisato, Taiji Kawasaki, Kaoru Ogawa
BACKGROUND: Conventional approaches for removing parapharyngeal space tumors require a cervical skin incision and resection of soft tissues between the skin and parapharyngeal space. The surgical visual field for this conventional approach is limited. METHODS: To decrease invasiveness during removal of benign parapharyngeal space tumors and to enhance the visual field, we devised a new approach called the modified endoscopic transnasal-transmaxillary-transpterygoid approach (MENMAP)...
June 2016: Head & Neck
Y Brand, E Lim, V Waran, N Prepageran
BACKGROUND: Endoscopic endonasal techniques have recently become the method of choice in dealing with cerebrospinal fluid leak involving the anterior cranial fossa. However, most surgeons prefer an intracranial approach when leaks involve the middle cranial fossa. This case report illustrates the possibilities of using endoscopic techniques for cerebrospinal fluid leaks involving the middle fossa. CASE REPORT: A 37-year-old male patient presented with multiple areas of cranial defect with cerebrospinal fluid leak due to osteoradionecrosis following radiation for nasopharyngeal carcinoma 4 years earlier...
December 2015: Journal of Laryngology and Otology
Ahmed Youssef, Ricardo L Carrau, Ahmed Tantawy, Ahmed Ibraheim, Arturo C Solares, Bradley A Otto, Daniel M Prevedello, Leo Ditzel Filho
Introduction Various lateral and anterior approaches to access the infratemporal fossa (ITF) have been described. We provide our observations regarding the endoscopic transpterygoid and preauricular subtemporal approaches, listing their respective advantages and limitations through cadaveric dissection. Methods A cadaver study was performed on five adult specimens. An endoscopic transpterygoid approach to the ITF was completed bilaterally in three specimens, and an open preauricular ITF approach was performed bilaterally in two specimens...
September 2015: Journal of Neurological Surgery. Part B, Skull Base
Adrian J Maurer, Phillip A Bonney, Courtney R Iser, Rohaid Ali, Jose A Sanclement, Michael E Sughrue
Chondrosarcomas of the skull base are rare tumors that present difficult management considerations due to the pathoanatomical relationships of the tumor to adjacent structures. We present the case of a 25-year-old female patient presenting with a chondrosarcoma of the right petrous apex extending inferiorly, medial to the cranial nerves. The tumor was resected via an endoscopic endonasal infrapetrous transpterygoid approach that achieved complete resection and an excellent long-term outcome with no complications...
July 2015: Journal of Neurological Surgery Reports
I P Tang, R L Carrau, B A Otto, D M Prevedello, P Kasemsiri, L Ditzel, J Muto, B Kapucu, C Kirsch
BACKGROUND AND METHODS: Reconstruction with a vascularised flap provides the most reliable outcome, with post-operative cerebrospinal fluid leak rates of less than 5 per cent. This article aims to review and summarise the critical technical aspects of the vascularised flaps most commonly used for skull base reconstruction. RESULTS: Vascularised flaps are classified as intranasal or extranasal. The intranasal group includes the Hadad-Bassagaisteguy nasoseptal flap, the Caicedo reverse nasoseptal flap, the nasoseptal rescue flap, the posteriorly or anteriorly based lateral wall flaps, and the middle turbinate flap...
August 2015: Journal of Laryngology and Otology
Tomasz A Dziedzic, Vijay K Anand, Theodore H Schwartz
Although the medial and inferior orbital apex are considered safely accessible using the endonasal endoscopic approach, the lateral apex has been considered unsafe to access since the optic nerve lies between the surgeon and the pathology. The authors present the case of a 4-year-old girl with recurrent rhabdomyosarcoma attached to the lateral rectus muscle located lateral and inferior to the optic nerve in the orbital apex. The tumor was totally resected through an endoscopic endonasal transmaxillary transpterygoidal approach using a 45° endoscope...
September 2015: Journal of Neurosurgery. Pediatrics
Alexandre Beraldo Ordones, Marco Aurélio Fornazieri, Fábio de Rezende Pinna, Thiago Freire Pinto Bezerra, Richard Louis Voegels, Luiz Ubirajara Sennes
Objective To describe a case of dermoid cyst arising from the pterygopalatine fossa and review the literature. Methods We report a case of a 23-year-old man who suffered a car accident 2 years before otolaryngologic attendance. He had one episode of generalized tonic-clonic seizure and developed a reduction of visual acuity of the left side after the accident. Neurologic investigation was performed and magnetic resonance imaging revealed an incidental finding of a heterogeneous ovoid lesion in the pterygopalatine fossa, hyperintense on T2-weighted imaging...
January 2014: International Archives of Otorhinolaryngology
Apostolos Karligkiotis, Maurizio Bignami, Paola Terranova, Mario Ciniglio-Appiani, Abdulrahman Shawkat, Benjamin Verrilaud, Francesco Meloni, Philippe Herman, Paolo Castelnuovo
BACKGROUND: Nowadays the endoscopic approach represents a useful alternative to traditional surgical approaches in the treatment of cholesterol granulomas (CGs) of the petrous apex (PA). Recently the nasoseptal flap (NSF) has been employed to permit long-term patency of drainage site. The purpose of this study is to report our experience with the NSF in the endoscopic management of CG and to analyze the advantages, limitations, and outcomes of the technique. METHODS: A retrospective analysis was carried out on 10 patients affected by CG of the PA who had been treated endoscopically, using the NSF...
August 2015: International Forum of Allergy & Rhinology
N Komune, S Komune, K Matsushima, A L Rhoton
INTRODUCTION: This project compares access to the anterolateral part of the jugular foramen provided by the lateral microsurgical preauricular and the anterior endoscopic approaches, and defines the important landmarks involved in each approach. STUDY DESIGN: Cadaveric study. RESULTS: The endoscopic transnasal/transmaxillary transpterygoid corridor provides a less invasive route for selected lesions in the jugular foramen than the traditional open route through the preauricular subtemporal infratemporal fossa approach...
March 2015: Journal of Laryngology and Otology
Timothée Jacquesson, Moncef Berhouma, Stéphane Tringali, Emile Simon, Emmanuel Jouanneau
OBJECTIVE: Petroclival tumors remain a surgical challenge. Classically, the retrosigmoid approach (RSA) has long been used to reach such tumors, whereas the anterior petrosectomy (AP) has been proposed to avoid crossing cranial nerves. More recently, the endoscopic endonasal approach has been "expanded" (i.e., EEEA) to the petroclival region. We aimed to compare these 3 approaches to help in the surgical management of petroclival tumors. METHODS: Petroclival approaches were performed on 5 specimens after they were prepared with formaldehyde colored via latex injection...
June 2015: World Neurosurgery
Alexander P Marston, Jamie J Van Gompel, Matthew L Carlson, Erin K O'Brien
OBJECTIVES: This case presents a previously undescribed clinical scenario of spontaneous cerebrospinal fluid (CSF) leaks secondary to a lateral sphenoid sinus recess skull base dehiscence and contralateral Sternberg's canal. This case report aims to characterize the presentation and successful management of these lesions. METHODS: The electronic medical record was used to collect information pertaining to the patient's clinical history. RESULTS: The patient was a middle-aged, obese female with persistent clear rhinorrhea as her only presenting symptom...
August 2015: Annals of Otology, Rhinology, and Laryngology
Ye Gu, Yong Yu, Xiaobiao Zhang, Fan Hu, Xuejian Wang, Wenlong Xu, Tao Xie
OBJECTIVE: Tumors involving Meckel cave (MC) always present challenges to neurosurgeons. We performed an investigation of the anatomical characteristics of the endoscopic endonasal transmaxillary transpterygoid approach to MC as an alternative to routine transcranial approaches and further confirmed its efficacy in the clinical setting. METHODS: Five adult fresh head specimens (10 sides) were studied to identify crucial anatomical landmarks and quantify the anatomical structures involved in the endoscopic endonasal transmaxillary transpterygoid approach...
May 2015: Journal of Neurological Surgery. Part A, Central European Neurosurgery
Danielle de Lara, Leo F S Ditzel Filho, Daniel M Prevedello, Ricardo L Carrau, Pornthep Kasemsiri, Bradley A Otto, Amin B Kassam
OBJECTIVE: To describe the technical and anatomic nuances related to endoscopic endonasal approaches (EEAs) to the paramedian skull base. METHODS: Surgical indications, limitations, and technical aspects pertaining to EEAs designed to access areas oriented in the coronal plane are systematically reviewed with special attention to caveats, pitfalls, and common complications and how to avoid them. Case examples are presented. RESULTS: The paramedian skull base may be divided into anterior (corresponding to the orbit and its contents), middle (corresponding to the middle cranial, pterygopalatine, and infratemporal fossae), and posterior (includes the craniovertebral junction lateral to the occipital condyles and the jugular foramen) segments...
December 2014: World Neurosurgery
Eduardo de Arnaldo Silva Vellutini, Leonardo Balsalobre, Diego Rodrigo Hermann, Aldo Cassol Stamm
OBJECTIVE: To report the use of the endoscopic transnasal transclival approach to treat tumors involving the clivus region. METHODS: The clinical records of 38 patients with clivus lesions were retrospectively reviewed to determine the surgical technique used. All patients were surgically treated using any of the options of the endoscopic transnasal transclival approach at the São Paulo Skull Base Center from 2000-2011. A transsphenoidal, transpterygoidal, retropharyngeal, or a combination of approaches was chosen based on the tumor topography...
December 2014: World Neurosurgery
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