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endoscopic skull base anatomy

Juan Luis Gómez-Amador, Luis Alberto Ortega-Porcayo, Isaac Jair Palacios-Ortíz, Alexander Perdomo-Pantoja, Felipe Eduardo Nares-López, Alfredo Vega-Alarcón
Brainstem cavernous malformations are challenging due to the critical anatomy and potential surgical risks. Anterolateral, lateral, and dorsal surgical approaches provide limited ventral exposure of the brainstem. The authors present a case of a midline ventral pontine cavernous malformation resected through an endoscopic endonasal transclival approach based on minimal brainstem transection, negligible cranial nerve manipulation, and a straightforward trajectory. Technical and reconstruction technique advances in endoscopic endonasal skull base surgery provide a direct, safe, and effective corridor to the brainstem...
October 21, 2016: Journal of Neurosurgery
S Chawla, J Bowman, M Gandhi, B Panizza
BACKGROUND: The skull base is a highly complex anatomical region that provides passage for important nerves and vessels as they course into and out of the cranial cavity. Key to the management of pathology in this region is a thorough understanding of the anatomy, with its variations, and the relationship of various neurovascular structures to the pathology in question. Targeted high-resolution magnetic resonance imaging on high field strength magnets can enable the skull base surgeon to understand this intricate relationship and deal with the pathology from a position of relative advantage...
October 20, 2016: Journal of Laryngology and Otology
Abib Agbetoba, Amber Luong, Jin Keat Siow, Brent Senior, Claudio Callejas, Kornel Szczygielski, Martin J Citardi
BACKGROUND: Endoscopic sinus surgery represents a cornerstone in the professional development of otorhinolaryngology trainees. Mastery of these surgical skills requires an understanding of paranasal sinus and skull-base anatomy. The frontal sinus is associated with a wide range of variation and complex anatomical configuration, and thus represents an important challenge for all trainees performing endoscopic sinus surgery. METHODS: Forty-five otorhinolaryngology trainees and 20 medical school students from 5 academic institutions were enrolled and randomized into 1 of 2 groups...
October 18, 2016: International Forum of Allergy & Rhinology
Noritaka Komune, Satoshi Matsuo, Koichi Miki, Albert L Rhoton
OBJECTIVE The application of the endoscope in the lateral skull base increases the importance of the middle ear cavity as the corridor to the skull base. The aim of this study was to define the middle ear as a route to the fundus (lateral end) of the internal acoustic canal and to propose feasible landmarks to the fundus. METHODS This was a cadaveric study; 34 adult cadaveric temporal bones and 2 dry bones were dissected with the aid of the endoscope and microscope to show the anatomy of the transcanal approach to the middle ear and fundus of the internal acoustic canal...
September 2, 2016: Journal of Neurosurgery
Filippo Gagliardi, Carmine A Donofrio, Alfio Spina, Michele Bailo, Cristian Gragnaniello, Alberto L Gallotti, Samer K Elbabaa, Anthony J Caputy, Pietro Mortini
OBJECTIVE: Anterolateral skull base surgery to sellar and parasellar region has always represented a technical challenge for neurosurgeons. The microscopic endoscope-assisted trans-maxillo-sphenoidal approach (MEMSA) affords a direct surgical corridor free from critical skull base structures. The aim of this study is to describe and critically evaluate its application to access the sellar and parasellar areas in terms of surgical exposure and operability. METHODS: Six cadaveric heads were examined...
August 18, 2016: World Neurosurgery
John Y K Lee, John T Pierce, Sukhmeet K Sandhu, Dmitriy Petrov, Andrew I Yang
OBJECTIVE Endoscopic surgery has revolutionized surgery of the ventral skull base but has not yet been widely adopted for use in the cerebellopontine angle. Given the relatively normal anatomy of the cerebellopontine angle in patients with trigeminal neuralgia (TN), the authors hypothesized that a fully endoscopic microvascular decompression (E-MVD) might provide pain outcomes equivalent to those of microscopic MVD (M-MVD) but with fewer complications. METHODS The authors conducted a single-institution, single-surgeon retrospective study with patients treated in the period of 2006-2013...
July 29, 2016: Journal of Neurosurgery
Puya Alikhani, Sananthan Sivakanthan, Harry van Loveren, Siviero Agazzi
BACKGROUND: The anatomy of the carotid artery has traditionally been understood into segments that correspond to the surrounding relevant anatomy. Transcranial surgery favors the seven segments classification initially posited by our group in 1996. With the advent of endoscopic approaches a new term has been added to the carotid anatomy lexicon "the paraclival internal carotid artery (ICA)." This "paraclival" carotid is a very familiar segment for all endoscopically trained skull base surgeons but a clear correlate to the transcranial anatomy has not been described...
August 2016: Journal of Neurological Surgery. Part B, Skull Base
Li Gao, Xinsheng Huang
As an important landmark, the posterolateral wall of maxillary sinus can help to locate numbers of significant signs such as maxillary artery and its branches, maxillary nerve and infraorbital nerve, infratemporal fossa and pterygopalatine fossa etc. in the endoscopic surgery for paranasal sinuses and lateral skull base. This article reviewed related researches about the anatomy and endoscopic surgery of posterolateral wall of maxillary sinus.
December 2015: Journal of Clinical Otorhinolaryngology, Head, and Neck Surgery
O I Sharipov, M A Kutin, P L Kalinin, D V Fomichev, V A Lukshin, A B Kurnosov
INTRODUCTION: Doppler ultrasound (DUS) has been widely used in neurosurgical practice to diagnose various cerebrovascular diseases. This technique is used in transsphenoidal surgery to identify the localization of intracranial arteries when making an approach or during tumor resection. MATERIAL AND METHODS: To identify the cavernous segment of the internal carotid artery (ICA) and/or basilar artery during endoscopic transsphenoidal surgery, we used a combined device on the basis of a click line curette («Karl Storz») and a 16 MHz Doppler probe (Lassamed)...
2016: Zhurnal Voprosy Neĭrokhirurgii Imeni N. N. Burdenko
Do Hyun Kim, Yong-Kil Hong, Sin-Soo Jeun, Yong Jin Park, Soo Whan Kim, Jin Hee Cho, Boo Young Kim, Sungwoo Han, Yong Joo Lee, Jae Hyung Hwang, Sung Won Kim
OBJECTIVE: We evaluated postoperative changes in nasal cavity volume and their effects on nasal function and symptoms after endoscopic endonasal transsphenoidal approach for antero-central skull base surgery. STUDY DESIGN: Retrospective chart review at a tertiary referral center. METHODS: We studied 92 patients who underwent binostril, four-hand, endoscopic endonasal transsphenoidal approach surgery using the bilateral modified nasoseptal rescue flap technique...
2016: PloS One
Carl H Snyderman, Paul A Gardner, Bostjan Lanisnik, Janez Ravnik
OBJECTIVES/HYPOTHESIS: To assess the efficacy of a surgical telementoring program for endoscopic skull base surgery. STUDY DESIGN: Prospective case series with surveys of surgeons. METHODS: A surgical telementoring program was established for mentoring of a skull base team at the University of Maribor in Slovenia by an experienced skull base team at the University of Pittsburgh Medical Center in Pennsylvania. Two-way video and audio streaming provided real-time communication with the surgical team...
June 2016: Laryngoscope
Marco Ferrari, Alberto Schreiber, Davide Mattavelli, Francesco Belotti, Vittorio Rampinelli, Davide Lancini, Francesco Doglietto, Marco Maria Fontanella, Manfred Tschabitscher, Luigi Fabrizio Rodella, Piero Nicolai
BACKGROUND: In recent years, transorbital endoscopic approaches are increasing in popularity as they provide several corridors to reach lateral areas of the ventral skull base through the orbit. The aim of this study is to investigate the feasibility of the inferolateral transorbital endoscopic approach (ILTEA) by detailing the step-by-step dissection, anatomic landmarks, and target anatomic areas. METHODS: Seven cadaveric specimens (14 sides) were dissected in the Laboratory of Endoscopic Anatomy of the University of Brescia...
June 2016: World Neurosurgery
Ali M Elhadi, Hasan A Zaidi, Kaan Yagmurlu, Shah Ahmed, Albert L Rhoton, Peter Nakaji, Mark C Preul, Andrew S Little
OBJECTIVE Endoscopic transmaxillary approaches (ETMAs) address pathology of the anterolateral skull base, including the cavernous sinus, pterygopalatine fossa, and infratemporal fossa. This anatomically complex region contains branches of the trigeminal nerve and external carotid artery and is in proximity to the internal carotid artery. The authors postulated, on the basis of intraoperative observations, that the infraorbital nerve (ION) is a useful surgical landmark for navigating this region; therefore, they studied the anatomy of the ION and its relationships to critical neurovascular structures and the maxillary nerve (V2) encountered in ETMAs...
March 4, 2016: Journal of Neurosurgery
Wenlong Tang, Xianhai Zeng, Shuqi Qiu
The clival region refers to the skull base between dorsum sellae and anterior border of foramen magnum. It is located in central area of skull base and is in close proximity to pons, medulla oblongata, basilar artery and other crucial intracranial structures. Although there are various microsurgical approaches using craniotomy to reach this region, there are still a lot of difficulty in exposure of clivus. With the increasing development in extended endoscopic endonasal approach, a new route to clivus, as well as meticulous endoscopic anatomy studies is emerging...
November 2015: Journal of Clinical Otorhinolaryngology, Head, and Neck Surgery
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
Cristian Ferrareze Nunes, Daniel Monte-Serrat Prevedello, Ricardo Luis Carrau, Clóvis Orlando Pereira da Fonseca, José Alberto Landeiro
BACKGROUND: The medial opticocarotid recess (MOCR) is located in the posterior wall of the sphenoid sinus, medial to the junction of the optic canal (OC) and the carotid prominence (CP). There is controversy in the literature in relation to the presence of the MOCR and its constancy, which is relevant when approaching the skull base through an endoscopic route. METHODS: The morphometric relations of the MOCR with the surrounding structures were studied in 18 cadaveric specimens after endoscopic endonasal approach (EEA)...
February 2016: Acta Neurochirurgica
Nicoleta Măru, Mugurel Constantin Rusu, Mihai Săndulescu
Multiple anatomical variants were encountered during a cone beam computed tomography (CBCT) study of the nasal cavity of a 43-year-old male patient. These were mostly related to the nasal turbinates, suggestive for an unusual development of ethmoturbinals. Pneumatized turbinates were observed: bilateral supreme, superior, and middle concha bullosa. There were bilateral paradoxically curved superior turbinates, as well as a unilateral paradoxically curved inferior turbinate. There was also found a unilateral accessory middle turbinate, presenting as a medially bent uncinate process...
2015: Romanian Journal of Morphology and Embryology, Revue Roumaine de Morphologie et Embryologie
Grant W Mallory, Grigoriy Arutyunyan, Meghan E Murphy, Kathryn M Van Abel, Elvis Francois, Nicholas M Wetjen, Jeremy L Fogelson, Erin K O'Brien, Michelle J Clarke, Laurence J Eckel, Jamie J Van Gompel
OBJECT: Endoscopic approaches to the anterior craniocervical junction are increasing in frequency. Choice of oral versus endoscopic endonasal approach to the odontoid often depends on the relationship of the C1-2 complex to the hard palate. However, it is not known how this relevant anatomy changes with age. We hypothesize that there is a dynamic relationship of C-2 and the hard palate, which changes with age, and potentially affects the choice of surgical approach. The aim of this study was to characterize the relationship of C-2 relative to the hard palate with respect to age and sex...
April 2016: Journal of Neurosurgery. Spine
Janalee K Stokken, Ashleigh Halderman, Pablo F Recinos, Troy D Woodard, Raj Sindwani
The nasal cavity has a robust vascular supply, and bleeding is a primary obstacle to the minimally invasive skull base technique. Venous bleeding, including the cavernous sinus, can be managed with various techniques using hemostatic materials and pressure. A thorough understanding of the skull base vascular anatomy is vital for avoiding injury to major arteries and having confidence to control venous bleeding to optimize the endoscopic view and tumor resection.
February 2016: Otolaryngologic Clinics of North America
Renato Hoffmann Nunes, Ana Lorena Abello, Adam M Zanation, Deanna Sasaki-Adams, Benjamin Y Huang
Endoscopic endonasal approaches have widely accepted techniques for managing benign and malignant processes along the entire ventral skull base with similar or better results compared with open procedures, but with lower rates of complication. Managing pathology affecting the skull base can be challenging because of complex anatomy and the proximity of critical neurovascular structures. Postoperative imaging can be challenging, because of surgical alterations of normal anatomy and the now common use of complex reconstruction techniques...
February 2016: Otolaryngologic Clinics of North America
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