Anatomical Approaches to Giant Pituitary Tumors

Beer‐Furlan, André; Abi-Hachem, Ralph; Jamshidi, Ali O.; Carrau, Ricardo L.; Prevedello, Daniel M.

doi:10.1007/978-3-319-56691-7_30

Cited by 2 publications

(2 citation statements)

References 25 publications

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“…1 2 During recent decades, however, endoscopic endonasal approaches (EEA) have been consolidated as safe and effective alternatives for the treatment of ventral skull base lesions. 3 4 5 The EEA provides an anterior midline approach, with some advantages when compared with open approaches. Besides avoiding brain retraction, the EEA can provide a more direct route to some lesions, without crossing the plane of cranial nerves, risking hearing or working through poorly visualized corridors.…”

Section: Introductionmentioning

confidence: 99%

Anatomical Limits of the Endoscopic Contralateral Transmaxillary Approach to the Petrous Apex and Petroclival Region

Mangussi‐Gomes

Belo

Truong

et al. 2020

J Neurol Surg B Skull Base

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Objectives This study aimed to establish the anatomical landmarks for performing a contralateral transmaxillary approach (CTM) to the petrous apex (PA) and petroclival region (PCR), and to compare CTM with a purely endoscopic endonasal approach (EEA). Design EEA and CTM to the PA and PCR were performed bilaterally in eight human anatomical specimens. Surgical techniques and anatomical landmarks were described, and EEA was compared with CTM with respect to ability to reach the contralateral internal acoustic canal (IAC). Computed tomographic scans of 25 cadaveric heads were analyzed and the “angle” and “reach” of CTM and EEA were measured. Results Entry to the PA via a medial approach was limited by (1) abducens nerve superiorly, (2) internal carotid artery (ICA) laterally, and (3) petroclival synchondrosis inferiorly (Gardner's triangle). With CTM, it was possible to reach the contralateral IAC bilaterally in all specimens dissected, without dissection of the ipsilateral ICAs, pterygopalatine fossae, and Eustachian tubes. Without CTM, reaching the contralateral IAC was possible only if: (1) angled endoscopes and instruments were employed or (2) the pterygopalatine fossa was dissected with mobilization of the ICA and resection of the Eustachian tube. The average “angle” and “reach” advantages for CTM were 25.6-degree greater angle of approach behind the petrous ICA and 1.4-cm more lateral reach. Conclusion The techniques and anatomical landmarks for CTM to the PA and PCR are described. Compared with a purely EEA, the CTM provides significant “angle” and “reach” advantages for the PA and PCR.

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Section: Introductionmentioning

confidence: 99%

Anatomical Limits of the Endoscopic Contralateral Transmaxillary Approach to the Petrous Apex and Petroclival Region

Mangussi‐Gomes

Belo

Truong

et al. 2020

J Neurol Surg B Skull Base

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“…33 Perhaps the greatest strength of EEA techniques is in the midline, where they are adeptly applied to chordomas, clival meningiomas, or readily adapted to provide additional access and visualization for complex lesions with a substantial clival component. 34…”

Section: Discussionmentioning

confidence: 99%

Anatomical Step-by-Step Dissection of Complex Skull Base Approaches for Trainees: Surgical Anatomy of the Middle Fossa Approaches and Anterior Petrosectomy, Surgical Principles, and Illustrative Cases

Salgado-López

Perry

Graffeo

et al. 2021

J Neurol Surg B Skull Base

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Introduction The middle fossa (MF) approaches encompass a group of versatile surgical accesses to pathologies in the MF, internal auditory canal (IAC), and superomedial aspect of the posterior fossa. Although many descriptions of the MF approaches have been published, a practical surgical guide that allows an easy understanding for Skull Base trainees is needed. Methods Three formalin-fixed, colored-injected specimens were dissected under microscopic magnification (six sides). A MF craniotomy followed by IAC drilling was performed on three sides, and anterior petrosectomy (AP) was performed in the remaining three sides. The anatomical dissection was documented in stepwise three-dimensional photographic images. Following dissection, representative case applications were reviewed. Results The MF approach provides direct access to the MF structures and IAC. The AP provides excellent access to the superomedial aspect of the posterior fossa. Key common steps include: positioning and skin incision; scalp and muscle flaps; burr holes; craniotomy flap elevation; dural dissection along the petrous ridge; division of the middle meningeal artery; and exposure of the greater superficial petrosal nerve, tegmen tympani, and V3. Then, to approach the IAC: superior IAC drilling, and longitudinal dura opening. The area drilled in the AP approach forms a pentagon limited by the petrous internal carotid artery, cochlea, IAC, petrous ridge, and lateral border of V3. Conclusion The MF approaches are challenging. Operatively oriented skull base dissections provide a crucial foundation for learning these techniques. We describe comprehensive step-by-step approaches intended to develop familiarity in the cadaver laboratory and facilitate understanding of their potential for skull base disorders. Basic surgical principles are described to help in the operating room as well as illustrative cases.

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Anatomical Approaches to Giant Pituitary Tumors

Cited by 2 publications

References 25 publications

Anatomical Limits of the Endoscopic Contralateral Transmaxillary Approach to the Petrous Apex and Petroclival Region

Anatomical Limits of the Endoscopic Contralateral Transmaxillary Approach to the Petrous Apex and Petroclival Region

Anatomical Step-by-Step Dissection of Complex Skull Base Approaches for Trainees: Surgical Anatomy of the Middle Fossa Approaches and Anterior Petrosectomy, Surgical Principles, and Illustrative Cases

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