Combined biportal unilateral endoscopic endonasal and endoscopic anterior transmaxillary approach for resection of lesions involving the infratemporal fossa

Martínez-Pérez, Rafael; Aref, Mohammed; Ramakhrisnan, Vijay; Youssef, A. Samy

doi:10.1007/s00701-021-04994-x

Cited by 6 publications

(11 citation statements)

References 9 publications

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“…34 To supplement the lateral extension of the EETPA, an ipsilateral ESTA may be utilized. [35][36][37] This facilitates dissection of the entire PPF and ITF, and, as such, allows access to the ramus of the mandible. Further, it offers access to the highest portion of the petrous ICA, adequate exposure of the foramen ovale, and easier dissection of V3 along its entire course.…”

Section: Discussionmentioning

confidence: 99%

Anatomical Step-by-Step Dissection of Complex Skull Base Approaches for Trainees: Surgical Anatomy of the Endoscopic Endonasal and Endoscopic-Assisted Transmaxillary Transpterygoid Approaches

Agosti

Rezende

Leonel

et al. 2022

J Neurol Surg B Skull Base

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Introduction The endoscopic endonasal transpterygoid approach (EETPA) with or without the addition of the endoscopic-assisted sublabial anterior transmaxillary approach (ESTA) has become increasingly utilized for lesions posterior to the pterygopalatine fossa (PPF), including infratemporal fossa (ITF), lateral recess of the sphenoid sinus, Meckel's cave, petrous apex, and parapharyngeal space. The main goal of this study is to develop an educational resource to learn the steps of the EETPA for trainees. Methods EETPA and ESTA were performed in 12 specimens by neurosurgery trainees, under supervision from the senior authors. One EETPA and one ESTA were performed on each specimen on opposite sides. Dissections were supplemented with representative cases. Results After a wide unilateral sphenoidotomy, ethmoidectomy, and partial medial maxillectomy, the anteromedial bone limits of the PPF were identified and drilled out. The pterygoid progress was modularly removed. By enlarging the opening of the posterior and lateral walls of the maxillary sinus through EETPA and ESTA, respectively, the neurovascular and muscular compartments of the PPF and ITF were better identified. The EETPA opens direct corridors to the PPF, medial ITF, middle cranial fossa, cavernous sinus, Meckel's cave, petrous apex, and internal carotid artery. If a more lateral exposure of the ITF is needed, the ESTA is an appropriate addition. Conclusion Despite the steep learning curve of the EETPA, granular knowledge of its surgical anatomy and basic surgical steps are vital for those advancing their learning in complex endoscopic approaches to the ventral skull base when expanding the approach laterally in the coronal plane.

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Section: Discussionmentioning

confidence: 99%

Anatomical Step-by-Step Dissection of Complex Skull Base Approaches for Trainees: Surgical Anatomy of the Endoscopic Endonasal and Endoscopic-Assisted Transmaxillary Transpterygoid Approaches

Agosti

Rezende

Leonel

et al. 2022

J Neurol Surg B Skull Base

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“…New visualization technologies, advanced surgical instrumentation, and the advent of image-guided surgery have enhanced the safety of surgery in this area and triggered the description of multiple endonasal, transcranial, transoral, and transorbital endoscopic and endoscopic-assisted approaches. [5][6][7][8][9][10][11][12][13][14][15] Each minimally invasive approach to the ITF has significant advantages and caveats. An endoscopic endonasal transpterygoid approach provides access to median structures but is limited superiorly and inferolaterally; 5,6 whereas, the endoscopic transoral approach is advantageous for accessing the inferior ITF (especially areas below the level of the hard palate) 8,9 ; and the endoscopic transorbital approach (via infraorbital foramen [IOF]) provides good exposure to the superior and lateral ITF.…”

Section: Introductionmentioning

confidence: 99%

“…10,11 Therefore, endoscopic endonasal approaches may be combined with external, transoral, and transorbital approaches to provide maximal exposure to vital neurovascular structures, allowing the safe management of select lesions. [11][12][13][14][15] This study examines the feasibility of using an endoscopic multiport approach as a minimal access technique…”

Section: Introductionmentioning

confidence: 99%

“…Currently, minimally invasive surgery plays an important role in the management of select lesions. New visualization technologies, advanced surgical instrumentation, and the advent of image‐guided surgery have enhanced the safety of surgery in this area and triggered the description of multiple endonasal, transcranial, transoral, and transorbital endoscopic and endoscopic‐assisted approaches 5–15 …”

Section: Introductionmentioning

confidence: 99%

“…Therefore, endoscopic endonasal approaches may be combined with external, transoral, and transorbital approaches to provide maximal exposure to vital neurovascular structures, allowing the safe management of select lesions 11–15 …”

Section: Introductionmentioning

confidence: 99%

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Endoscopic Multiport Approach for Exenteration of the Infratemporal Fossa

et al. 2023

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Objective: To demonstrate anatomic relationships pertinent to the endoscopic multiport approach to the infratemporal fossa (ITF). Discuss advantages and limitations of each individual approach.Study Design: Cadaveric study.Methods: Endoscopic and endoscopic-assisted endonasal transpterygoid, sublabial transmaxillary, endoscopic transorbital, and endoscopic transoral approaches to accessing the ITF were completed in five silicone-injected fresh cadaveric specimens (10 sides) with the assistance of 0, 30, and 45 0 rods-lens endoscopes. Image guidance was used to confirm and document the anatomical relationships encountered in each approach.Results: The endonasal endoscopic transpterygoid approach provides better visualization and more direct exposure to median structures. Endoscopic-assisted sublabial transmaxillary approach enhances the field of exposure, angle of attack, and ease of instrumentation to the lateral part of the ITF. Endoscopic-assisted transorbital approach via the inferior orbital fissure provided cephalic and anterior access. Endoscopic-assisted transoral approach complements the access to lesions extending inferior to the hard palate or far lateral to the mandibular condyle.Conclusions: A combination of minimal access infratemporal approaches can provide adequate exposure of the entire ITF while avoiding some of the morbidity associated with open approaches.

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Advantages and caveats of endoscopic to the infratemporal fossa as isolated and combined techniques

Mongkolkul,

Salem,

Alsavaf

et al. 2024

Laryngoscope Investig Oto

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ObjectiveIdentify the benefits and caveats of combining minimal access approaches to the infratemporal fossa (ITF), such as the endoscopic transnasal, endoscopic transorbital, endoscopic transoral, and endoscopic sublabial transmaxillary approaches to address extensive lesions not amenable to a single approach. The study provides anatomical metrics including area of exposure and degree of surgical freedom.MethodsFive human cadaveric specimens (10 sides) were dissected to expose and methodically analyze the anatomical intricacies of the ITF using the following minimal access approaches: endoscopic transnasal transpterygoid (EETA), endoscopic sublabial transmaxillary, endoscopic transorbital via infraorbital foramen, and endoscopic transoral techniques. Area of exposure at the pterygopalatine fossa and surgical freedom at the ITF were obtained for each approach.ResultsThe endoscopic sublabial transmaxillary sinus and the combined approach afford a significantly greater exposure than an isolated EETA. The difference in exposure (mean) between the endoscopic sublabial transmaxillary and EETA was 1.62 ± 0.85 cm2 (p < 0.001), and the difference between the combined approach and EETA was 4.25 ± 0.85 cm2 (p < 0.001).ConclusionsCombining minimal access endoscopic approaches to the ITF can provide significantly greater exposure than an isolated EETA; thus, providing enhanced access to address lesions with extensive involvement of the ITF, especially those with superolateral and inferolateral extensions. In addition, some approaches may have an adjunctive role to the resection, such as the endoscopic transoral approach offering the potential for early control of the internal maxillary artery and its branches, some of which may be supplying the tumor in the ITF; or the endoscopic transorbital approach yielding a direct line of sight to the superior ITF and middle cranial fossa.Level of EvidenceNA.

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Combined biportal unilateral endoscopic endonasal and endoscopic anterior transmaxillary approach for resection of lesions involving the infratemporal fossa

Cited by 6 publications

References 9 publications

Anatomical Step-by-Step Dissection of Complex Skull Base Approaches for Trainees: Surgical Anatomy of the Endoscopic Endonasal and Endoscopic-Assisted Transmaxillary Transpterygoid Approaches

Anatomical Step-by-Step Dissection of Complex Skull Base Approaches for Trainees: Surgical Anatomy of the Endoscopic Endonasal and Endoscopic-Assisted Transmaxillary Transpterygoid Approaches

Endoscopic Multiport Approach for Exenteration of the Infratemporal Fossa

Advantages and caveats of endoscopic to the infratemporal fossa as isolated and combined techniques

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