Endonasal endoscopic transpterygoid approach to the upper parapharyngeal space

Li, Lifeng; London, Nyall R.; Prevedello, Daniel M.; Carrau, Ricardo L.

doi:10.1002/hed.26127

Cited by 25 publications

(36 citation statements)

References 30 publications

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“…4 Previous cadaveric studies have largely focused on accessing the ICA, internal jugular vein, and the lower cranial nerves in the upper parapharyngeal space (UPPS). [12][13][14] A far medial endonasal approach was introduced to expose the proximal intracranial segments of the CN IX to XII. 7 Moreover, Francisco et al described an extreme-medial approach to explore the ventral aspect of the jugular foramen.…”

Section: Introductionmentioning

confidence: 99%

Endonasal access to lower cranial nerves: From foramina to upper parapharyngeal space

London

Prevedello

et al. 2021

Head & Neck

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Lesions arising from the upper parapharyngeal space (UPPS) often involved the jugular foramen region (JFR), occasionally extending into the posterior cranial fossa. This study aims to investigate the surgical anatomy of the JFR and UPPS from the perspective of an expanded endoscopic approach (EEA), tracing the lower cranial nerves from their extracranial foramina to the UPPS. Six cadaveric specimens (12 sides) underwent a transpterygoid EEA to expose the JFR and UPPS. Distances from the medial pterygoid plate (MPP) to the internal carotid artery (ICA), hypoglossal canal (HC), and jugular tubercle (JT) were measured on anonymized Computed tomography angiography images previously obtained from 30 patients with pulsatile tinnitus. Full access to the JFR, and its medial, superior, and anterior aspects, could be adequately achieved via an EEA. Upon exiting the jugular foramen, the glossopharyngeal nerve courses posterior to the ICA, traveling inferiorly into the UPPS between ICA and IJV. The vagus nerve is in close proximity to the hypoglossal nerve traveling posterior to the ICA. The accessory nerve courses lateral to the vagus nerve, running posterior to the IJV. The minimal distances from the MPP to ICA, HC, and JT were 2.52 ± 0.34, 2.86 ± 0.36, and 3.18 ± 0.33 cm, respectively. This anatomical study strongly suggests the feasibility of using an EEA to access to the medial, superior, and anterior aspects of the jugular foramen and the adjacent UPPS.

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Section: Introductionmentioning

confidence: 99%

Endonasal access to lower cranial nerves: From foramina to upper parapharyngeal space

London

Prevedello

et al. 2021

Head & Neck

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“…4,5 The pterygopalatine fossa (PPF) is frequently transgressed during endoscopic transpterygoid approaches to access the lateral recess of the sphenoid sinus, infratemporal fossa, upper parapharyngeal space, Meckel's cave, inferior petrous apex, and foramen lacerum. [6][7][8][9][10] Its contents include a complex array of neurovascular structures, such as the vidian nerve, maxillary nerve, pterygopalatine ganglion, greater and lesser palatine nerves, and distal branches of the internal maxillary artery (e.g., sphenopalatine artery and descending palatine artery). 11 Despite detailed anatomical descriptions provided previously by others, [12][13][14][15] surgery in the PPF remains challenging and prone to inadvertent injury to its neurovascular structures.…”

Section: Introductionmentioning

confidence: 99%

A novel landmark for endonasal surgery of the pterygopalatine fossa and inferior orbital fissure: The orbito‐pterygo‐sphenoidal ligament

London

Prevedello

et al. 2021

Head & Neck

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“…4 Adequate preoperative assessment of the relationships between the tumor and the internal carotid artery (ICA) and function of CNs (VII to XII) are necessary prior to choose a safe and appropriate surgical treatment strategy. [9][10][11] However, in patients with multiple occurrences of paragangliomas, the ICA and CNs may intimately adhere to the tumor. Surgical resection of these multiple tumors at a time or in a staged fashion may pose great risk of injury to the great vessels and related CNs.…”

Section: Introductionmentioning

confidence: 99%

Management of Multiple Head and Neck Paragangliomas With Assistance of a 3-D Model

Chen

et al. 2021

Ear Nose Throat J

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Introduction: Extirpation of multiple head and neck paragangliomas carries challenge due to close anatomic relationships with critical neurovascular bundles. Objectives: This study aims to assess whether the application of 3-D models can assist with surgical planning and treatment of these paragangliomas, decrease surgically related morbidity and mortality. Methods: Fourteen patients undergoing surgical resection of multiple head and neck paragangliomas were enrolled in this study. A preoperative 3-D model was created based on radiologic data, and relevant critical anatomic relationships were preoperatively assessed and intraoperatively validated. Results: All 14 patients presented with multiple head and neck paragangliomas, including bilateral carotid body tumors (CBT, n = 9), concurrent CBT with glomus jugulare tumors (GJT, n = 4), and multiple vagal paragangliomas (n = 1). Ten patients underwent genomic analysis and all harbored succinate dehydrogenase complex subunit D (SDHD) mutations. Under guidance of the 3-D model, the internal carotid artery (ICA) was circumferentially encased by tumor on 5 of the operated sides, in 4 (80%) of which the tumor was successfully dissected out from the ICA, whereas ICA reconstruction was required on one side (20%). Following removal of CBT, anterior rerouting of the facial nerve was avoided in 3 (75%) of 4 patients during the extirpation of GJT with assistance of a 3-D model. Two patients developed permanent postoperative vocal cord paralysis. There was no vessel rupture or mortality in this study cohort. Conclusion: The 3-D model is beneficial for establishment of a preoperative strategy, as well as planning and guiding the intraoperative procedure for resection of multiple head and neck paragangliomas.

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Endonasal endoscopic transpterygoid approach to the upper parapharyngeal space

Cited by 25 publications

References 30 publications

Endonasal access to lower cranial nerves: From foramina to upper parapharyngeal space

Endonasal access to lower cranial nerves: From foramina to upper parapharyngeal space

A novel landmark for endonasal surgery of the pterygopalatine fossa and inferior orbital fissure: The orbito‐pterygo‐sphenoidal ligament

Management of Multiple Head and Neck Paragangliomas With Assistance of a 3-D Model

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