Endoscope-assisted contralateral transmaxillary approach to the clivus and the hypoglossal canal: technical case report

Pamias-Portalatin, Eva; Mahato, Deependra; Rincón-Torroella, Jordina; Vivas-Buitrago, Tito; Quiñones‐Hinojosa, Alfredo; Boahene, Kofi

doi:10.3171/2018.1.jns171972

Cited by 14 publications

(15 citation statements)

References 40 publications

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“…9,11 For such cases, CTM could be a good surgical alternative or adjunct. [13][14][15] The CTM presents significant advantages over a classical EEA for lesions in the coronal plane, especially if intimately related to the ICA. Borghei-Razavi et al have discussed the limitations of an ipsilateral EEA to the PA. 8 The single most important benefit provided by CTM is the "angle advantage."…”

Section: Discussionmentioning

confidence: 99%

“…Its major limitation is that it is a cadaver dissection-based study, not performed in the clinical setting. Although the clinical feasibility of CTM has already been demonstrated [13][14][15] ; further studies are necessary to prove its superiority in terms of surgical and clinical outcomes.…”

Section: Limitationmentioning

confidence: 99%

“…The CTM can overcome the anatomical limitations of a purely EEA with less risk to neural and vascular structures and increased access, especially for lesions located far laterally behind the ICA. [13][14][15] The full range of access of the CTM has not been fully described. The objective of this study was to refine the surgical techniques and establish anatomical landmarks for performing a CTM to the PA and PCR, and to compare anatomical-radiological features of the CTM with EEA.…”

Section: Introductionmentioning

confidence: 99%

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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: Discussionmentioning

confidence: 99%

Section: Limitationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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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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“…Per this review, the only other reports of this approach come from a case series and 2 case reports, with 3 of the 4 publications coming from the same institution. 8,15,16 In this article, we describe the use of the CTM approach to the petrous apex in a tertiary academic center with minimal prior experience in expanded endoscopic approaches to the skull base. This report adds to the sparse literature examining this complex approach and attests to the reproducibility of prior results.…”

Section: Discussionmentioning

confidence: 99%

Contralateral Transmaxillary Approach for Resection of Chondrosarcoma of the Petrous Apex: A Case Report

2021

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Background: Deep location and neurovascular structures make access to lesions of the petrous apex a significant challenge. A novel approach for these tumors is the contralateral transmaxillary approach. Clinical Presentation: A 31-year-old male was evaluated for left abducens nerve palsy. Magnetic resonance imaging (MRI) and computed tomography revealed an enhancing, lytic lesion of the petrous apex with extension to the cavernous sinus and petroclival junction. The patient underwent a combined endoscopic contralateral transmaxillary and endoscopic endonasal transclival approach for resection of the lesion. No new or worsening neurologic deficits were noted following the procedure. Pathology revealed low-grade chondrosarcoma (grade I). Postoperative MRI revealed gross total resection of the lesion. Patient underwent adjuvant radiation therapy at the discretion of radiation oncology. Conclusion: The contralateral transmaxillary approach to the petrous apex allows for resection of lesions of the petrous apex with the ability to extend the dissection laterally. Excellent results achieved by institutions with advanced extended endoscopic endonasal experience can be reproduced in institutions with less experience. Further characterization of the risks and benefits of this approach is needed.

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“…The average age was 51.6 years (range = 19-78 years) with a male:female ratio of 15:14. Diagnoses confirmed pathologically included chondrosarcoma (12), chordoma (11), meningioma (two), schwannoma one metastasis (one), petrous apicitis (one), and arachnoid cyst (one). Eleven patients (50% of chondroid neoplasms) presented with recurrent tumors following surgery/radiation therapy: chordoma (nine) and chondrosarcoma (two).…”

Section: Patient Populationmentioning

confidence: 99%

Experience With the Endoscopic Contralateral Transmaxillary Approach to the Petroclival Skull Base

et al. 2020

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Objectives/Hypothesis The contralateral transmaxillary (CTM) approach is a new surgical approach that improves the surgical trajectory relative to the petrous segment of the internal carotid artery (ICA). Here, we present our clinical experience with the CTM approach to the petroclival region of the skull base. Study Design Retrospective review. Methods A retrospective review of 29 patients who underwent a CTM approach for skull base pathology from 2015 to 2020 was performed. Assessment of gross total resection (GTR) was based on postoperative imaging. Results The male:female ratio was 15:14, with an average age of 52 years (range = 19–78 years). Diagnoses included: 12 chondrosarcomas, 11 chordomas, two meningiomas, one schwannoma, one metastasis, one petrous apicitis, and one arachnoid cyst. CTM was performed in addition to a transclival approach and ipsilateral transpterygoid approach in all patients. Reconstruction of surgical defects included a vascularized flap in all but two patients: 24 nasoseptal flaps and three lateral nasal wall flaps. The reconstructive flap was on the same side as the CTM approach in 22 of 28 (79%) patients. There were no ICA injuries. In a subset of patients with chondromatous tumors, GTR of the targeted area was achieved in 16 of 22 (73%) evaluable chondromatous tumors. With a median follow‐up of 13 months, 64% of these patients are without disease or dead of other causes; the remainder are alive with disease. Conclusions The CTM approach improves the degree of resection of skull base tumors involving the petroclival region using an endoscopic endonasal approach and may minimize risk to the ICA. Level of Evidence 4 Laryngoscope, 131:294–298, 2021

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Endoscope-assisted contralateral transmaxillary approach to the clivus and the hypoglossal canal: technical case report

Cited by 14 publications

References 40 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

Contralateral Transmaxillary Approach for Resection of Chondrosarcoma of the Petrous Apex: A Case Report

Experience With the Endoscopic Contralateral Transmaxillary Approach to the Petroclival Skull Base

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