Endoscopic Endonasal Dissection of the Pterygopalatine fossa, Infratemporal fossa, and Post‐styloid compartment. Anatomical Relationships and Importance of Eustachian Tube in the Endoscopic Skull Base Surgery

Rivera-Serrano, Carlos M.; Terre-Falcon, Ramon; Fernández-Miranda, Juan C.; Prevedello, Daniel M.; Snyderman, Carl H.; Gardner, Paul A.; Kassam, Amin; Carrau, Ricardo L.

doi:10.1002/lary.21711

Cited by 25 publications

(24 citation statements)

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“…Exposure of the ITF relies on the dissection of 5 anatomic planes, as we move from an anterior (superficial) and medial to posterior (deep) and lateral planes. These dissection planes have been described previously 14, 20, 23, 24. Key anatomic features in relation to the steps for a nasopharyngectomy include features shown in Figures 2 and 3.…”

Section: Resultsmentioning

confidence: 99%

Endoscopic transpterygoid nasopharyngectomy: Correlation of surgical anatomy with multiplanar CT

et al. 2012

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Section: Resultsmentioning

confidence: 99%

Endoscopic transpterygoid nasopharyngectomy: Correlation of surgical anatomy with multiplanar CT

et al. 2012

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“…An endoscopic endonasal transpterygoid approach was performed as described in the pertinent literature. 2,6,7,9,[18][19][20][21] The surgical corridor was created by removing both middle turbinates and resecting the posterior nasal septum in order to create conditions that allow use of the endoscope and instruments through both nostrils. The medial wall of the maxillary sinus was removed to gain access to its posterior wall, which constitutes the anterior wall of the pterygopalatine fossa, and to the sphenopalatine foramen, through which the sphenopalatine artery reaches the nasal cavity; inferior turbinectomy and removal of the lateral nasal wall down to the level of the nasal floor were performed as well.…”

Section: Endoscopic Endonasal Transpterygoid Approachmentioning

confidence: 99%

Refining the anatomic boundaries of the endoscopic endonasal transpterygoid approach: the “VELPPHA area” concept

Kaen¹,

Ruiz‐Valdepeñas²,

Somma

et al. 2019

Journal of Neurosurgery

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T he endoscopic endonasal transpterygoid approach is a lateral extension of the midline endonasal route; although it was initially described to access only the lateral recess of the sphenoid sinus, currently this route is used to reach the most lateral aspect of the skull base. In this surgical scenario, injury to the internal carotid artery (ICA) is one of the most feared complications.The vidian nerve (VN) has been clearly described as a critical landmark for the safe identification of the petrous ICA in the foramen lacerum (FL) during the endoscopic ABBREVIATIONS ET = eustachian tube; FL = foramen lacerum; ICA = internal carotid artery; VC = vidian canal; VELPPHA = vidian nerve, eustachian tube, foramen lacerum, petroclival fissure, and pharyngobasilar fascia; VN = vidian nerve. OBJECTIVEThe endoscopic endonasal transpterygoid route has been widely evaluated in cadavers, and it is currently used during surgery for specific diseases involving the lateral skull base. Identification of the petrous segment of the internal carotid artery (ICA) is a key step during this approach, and the vidian nerve (VN) has been described as a principal landmark for safe endonasal localization of the petrous ICA at the level of the foramen lacerum. However, the relationship of the VN to the ICA at this level is complex as well as variable and has not been described in the pertinent literature. Accordingly, the authors undertook this purely anatomical study to detail and quantify the peri-lacerum anatomy as seen via an endoscopic endonasal transpterygoid pathway. METHODS Eight human anatomical specimens (16 sides) were dissected endonasally under direct endoscopic visualization. Anatomical landmarks of the VN and the posterior end of the vidian canal (VC) during the endoscopic endonasal transpterygoid approach were described, quantitative anatomical data were compiled, and a schematic classification of the most relevant structures encountered was proposed. RESULTS The endoscopic endonasal transpterygoid approach was used to describe the different anatomical structures surrounding the anterior genu of the petrous ICA. Five key anatomical structures were identified and described: the VN, the eustachian tube, the foramen lacerum, the petroclival fissure, and the pharyngobasilar fascia. These structures were specifically quantified and summarized in a schematic acronym-VELPPHA-to describe the area. The VELPPHA area is a dense fibrocartilaginous space around the inferior compartment of the foramen lacerum that can be reached by following the VC posteriorly; this area represents the posterior limits of the transpterygoid approach and, of utmost importance, no neurovascular structures were observed through the VELPPHA area in this study, indicating that it should be a safe zone for surgery in the posterior end of the endoscopic endonasal transpterygoid approach. CONCLUSIONS The VELPPHA area represents the posterior limits of the endoscopic endonasal transpterygoid approach. Early identification of this area can enhance the safety of the e...

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“…Surgery of the retrostyloid space (RSS) and of the infratemporal fossa (ITF) is increasingly done endoscopically . Some teams prefer open techniques, arguing better visual control, such as the maxillary swing approach .…”

Section: Introductionmentioning

confidence: 99%

“…Some teams prefer open techniques, arguing better visual control, such as the maxillary swing approach . However, both use an anterior approach and share the same major risk laterally, the internal carotid artery (ICA), which has a very close relationship with the nasopharyngeal wall . Although the intrapetrous, paraclival, and parasellar portions of the ICA have clear surgical landmarks due to their fixed position in the bony canals, the paranasopharyngeal portion, which is surrounded by soft tissue, does not have reliable surgical landmarks and is always hazardous to find.…”

Section: Introductionmentioning

confidence: 99%

Surgical landmarks of the nasopharyngeal internal carotid using the maxillary swing approach: A cadaveric study

et al. 2016

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Endoscopic Endonasal Dissection of the Pterygopalatine fossa, Infratemporal fossa, and Post‐styloid compartment. Anatomical Relationships and Importance of Eustachian Tube in the Endoscopic Skull Base Surgery

Cited by 25 publications

References 0 publications

Endoscopic transpterygoid nasopharyngectomy: Correlation of surgical anatomy with multiplanar CT

Endoscopic transpterygoid nasopharyngectomy: Correlation of surgical anatomy with multiplanar CT

Refining the anatomic boundaries of the endoscopic endonasal transpterygoid approach: the “VELPPHA area” concept

Surgical landmarks of the nasopharyngeal internal carotid using the maxillary swing approach: A cadaveric study

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