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

Abstract

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

Three‐hundred and sixty degrees of surgical approaches to the maxillary sinus

“…Lastly, it can be an option to approach pathology in the masticator space or lateral recess of the sphenoid sinus. 7 , 11 , 12 …”

“…Lastly, it can be an option to approach pathology in the masticator space or lateral recess of the sphenoid sinus. 7,11,12 CL (anterior transmaxillary) step-by-step dissection (Figure 3)…”

Midline Skull Base Meningiomas: Transcranial and Endonasal Perspectives

“…The petrous apex is then drilled inferiorly to the horizontal ICA in a caudal-to-rostral and medial-to-lateral direction, with the vidian canal representing the superior limit of this portion of the dissection [ 158 , 159 , 160 , 161 ] in order to ensure wide ventral exposure of the petroclival area through the carotid-basilar corridor [ 154 , 162 ]. Furthermore, a contralateral transmaxillary (CTM) trajectory may be added to the aforementioned exposure, enlarging the surgical view and administration of the petrous segment of the internal carotid artery [ 163 , 164 , 165 ]. Pituitary transposition can be completed to access the interpeduncular cistern and perform a posterior clinoidectomy by removing the dorsum sellae [ 166 , 167 , 168 , 169 ].…”

Surgical Management of Sinonasal Cancers: A Comprehensive Review

“…It has also been shown that they can be of benefit to treat certain maxillary tumors: when an open maxillectomy has to be performed, the section of the lateral, posterior, and medial walls of the maxillary sinus, as well as the section of the pterygoid process, can be precisely performed during the endoscopic approach [35,36]. An endoscopic contralateral transmaxillary approach has also been developed, using a sublabial approach to introduce the endoscope and reach out even further laterally or to better control the internal carotid artery [37].…”