Full endoscopic endonasal expanded approach to the petroclival region: optimizing the carotid-clival window

Simal-Julián, Juan Antonio; Miranda-Lloret, Pablo; Botella-Asunción, Carlos; Kassam, A.B.

doi:10.1007/s00701-014-2125-6

Cited by 12 publications

(6 citation statements)

References 2 publications

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“…To the best of our knowledge, few clinical reports have described an endoscopic endonasal approach to skull base tumors involving the petrous apex or CPA. 23,24,32,41 In these reports, a transsphenoidal approach from the retrocarotid window was undertaken only when the tumor was small and located close to the sphenoid sinus. 32,41 Learning from cadaveric studies, the authors of those reports performed extensive removal of the normal nasal anatomy, including bilateral middle turbinectomies, wide septectomy, sphenoidotomy, and maxillotomy with removal of the pterygoid plate and pterygoid muscles.…”

Section: Discussionmentioning

confidence: 99%

“…23,24,32,41 In these reports, a transsphenoidal approach from the retrocarotid window was undertaken only when the tumor was small and located close to the sphenoid sinus. 32,41 Learning from cadaveric studies, the authors of those reports performed extensive removal of the normal nasal anatomy, including bilateral middle turbinectomies, wide septectomy, sphenoidotomy, and maxillotomy with removal of the pterygoid plate and pterygoid muscles. Skeletonization of the petrous carotid artery was performed to allow lateral mobilization to excise underlying tumor tissue and achieved successful resection of the tumors with acceptable levels of neurological complications.…”

Section: Discussionmentioning

confidence: 99%

“…These corridors are not present in individuals who do not harbor these tumors. 12,23,24,32,41 Learning from the clinical experience of transsphenoidal surgery for cystic inflammatory lesions in this region, we tried to approach skull base tumors occupying the petrous region and CPA through the retrocarotid triangle, demarcated by the cavernous and vertical segments of the ICA, the clival dura, and the petrooc- cipital fissure (Fig. 1).…”

Section: Discussionmentioning

confidence: 99%

“…12,22,36,41 Reports remain quite limited regarding experiences with endoscopic transnasal surgery aimed at radical resection of invasive skull base tumors around the petrous regions, including the IAC, jugular fossa, and cavernous sinus. 23,24,32 When tumors with aggressive behavior occupy the lateral parts of the petrosal apex such as the IAC and the jugular fossa, radical resection with acceptable neurological complications is mandatory because there is no alternative treatment achieving successful tumor control without risks of facial palsy or hearing deterioration. In contrast to numerous reports about transcranial approaches to these lateral petrosal areas, few reports have described the endoscopic endonasal approach, and a clear "inside" view of anatomy after anteromedial petrosectomy has not been previously demonstrated.…”

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confidence: 99%

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Endoscopic transsphenoidal anterior petrosal approach for locally aggressive tumors involving the internal auditory canal, jugular fossa, and cavernous sinus

Shin¹,

Kondo

Hanakita³

et al. 2017

JNS

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OBJECTIVE Reports about endoscopic endonasal surgery for skull base tumors involving the lateral part of petrous apex remain scarce. The authors present their experience with the endoscopic transsphenoidal anterior petrosal (ETAP) approach through the retrocarotid space for tumors involving the internal auditory canal, jugular fossa, and cavernous sinus. METHODS The authors performed the ETAP approach in 10 patients with 11 tumors (bilateral in 1 patient) that extensively occupied the lateral part of petrous apex, e.g., the internal auditory canal and jugular fossa. Eight patients presented with diplopia (unilateral abducens nerve palsy), 3 with tinnitus, and 1 with unilateral hearing loss with facial palsy. After wide anterior sphenoidotomy, the sellar floor, clival recess, and carotid prominence were verified. Tumors were approached via an anteromedial petrosectomy through the retrocarotid triangular space, defined by the cavernous and vertical segments of the internal carotid artery (ICA), the clivus, and the petrooccipital fissure. The surgical window was easily enlarged by drilling the petrous bone along the petrooccipital fissure. After exposure of the tumor and ICA, dissection and resection of the tumor were mainly performed under direct visualization with 30° and 70° endoscopes. RESULTS Gross-total resection was achieved in 8 patients (9 tumors). In a patient with invasive meningioma, the tumor was strongly adherent to the ICA, necessitating partial resection. Postoperatively, all 8 patients who had presented with abducens nerve palsy preoperatively showed improvement within 6 months. In the patient presenting with hearing loss and facial palsy, the facial palsy completely resolved within 3 months, but hearing loss remained. Regarding complications, 3 patients showed mild and transient abducens nerve palsy resolving within 2 weeks, 3 months, and 6 months. Postoperative CSF rhinorrhea requiring surgical repair was observed in 1 patient. No patient exhibited hearing deterioration, facial palsy, or symptoms of lower cranial nerve palsy after surgery. CONCLUSIONS The ETAP approach can offer a simple, less invasive option for invasive skull base tumors involving petrous regions, including the internal auditory canal, jugular fossa, and cavernous sinus. The ETAP approach can reach more extensive areas in the extradural regions around the petrous bone. The authors' results indicate that the transsphenoidal retrocarotid route is sufficient to approach the petrosal areas in select cases. Further expansion of the surgical field is not always necessary. However, experience with intradural lesions remains limited, and the extent of tumor resection largely depends on tumor characteristics. Application of the ETAP approach should thus be carefully determined in each patient, taking into consideration the size of the retrocarotid window and tumor characteristics.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Endoscopic transsphenoidal anterior petrosal approach for locally aggressive tumors involving the internal auditory canal, jugular fossa, and cavernous sinus

Shin¹,

Kondo

Hanakita³

et al. 2017

JNS

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“…Generally, a “panclival” approach allows exposing a rectangular dura surface in front of the brain stem from the tuberculum sellae to the arch of the atlas. Laterally exposure is limited in the petroclival region by the internal carotid artery, the abducens nerve as well as the hypoglossal canal [ 72 ], [ 84 ], [ 485 ].…”

Section: Basic Surgical Techniques Hemostasis Special Technical Amentioning

confidence: 99%