Full endoscopic endonasal extreme far-medial approach: eustachian tube transposition

Abstract

<jats:p>The complex anatomical relationships within the skull base have been described from an endoscopic point of view. However, systematic surgical, not just anatomical, management of the eustachian tube (ET) and the approach to the styloid and parapharyngeal spaces have not yet been described. The authors describe the full endoscopic endonasal extreme far-medial approach used in their surgical practice and show how they applied it to a case. To the authors' knowledge, from a strictly surgical viewpoint, this work is the first to describe a fundamental endonasal approach to the inferior clivus, the condylar and tubercular compartments, the prestyloid and poststyloid spaces, and ET transposition to expose the aforementioned structures without disrupting the ET. For lesions with mediolateral growth patterns, the authors consider the extreme far-medial approach to be superior to the pure transmaxillary approach. Additional cases and more evidence are needed to refine this surgical technique.</jats:p>

Endoscopic endonasal translacerum approach to the inferior petrous apex

“…See advocated the importance of preserving the function of the ET. 23 We agree fully with their argument and consider that the translacerum approach presented in this paper is applicable for more laterally located lesion such as at the IPA, while preserving the ET.…”

Comprehensive review on rhino-neurosurgery

“…Further resections of or at the condyle may lead to secondary cranio-cervical instability. Tumor extensions behind the petrous apex require surgical exposition and transposition of the petroclival internal carotid artery; a technical variation with transposition of the Eustachian tube was described [ 489 ], [ 490 ]. Alternatively, the transclival approach may be expanded by use of angular optics in combination with flexible or special controllable instruments.…”

Role of resection of torus tubarius to maximize the endonasal exposure of the inferior petrous apex and petroclival area

“…Simal et al proposed the transposition of the cartilaginous Eustachian tube for exposure; however, the applicability of this approach is sometimes limited 15 . Labib et al demonstrated that anterolateral mobilization of the Eustachian tube can achieve an exposure and surgical freedom of the ventral jugular foramen and the infrapetrous region that is similar to those achieved by the resection of the Eustachian tube 16 .…”