Petrous apex cholesterol granulomas: Endonasal versus infracochlear approach

Abstract

The transnasal approach provides reliable access to the PA when combined with internal carotid artery exposure and allows for large drainage window. The transcanal approach is less versatile and more limited than the transnasal approach but provides access to the most posterior and inferior portion of the PA without Eustachian tube transection. Here we propose a new surgical classification that may help to decide the most suitable approach to the PA according to the location and extension of the lesion.

A novel endoscopic technique for long‐term patency of cholesterol granulomas of the petrous apex

“…Moreover the endoscopic route can provide a large drainage window, allowing placement of a Silastic stent three times larger than the infracochlear approach. 11 This last finding may permit the application of the nasoseptal flap instead of the Silastic stent. Pinheiro-Neto et al 12 assessed that the potential length and width of the nasoseptal flap is adequate to cover all defects resulting from all anterior skull base, sphenoid, and clivus approaches, independently.…”

“…In the present case, the lesion had expanded into the infrapetrous region and protruded medially into the sphenoid sinus, a condition that allowed a large endoscopic marsupialization and facilitated the flap to cover all of the surface of the CG's cavity. In a recent study comparing the endoscopic endonasal and the infracochlear approaches, Scopel et al proposed the endonasal approach as the preferred surgical option for CGs that extended into the sphenoid sinus and those in the superior and antero‐inferior petrous apex, which requires exposure and lateralization of the ICA. Moreover the endoscopic route can provide a large drainage window, allowing placement of a Silastic stent three times larger than the infracochlear approach .…”

“…In a recent study comparing the endoscopic endonasal and the infracochlear approaches, Scopel et al proposed the endonasal approach as the preferred surgical option for CGs that extended into the sphenoid sinus and those in the superior and antero‐inferior petrous apex, which requires exposure and lateralization of the ICA. Moreover the endoscopic route can provide a large drainage window, allowing placement of a Silastic stent three times larger than the infracochlear approach . This last finding may permit the application of the nasoseptal flap instead of the Silastic stent.…”

Clival chordomas: A pathological, surgical, and radiotherapeutic review

“…Extension of the inferior transclival approach lateral to the petroclival junction requires a transpterygoid infravidian approach followed by a sublacerum or infrapetrous approach . The posterior wall of the maxillary sinus is first removed exposing the pterygopalatine fossa.…”

Quantitative imaging analysis of transcanal endoscopic Infracochlear approach to the internal auditory canal

“…Transcanal endoscopic or microscopic infracochlear petrosectomy has been described [9–11]. Using a similar approach and combined with real-time surgical navigation, EES may enable transcanal approaches to the IAC that preserve cochlear anatomy [12].…”