Transposition of the paraclival carotid artery: a novel concept of self-retaining vascular retraction during endoscopic endonasal skull base surgery technical report

Freeman, Jacob; Sampath, Raghuram; Casey, Michael A.; Quattlebaum, Steven Craig; Ramakrishnan, Vijay R.; Youssef, A. Samy

doi:10.1007/s00701-016-2873-6

Cited by 12 publications

(15 citation statements)

References 12 publications

(16 reference statements)

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“…The quadrangular space is considered as the "front door" for an endoscopic endonasal corridor accessing Meckel's cave. 11 Moreover, during an EEA to address lesions arising from both the medial petrous apex or the medial aspect of Meckel's cave, the paraclival ICA serves as a critical landmark. [16][17][18] In addition to the paraclival ICA, the development of an LPSB may also impact the exposure of Meckel's cave via an EEA corridor.…”

Section: Discussionmentioning

confidence: 99%

“…9 The medial petrous apex can be accessed directly through the sphenoid sinus, although a lateral transposition of the paraclival ICA may be necessary to increase the exposure of the medial petrous apex. 10 Freeman et al 11 reported that an average of 4.75 mm of lateral transposition of the paraclival ICA could be achieved to increase the exposure of the petrous apex and the paramedial skull base. However, the existence of the lingual process of the sphenoid bone (LPSB), located at the lateral border of the paraclival ICA, may restrict the lateral displacement of the paraclival ICA.…”

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confidence: 99%

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Characterization and implications of the lingual process of the sphenoid bone: a cadaveric and radiographic study

London

Chen

et al. 2020

Int Forum Allergy Rhinol

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Background: The surgical significance of the lingual process of the sphenoid bone (LPSB) has not been sufficiently addressed. The purpose of this study was to describe the anatomical details of the LPSB in relation to the quadrangular space. Moreover, the incidence of the LPSB and its correlation with the pneumatization of the sphenoid sinus and the development of the lateral recess of the sphenoid sinus (LRSS) were also evaluated. Methods: A dissection and exposure of the LPSB and the quadrangular space was performed on 10 cadaveric specimens (20 sides). The incidence, length, and height of the LPSB were also assessed on computed tomography (CT) images (60 patients, 120 sides). The association between the presence of the LPSB with the pneumatization type of the sphenoid sinus and the presence of a LRSS was evaluated. Results: In a cadaveric model, the LPSB, in association with the petrolingual ligament extending from the LPSB to the petrous apex, was identified on 7 sides (35%). The LPSB was continuous with the mandibular strut. The overall incidence of a LPSB was 48.33% on CT images, and the average length and height of the LPSB was (mean ± standard deviation) 5.30 ± 1.44 mm and 6.51 ± 1.32 mm, respectively. A significant correlation was identified between presence of the LPSB with the pneumatization type of the sphenoid sinus (p = 0.004) but no correlation was identified with the presence of the LRSS (p = 0.071). Conclusion: The LPSB and the petrolingual ligament are useful landmarks for procedures in the quadrangular space and Meckel's cave. However, the LPSB is not consistently present.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Characterization and implications of the lingual process of the sphenoid bone: a cadaveric and radiographic study

London

Chen

et al. 2020

Int Forum Allergy Rhinol

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“…Freeman et al in their experimental work carried out lateralization of the ICA using a self-retaining vascular retractor and showed that the artery could potentially be displaced 4.75 mm laterally (the work was carried out only on cadaveric material), which could potentially turn out to be sufficient to complete the task; however, this manipulation is associated with certain risks, both from the sinonasal part and catastrophic bleeding from the ICA ( 13 ). It is necessary to be very careful in choosing this approach since this approach as a “monomethod” is not suitable for a strongly lateral or low location of the tumor.…”

Section: Limitations and Future Perspectivesmentioning

confidence: 99%

Endoscopic Transnasal Approaches to Petrous Apex

Kovalev¹,

Sufianov

Prevedello

et al. 2022

Front. Surg.

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Endoscopic extended transnasal approaches to the apex of the temporal bone pyramid are rapidly developing and are widely used in our time around the world. Despite this, the problem of choosing an approach remains relevant and open not only between the “open” and “endoscopic transnasal” access groups but also within the latter. In the article, we systematized all endoscopic approaches to the pyramid of the temporal bone and divided them into three large groups: medial, inferior, and superior—in accordance with the anatomical relationship with the internal carotid artery—and also presented their various, modern (later described), modifications that allow you to work more targeted, depending on the nature of the neoplasm and the goals of surgical intervention, which in turn allows you to complete the operation with minimal losses, and improve the quality of life of the patient in the early and late postoperative period. We described the indications and limitations for these accesses and the problems that arise in the way of their implementation, which in turn can theoretically allow us to obtain an algorithm for choosing access, as well as identify growth points.

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“…After completion of these steps, the ICA can be laterally mobilized approximately 4.5 mm to maximally expose the petrous apex. 7 The reaches of the endonasal endoscopic TMTP approach with and without ET resection and/or carotid mobilization were studied, as listed in Table 3. Moreover, there have been a number of cadaveric comparative analyses examining the differences between the TMTP approach and traditional transcranial alternatives.…”

Section: Approaches To the Petrous Apex And Petroclival Regionmentioning

confidence: 99%

“…We have previously shown that the combination of these maneuvers allows for an average carotid mobilization of 4.5 mm in the axial plane and exposes more of the superior portion of the petrous apex. 7 With static ICA mobilization, we were able to perform 4-handed, binostril surgery to maximize petrous apex resection. Whereas removal of the ET accesses the lower and middle portions of the petrous apex and petroclival region (Fig.…”

Section: Carotid Mobilizationmentioning

confidence: 99%

Expanding the endoscopic transpterygoid corridor to the petroclival region: anatomical study and volumetric comparative analysis

Freeman¹,

Sampath²,

Quattlebaum³

et al. 2018

Journal of Neurosurgery

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OBJECTIVE The endoscopic endonasal transmaxillary transpterygoid (TMTP) approach has been the gateway for lateral skull base exposure. Removal of the cartilaginous eustachian tube (ET) and lateral mobilization of the internal carotid artery (ICA) are technically demanding adjunctive steps that are used to access the petroclival region. The gained expansion of the deep working corridor provided by these maneuvers has yet to be quantified. METHODS The TMTP approach with cartilaginous ET removal and ICA mobilization was performed in 5 adult cadaveric heads (10 sides). Accessible portions of the petrous apex were drilled during the following 3 stages: 1) before ET removal, 2) after ET removal but before ICA mobilization, and 3) after ET removal and ICA repositioning. Resection volumes were calculated using 3D reconstructions generated from thin-slice CT scans obtained before and after each step of the dissection. RESULTS The average petrous temporal bone resection volumes at each stage were 0.21 cm, 0.71 cm, and 1.32 cm (p < 0.05, paired t-test). Without ET removal, inferior and superior access to the petrous apex was limited. Furthermore, without ICA mobilization, drilling was confined to the inferior two-thirds of the petrous apex. After mobilization, the resection was extended superiorly through the upper extent of the petrous apex. CONCLUSIONS The transpterygoid corridor to the petroclival region is maximally expanded by the resection of the cartilaginous ET and mobilization of the paraclival ICA. These added maneuvers expanded the deep window almost 6 times and provided more lateral access to the petroclival region with a maximum volume of 1.5 cm. This may result in the ability to resect small-to-moderate sized intradural petroclival lesions up to that volume. Larger lesions may better be approached through an open transcranial approach.

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Transposition of the paraclival carotid artery: a novel concept of self-retaining vascular retraction during endoscopic endonasal skull base surgery technical report

Abstract: Static repositioning of the ICA and other delicate neurovascular structures was effectively performed during endonasal, endoscopic cadaveric surgery of the skull base and has potential merits in live patients.

Cited by 12 publications

References 12 publications

Characterization and implications of the lingual process of the sphenoid bone: a cadaveric and radiographic study

Characterization and implications of the lingual process of the sphenoid bone: a cadaveric and radiographic study

Endoscopic Transnasal Approaches to Petrous Apex

Expanding the endoscopic transpterygoid corridor to the petroclival region: anatomical study and volumetric comparative analysis

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