Endoscopic Three-surgeon Six-handed Transorbital Transnasal Technique for Excision of Juvenile Nasopharygeal Angiofibroma: New Frontier Explored

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Abstract

Endoscopic endonasal transorbital approach has been described for the removal of orbital lesions located anteromedially in temporal fossa. The same has been observed to be a versatile approach to the anterior and middle cranial fossa only in laboratory studies. This is the first clinical report of combined transorbital transnasal endoscopic approach to the cavernous sinus, superior orbital fissure, and middle cranial fossa in a case of recurrent nasopharyngeal angiofibroma using the three-surgeon six-handed technique.

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Expanded endonasal approach: the rostrocaudal axis. Part I. Crista galli to the sella turcica.

Arlan Mintz, Carl H Snyderman, Amin Kassam … (2005)

Transsphenoidal approaches have been used for a century for the resection of pituitary and other sellar tumors. More recently, the standard endonasal approach has been expanded to provide access to other, parasellar lesions. With the addition of the endoscope, this expansion carries significant potential for the resection of skull base lesions. The anatomical landmarks and surgical techniques used in expanded (extended) endoscopic approaches to the rostral, anterior skull base are reviewed and presented, accompanied by case illustrations of each segment (or module) of approach. The rostral half of the anterior skull base is divided into modules of approach: sellar/parasellar, transplanum/transtuberculum, and transcribriform. Case illustrations of successful resections of lesions with each module are presented and discussed. Endoscopic, expanded endonasal approaches to rostral anterior skull base lesions are feasible and hold great potential for decreased morbidity. The effectiveness and appropriate use of these techniques must be evaluated by close examination of outcomes as case series expand.

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Expanded endonasal approach: fully endoscopic, completely transnasal approach to the middle third of the clivus, petrous bone, middle cranial fossa, and infratemporal fossa.

Arlan Mintz, Amin Kassam, Carl H Snyderman … (2005)

The middle third of the clivus and the region around the petrous internal carotid artery (ICA) is a difficult area of the skull base in terms of access. This is a deep area rich with critical neurovascular structures, which is often host to typical skull base diseases. Expanded endoscopic endonasal approaches offer a potential option for accessing this difficult region. The objective of this paper was to establish the clinical feasibility of gaining access to the paraclival space in the region of the middle third of the clivus, to provide a practical modular and clinically applicable classification, and to describe the relevant critical surgical anatomy for each module. The anatomical organization of the region around the petrous ICA, cavernous sinus, and middle clivus is presented, with approaches divided into zones. In an accompanying paper in this issue by Cavallo, et al., the anatomy of the pterygopalatine fossa is presented; this was observed through cadaveric dissection for which an expanded endonasal approach was used. In the current paper the authors translate the aforementioned anatomical study to provide a clinically applicable categorization of the endonasal approach to the region around the petrous ICA. A series of zones inferior and superior to the petrous ICA are described, with an illustrative case presented for each region. The expanded endonasal approach is a feasible approach to the middle third of the clivus, petrous ICA, cavernous sinus, and medial infratemporal fossa in cases in which the lesion is located centrally, with neurovascular structures displaced laterally.

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Transorbital neuroendoscopic surgery.

Kris S Moe, Chris M Bergeron, Richard Ellenbogen (2010)

Transorbital neuroendoscopic surgery (TONES) pathways attempt to address some of the technical challenges of accessing laterally placed anterior skull base lesions or paramedian lesions that cross neurovascular structures. TONES approaches allow simultaneous coplanar visualization and working space above and below the skull base.

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Author and article information

Journal

Journal ID (nlm-ta): Asian J Neurosurg

Journal ID (iso-abbrev): Asian J Neurosurg

Journal ID (publisher-id): AJNS

Title: Asian Journal of Neurosurgery

Publisher: Medknow Publications & Media Pvt Ltd (India )

ISSN (Print): 1793-5482

ISSN (Electronic): 2248-9614

Publication date (Print): Oct-Dec 2017

Volume: 12

Issue: 4

Pages: 790-793

Affiliations

[1] Department of Otorhinolaryngology, Royal Pearl Hospital, Tiruchirapally, Tamil Nadu, India

Author notes

Address for correspondence: Dr. Trichy Narayanan Janakiram, Department of Otorhinolaryngology, Royal Pearl Hospital, Tiruchirapally, Tamil Nadu, India. E-mail: research.royalpearl@ 123456gmail.com

Article

Publisher ID: AJNS-12-790

DOI: 10.4103/1793-5482.181148

PMC ID: 5652126

SO-VID: c3371928-a66b-47d1-b4a4-0be97ae0856b

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This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

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Combined endoscopic endonasal and transorbital multiportal approach for complex skull base lesions involving multiple compartments
Authors: Won-Jae Lee, Sang Duk Hong, Kyung In Woo …

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Endoscopic Three-surgeon Six-handed Transorbital Transnasal Technique for Excision of Juvenile Nasopharygeal Angiofibroma: New Frontier Explored

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Karger: Dermatology

Most cited references 15

Expanded endonasal approach: the rostrocaudal axis. Part I. Crista galli to the sella turcica.

Expanded endonasal approach: fully endoscopic, completely transnasal approach to the middle third of the clivus, petrous bone, middle cranial fossa, and infratemporal fossa.

Transorbital neuroendoscopic surgery.

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Cited by 1

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