Endoscopic precaruncular medial transorbital and endonasal multiport approaches to the contralateral skull base: a clinicoanatomical study.

Autor:	Bhuskute GS; 1Department of ENT, All India Institute of Medical Sciences, Patna, Bihar, India.; 3Otolaryngology-Head and Neck Surgery, The James Cancer Hospital at the Wexner Medical Center of The Ohio State University College of Medicine, Columbus, Ohio., Gosal JS; Departments of2Neurological Surgery and.; 4Department of Neurosurgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India., Alsavaf MB; 3Otolaryngology-Head and Neck Surgery, The James Cancer Hospital at the Wexner Medical Center of The Ohio State University College of Medicine, Columbus, Ohio., Manjila S; Departments of2Neurological Surgery and., Wu KC; Departments of2Neurological Surgery and., Alwabili M; 5Department of Otolaryngology-Head and Neck Surgery, Prince Sultan Military Medical City, Riyadh, Saudi Arabia., Abouammo MD; 3Otolaryngology-Head and Neck Surgery, The James Cancer Hospital at the Wexner Medical Center of The Ohio State University College of Medicine, Columbus, Ohio.; 6Department of Otolaryngology-Head and Neck Surgery, Tanta University, Tanta, Egypt., Manogaran RS; 7Department of Neurosurgery, Neuro-Otology Unit, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India; and., Lubbe DE; 8Division of Otolaryngology, University of Cape Town Faculty of Health Sciences, Cape Town, South Africa., Carrau RL; Departments of2Neurological Surgery and.; 3Otolaryngology-Head and Neck Surgery, The James Cancer Hospital at the Wexner Medical Center of The Ohio State University College of Medicine, Columbus, Ohio., Prevedello DM; Departments of2Neurological Surgery and.; 3Otolaryngology-Head and Neck Surgery, The James Cancer Hospital at the Wexner Medical Center of The Ohio State University College of Medicine, Columbus, Ohio.
Jazyk:	angličtina
Zdroj:	Neurosurgical focus [Neurosurg Focus] 2024 Apr; Vol. 56 (4), pp. E10.
DOI:	10.3171/2024.1.FOCUS23863
Abstrakt:	Objective: Minimally invasive endoscopic endonasal multiport approaches create additional visualization angles to treat skull base pathologies. The sublabial contralateral transmaxillary (CTM) approach and superior eyelid lateral transorbital approach, frequently used nowadays, have been referred to as the "third port" when used alongside the endoscopic endonasal approach (EEA). The endoscopic precaruncular contralateral medial transorbital (cMTO) corridor, on the other hand, is an underrecognized but unique port that has been used to repair CSF rhinorrhea originating from the lateral sphenoid sinus recess. However, no anatomical feasibility studies or clinical experience exists to assess its benefits and demonstrate its potential role in multiport endoscopic access to the other contralateral skull base areas. In this study, the authors explored the application and potential utility of multiport EEA combined with the endoscopic cMTO approach (EEA/cMTO) to three target areas of the contralateral skull base: lateral recess of sphenoid sinus (LRSS), petrous apex (PA) and petroclival region, and retrocarotid clinoidocavernous space (CCS). Methods: Ten cadaveric specimens (20 sides) were dissected bilaterally under stereotactic navigation guidance to access contralateral LRSS via EEA/cMTO. The PA and petroclival region and retrocarotid CCS were exposed via EEA alone, EEA/cMTO, and EEA combined with the sublabial CTM approach (EEA/CTM). Qualitative and quantitative assessments, including working distance and visualization angle to the PA, were recorded. Clinical application of EEA/cMTO is demonstrated in a lateral sphenoid sinus CSF leak repair. Results: During the qualitative assessment, multiport EEA/cMTO provides superior visualization from a high vantage point and better instrument maneuverability than multiport EEA/CTM for the PA and retrocarotid CCS, while maintaining a similar lateral trajectory. The cMTO approach has significantly shorter working distances to all three target areas compared with the CTM approach and EEA. The mean distances to the LRSS, PA, and retrocarotid CCS were 50.69 ± 4.28 mm (p < 0.05), 67.11 ± 5.05 mm (p < 0.001), and 50.32 ± 3.6 mm (p < 0.001), respectively. The mean visualization angles to the PA obtained by multiport EEA/cMTO and EEA/CTM were 28.4° ± 3.27° and 24.42° ± 5.02° (p < 0.005), respectively. Conclusions: Multiport EEA/cMTO to the contralateral LRSS offers the advantage of preserving the pterygopalatine fossa contents and the vidian nerve, which are frequently sacrificed during a transpterygoid approach. This approach also offers superior visualization and better instrument maneuverability compared with EEA/CTM for targeting the petroclival region and retrocarotid CCS.
Databáze:	MEDLINE
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