From the Occipital Condyle to the Sphenoid Sinus: Extradural Extension of the Far Lateral Transcondylar Approach with Endoscopic Assistance
| Autor: | Anne Laure Bernat, Valentina Tardivo, Eduard H.J. Voormolen, Nicolas Penet, Thibault Passeri, Moujahed Labidi, Francesco Zenga, Sébastien Froelich |
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| Rok vydání: | 2020 |
| Předmět: |
Adult
Male Hypoglossal Nerve Sphenoid Sinus Hypoglossal canal Skull Base Neoplasms Neurosurgical Procedures Condyle 03 medical and health sciences 0302 clinical medicine Clivus Cadaver Chordoma medicine Humans Sinus (anatomy) Skull Base Petrous Apex business.industry Inferior petrosal sinus Organ Size Anatomy Occipital condyle Skull medicine.anatomical_structure Cranial Fossa Posterior Occipital Bone 030220 oncology & carcinogenesis Neuroendoscopy Surgery Neurology (clinical) Anatomic Landmarks Jugular Veins business Carotid Artery Internal 030217 neurology & neurosurgery Petrous Bone |
| Zdroj: | World Neurosurgery. 134:e771-e782 |
| ISSN: | 1878-8750 |
| DOI: | 10.1016/j.wneu.2019.10.190 |
| Popis: | Background Surgical management of extensive skull base tumors, such as chordoma and chondrosarcoma, remains very challenging. The need for gross total removal to improve survival must be weighed against the risk of injury to neurovascular structures and the loss of stability at the craniovertebral junction. In cases of tumors that are already compromising craniovertebral junction stability, the occipital condyle can be exploited as a deep keyhole to reach the clivus, petrous apex, and sphenoid sinus. Methods We performed an anatomic study on 7 cadaveric specimens to describe the main landmarks and boundaries of the corridor. We also provide a clinical case to demonstrate the feasibility of the approach. Results In all specimens, using the space provided by the condyle, it was possible to drill the petrous bone up to the posterior wall of the sphenoid sinus following the direction of the inferior petrosal sinus. To successfully complete the approach, after the hypoglossal canal was exposed, endoscopic assistance was needed to overcome the narrowing of the visual field provided by the microscope. Conclusions In cases of invasive skull base tumor involving the craniovertebral junction and affecting its stability, the occipital condyle can be exploited as a deep keyhole to the homolateral and contralateral petrous apex, clivus, and sphenoid sinus. |
| Databáze: | OpenAIRE |
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