Anatomical landmarks for transnasal endoscopic skull base surgery.

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Ressource 1Download: serval:BIB_00AE91970252.P001 (1749.43 [Ko])
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Serval ID
serval:BIB_00AE91970252
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Anatomical landmarks for transnasal endoscopic skull base surgery.
Journal
European Archives of Oto-Rhino-Laryngology
Author(s)
Sandu K., Monnier P., Pasche P.
ISSN
1434-4726 (Electronic)
ISSN-L
0937-4477
Publication state
Published
Issued date
2012
Volume
269
Number
1
Pages
171-178
Language
english
Abstract
Resection of midline skull base lesions involve approaches needing extensive neurovascular manipulation. Transnasal endoscopic approach (TEA) is minimally invasive and ideal for certain selected lesions of the anterior skull base. A thorough knowledge of endonasal endoscopic anatomy is essential to be well versed with its surgical applications and this is possible only by dedicated cadaveric dissections. The goal in this study was to understand endoscopic anatomy of the orbital apex, petrous apex and the pterygopalatine fossa. Six cadaveric heads (3 injected and 3 non injected) and 12 sides, were dissected using a TEA outlining systematically, the steps of surgical dissection and the landmarks encountered. Dissection done by the "2 nostril, 4 hands" technique, allows better transnasal instrumentation with two surgeons working in unison with each other. The main surgical landmarks for the orbital apex are the carotid artery protuberance in the lateral sphenoid wall, optic nerve canal, lateral optico-carotid recess, optic strut and the V2 nerve. Orbital apex includes structures passing through the superior and inferior orbital fissure and the optic nerve canal. Vidian nerve canal and the V2 are important landmarks for the petrous apex. Identification of the sphenopalatine artery, V2 and foramen rotundum are important during dissection of the pterygopalatine fossa. In conclusion, the major potential advantage of TEA to the skull base is that it provides a direct anatomical route to the lesion without traversing any major neurovascular structures, as against the open transcranial approaches which involve more neurovascular manipulation and brain retraction. Obviously, these approaches require close cooperation and collaboration between otorhinolaryngologists and neurosurgeons.
Pubmed
Web of science
Open Access
Yes
Create date
17/02/2012 14:42
Last modification date
01/10/2019 7:16
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