Techniques and challenges of the expanded endoscopic endonasal access to the ventrolateral skull base during the “far-medial” and “extreme medial” approaches

Giuliano Silveira-Bertazzo, Sunil Manjila, Nyall R. London, Daniel M. Prevedello

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Expanding the ventrolateral skull base corridor from the midline of lower clivus to the petroclival fissure is a challenging endonasal surgical task. Resection of lytic lesions like chondrosarcoma can cause cranial nerve morbidities and injury of ICA, necessitating accurate knowledge of correlative endoscopic anatomy with stereotactic landmarks. Methods: We describe an extended endoscopic endonasal approach (EEA) for a right petroclival chondrosarcoma with the demonstration of ipsilateral surgical landmarks with contralateral normal correlates, using a stepwise comparative image-guided cadaveric dissection study. Conclusion: EEA for lytic lesions like chondrosarcomas needs to address brain shift and displacement of ICA, posing a chance for cranial nerve morbidities and ICA injury. Meticulous utilization of intraoperative stereotactic landmarks can help avoid and mitigate surgical complications.

Original languageEnglish (US)
Pages (from-to)597-603
Number of pages7
JournalActa Neurochirurgica
Volume162
Issue number3
DOIs
StatePublished - Mar 1 2020

Keywords

  • Endoscopic landmarks
  • Expanded endonasal
  • Extreme medial
  • Far-medial
  • Lower clivus
  • Skull base
  • Sublacerum corridor
  • Transclival approach

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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