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Donofrio CA, Corrivetti F, Riccio L, Corvino S, Dallan I, Fioravanti A, de Notaris M. Combined Endoscopic Endonasal Transclival and Contralateral Transmaxillary Approach to the Petrous Apex and the Petroclival Synchondrosis: Working "Around the Corner" of the Internal Carotid Artery-Quantitative Anatomical Study and Clinical Applications. J Clin Med 2024; 13:2713. [PMID: 38731242 PMCID: PMC11084429 DOI: 10.3390/jcm13092713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 04/30/2024] [Accepted: 05/01/2024] [Indexed: 05/13/2024] Open
Abstract
The endoscopic contralateral transmaxillary (CTM) approach has been proposed as a potential route to widen the corridor posterolateral to the internal carotid artery (ICA). In this study, we first refined the surgical technique of a combined multiportal endoscopic endonasal transclival (EETC) and CTM approach to the petrous apex (PA) and petroclival synchondrosis (PCS) in the dissection laboratory, and then validated its applications in a preliminary surgical series. The combined EETC and CTM approach was performed on three cadaver specimens based on four surgical steps: (1) the nasal, (2) the clival, (3) the maxillary and (4) the petrosal phases. The CTM provided a "head-on trajectory" to the PA and PCS and a short distance to the surgical field considerably furthering surgical maneuverability. The best operative set-up was achieved by introducing angled optics via the endonasal route and operative instruments via the transmaxillary corridor exploiting the advantages of a non-coaxial multiportal surgery. Clinical applications of the combined EETC and CTM approach were reported in three cases, a clival chordoma and two giant pituitary adenomas. The present translational study explores the safety and feasibility of a combined multiportal EETC and CTM approach to access the petroclival region though different corridors.
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Affiliation(s)
- Carmine Antonio Donofrio
- Department of Neurosurgery, ASST Cremona, 2610 Cremona, Italy; (C.A.D.); (L.R.); (A.F.)
- Division of Biology and Genetics, Department of Molecular and Translational Medicine, Faculty of Medicine, University of Brescia, 25121 Brescia, Italy
| | - Francesco Corrivetti
- Laboratory of Neuroscience, EBRIS Foundation, European Biomedical Research Institute of Salerno, 84125 Salerno, Italy; (S.C.); (M.d.N.)
| | - Lucia Riccio
- Department of Neurosurgery, ASST Cremona, 2610 Cremona, Italy; (C.A.D.); (L.R.); (A.F.)
| | - Sergio Corvino
- Laboratory of Neuroscience, EBRIS Foundation, European Biomedical Research Institute of Salerno, 84125 Salerno, Italy; (S.C.); (M.d.N.)
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Neurosurgical Clinic, School of Medicine, University of Naples “Federico II”, 80131 Naples, Italy
| | - Iacopo Dallan
- Otorhinolaryngology, Audiology and Phoniatrics Operative Unit, Department of Surgical, Medical, Molecular Pathology and Emergency Medicine, Azienda Ospedaliero Universitaria Pisana, University of Pisa, 56124 Pisa, Italy
| | - Antonio Fioravanti
- Department of Neurosurgery, ASST Cremona, 2610 Cremona, Italy; (C.A.D.); (L.R.); (A.F.)
| | - Matteo de Notaris
- Laboratory of Neuroscience, EBRIS Foundation, European Biomedical Research Institute of Salerno, 84125 Salerno, Italy; (S.C.); (M.d.N.)
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Neurosurgical Clinic, School of Medicine, University of Naples “Federico II”, 80131 Naples, Italy
- Otorhinolaryngology, Audiology and Phoniatrics Operative Unit, Department of Surgical, Medical, Molecular Pathology and Emergency Medicine, Azienda Ospedaliero Universitaria Pisana, University of Pisa, 56124 Pisa, Italy
- Department of Neurosurgery, San Luca Hospital, Vallo della Lucania, 84078 Salerno, Italy
- Unit of Neurosurgery, University Hospital San Giovanni di Dio e Ruggi d’Aragona, University of Salerno, 84131 Salerno, Italy
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Berardinelli J, Solari D, di Maria D, Parbonetti G, Cavallo LM, de Notaris M. Case Report of Indocyanine Green Endoscopy for Intrasellar Pituitary Adenoma Resection. World Neurosurg 2024; 183:14. [PMID: 38070734 DOI: 10.1016/j.wneu.2023.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 12/03/2023] [Indexed: 01/05/2024]
Abstract
Indocyanine green (ICG) angiography has become an established technology in many surgical fields, as well as in neurosurgery with the first application of microscope-integrated indocyanine angiography, which dates to 2003.1 More recently we observed the integration of ICG into endoscopic visualization (e-ICG), which resulted in different applications during the endoscopic endonasal approach ranging from evaluation of intranasal flap perfusion to differentiation of pituitary neuroendocrine tumors from normal gland or even as a predictive factor of postoperative visual function after expanded approaches.2-8 A 49-year-old woman was admitted to our hospital after a 1-year history of amenorrhea and radiologic finding of an intrasellar lesion. The clinical picture was compatible with a nonfunctioning pituitary neuroendocrine tumor, and the mass was completely removed by means of an endoscopic endonasal approach with intraoperative use of e-ICG (Video 1). A 25 mg intravenous bolus of ICG was injected immediately after completion of the sphenoid phase of the approach. ICG was visualized with a dedicated ICG-integrated endoscope coupled to an IMAGE1 S camera system set on Chroma enhancement mode. Near-infrared excitation of fluorescence (780-820 nm) was obtained using a D-light P Cold Light Fountain. At follow-up, the patient experienced resolution of her symptoms, without residues or relapses on control magnetic resonance. This case sheds light on some possible applications and advantages of e-ICG, including visualization of internal carotid arteries before the sellar opening, individuation of the pituitary gland, its distinction from the adenomatous tissue, and the possible evaluation of its degree of compression.
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Affiliation(s)
- Jacopo Berardinelli
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II," Naples, Italy.
| | - Domenico Solari
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II," Naples, Italy
| | - Domenico di Maria
- Department of Medical Sciences, Otorhinolaryngology Operative Unit, "G. Rummo" Hospital, Benevento, Italy
| | - Giovanni Parbonetti
- Department of Neurosciences, Neurosurgery Operative Unit, "G. Rummo" Hospital, Benevento, Italy
| | - Luigi Maria Cavallo
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II," Naples, Italy
| | - Matteo de Notaris
- Unit of Neurosurgery, University Hospital "San Gionanni di Dio e Ruggi d'Aragona", University of Salerno, Salerno, Italy; Laboratory of Neuroanatomy, EBRIS Foundation, European Biomedical Research Institute of Salerno, Salerno, Italy
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