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Nizzola M, Leonel LCPC, Peris-Celda M. Neurosurgery for the rhinologist. Curr Opin Otolaryngol Head Neck Surg 2024; 32:40-49. [PMID: 38193519 DOI: 10.1097/moo.0000000000000950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
PURPOSE OF REVIEW The purpose of this review is to provide a comprehensive anatomical appraisal of the neurosurgical anatomy exposed through the endonasal and paranasal sinuses routes, focusing on the most common expanded endonasal approaches (EEAs) as well as recent advances in this surgical field. RECENT FINDINGS The EEAs are redefining the management of skull base pathology. Neurovascular structures previously considered a limitation, can be now approached through these surgical corridors. Advances in this field include the development of new surgical techniques and routes that allow better visualization and access to pathologies located in the ventral skull base. Understanding the surgical anatomy related to EEAs is essential not only for neurosurgeons but also for rhinologists. SUMMARY Knowledge of the surgical anatomy of the most common EEAs that utilize paranasal sinuses as a surgical corridor enables more effective management of complex skull base pathologies. Comprehensive anatomical knowledge of these corridors and the surrounding neurovascular structures is crucial to maximize benefits of EEAs and improve outcomes.
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Affiliation(s)
- Mariagrazia Nizzola
- Mayo Clinic Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurosurgery and Gamma Knife radiosurgery, Vita-Salute San Raffaele University and IRCCS San Raffaele Scientific Institute, Milan, Italy
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
| | - Luciano C P C Leonel
- Mayo Clinic Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
| | - Maria Peris-Celda
- Mayo Clinic Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
- Department of Otolaryngology/Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
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Bu J, Hu Y, Sun S, Jin X, Zhu J, Yu Z, Wu J. Microscopic with Endoscopic Surgery via Subtemporal Approach for Cavernous Sinus Cholesteatomas. World Neurosurg 2023; 180:e624-e630. [PMID: 37806522 DOI: 10.1016/j.wneu.2023.09.124] [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: 06/11/2023] [Revised: 09/29/2023] [Accepted: 09/30/2023] [Indexed: 10/10/2023]
Abstract
OBJECTIVE The aim of this study was to retrospectively analyze the clinical data of 16 patients with cavernous sinus cholesteatomas, explore the surgical outcomes, and summarize the surgical experience. METHODS Patients with cavernous sinus cholesteatomas underwent surgery between June 2016 and June 2022 at the Department of Neurosurgery at the First Affiliated Hospital of Soochow University. Clinical data were obtained from all patients for analysis. RESULTS Common preoperative symptoms included headache, dizziness, diplopia, ptosis, and facial numbness. There were 7 patients with 2 or more symptoms. There were 13 patients with total resection and 3 patients with subtotal resection. There were 5 patients with improved postoperative symptoms, 10 patients with no significant change, and 1 patient with worse symptoms. New postoperative cranial nerve defects occurred in 4 patients. During the follow-up, all patients had favorable prognosis without progression. CONCLUSIONS Using "double-scope" technique, the subtemporal approach, a surgical strategy for cavernous sinus cholesteatomas, was sufficient to completely resect the tumors.
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Affiliation(s)
- Jiyuan Bu
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, People's Republic of China
| | - Yukun Hu
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, People's Republic of China
| | - Song Sun
- Department of Neurosurgery, Guanyun People's Hospital of Lianyungang, Lianyungang, People's Republic of China
| | - Xin Jin
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, People's Republic of China
| | - Jiandong Zhu
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, People's Republic of China
| | - Zhengquan Yu
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, People's Republic of China
| | - Jiang Wu
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, People's Republic of China.
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Corvino S, Villanueva-Solórzano PL, Offi M, Armocida D, Nonaka M, Iaconetta G, Esposito F, Cavallo LM, de Notaris M. A New Perspective on the Cavernous Sinus as Seen through Multiple Surgical Corridors: Anatomical Study Comparing the Transorbital, Endonasal, and Transcranial Routes and the Relative Coterminous Spatial Regions. Brain Sci 2023; 13:1215. [PMID: 37626571 PMCID: PMC10452901 DOI: 10.3390/brainsci13081215] [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: 07/05/2023] [Revised: 07/27/2023] [Accepted: 08/16/2023] [Indexed: 08/27/2023] Open
Abstract
Background: The cavernous sinus (CS) is a highly vulnerable anatomical space, mainly due to the neurovascular structures that it contains; therefore, a detailed knowledge of its anatomy is mandatory for surgical unlocking. In this study, we compared the anatomy of this region from different endoscopic and microsurgical operative corridors, further focusing on the corresponding anatomic landmarks encountered along these routes. Furthermore, we tried to define the safe entry zones to this venous space from these three different operative corridors, and to provide indications regarding the optimal approach according to the lesion's location. Methods: Five embalmed and injected adult cadaveric specimens (10 sides) separately underwent dissection and exposure of the CS via superior eyelid endoscopic transorbital (SETOA), extended endoscopic endonasal transsphenoidal-transethmoidal (EEEA), and microsurgical transcranial fronto-temporo-orbito-zygomatic (FTOZ) approaches. The anatomical landmarks and the content of this venous space were described and compared from these surgical perspectives. Results: The oculomotor triangle can be clearly exposed only by the FTOZ approach. Unlike EEEA, for the exposure of the clinoid triangle content, the anterior clinoid process removal is required for FTOZ and SETOA. The supra- and infratrochlear as well as the anteromedial and anterolateral triangles can be exposed by all three corridors. The most recently introduced SETOA allowed for the exposure of the entire lateral wall of the CS without entering its neurovascular structures and part of the posterior wall; furthermore, thanks to its anteroposterior trajectory, it allowed for the disclosure of the posterior ascending segment of the cavernous ICA with the related sympathetic plexus through the Mullan's triangle, in a minimally invasive fashion. Through the anterolateral triangle, the transorbital corridor allowed us to expose the lateral 180 degrees of the Vidian nerve and artery in the homonymous canal, the anterolateral aspect of the lacerum segment of the ICA at the transition zone from the petrous horizontal to the ascending posterior cavernous segment, surrounded by the carotid sympathetic plexus, and the medial Meckel's cave. Conclusions: Different regions of the cavernous sinus are better exposed by different surgical corridors. The relationship of the tumor with cranial nerves in the lateral wall guides the selection of the approach to cavernous sinus lesions. The transorbital endoscopic approach can be considered to be a safe and minimally invasive complementary surgical corridor to the well-established transcranial and endoscopic endonasal routes for the exposure of selected lesions of the cavernous sinus. Nevertheless, peer knowledge of the anatomy and a surgical learning curve are required.
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Affiliation(s)
- Sergio Corvino
- Division of Neurosurgery, Department of Neuroscience and Reproductive and Odontostomatological Sciences, Università di Napoli “Federico II”, 80131 Naples, Italy; (S.C.); (L.M.C.)
- PhD Program in Neuroscience, Department of Neuroscience and Reproductive and Odontostomatological Sciences, Università di Napoli “Federico II”, 80131 Naples, Italy
| | - Pedro L. Villanueva-Solórzano
- Department of Neurosurgery, National Institute of Neurology and Neurosurgery “Manuel Velasco Suarez”, Mexico City 14269, Mexico;
| | - Martina Offi
- Institute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli, 00168 Rome, Italy;
- Division of Neurosurgery, Catholic University of Rome, 00153 Rome, Italy
| | - Daniele Armocida
- Neurosurgery Division, Human Neurosciences Department, “Sapienza” University, 00185 Rome, Italy;
| | - Motonobu Nonaka
- Department of Neurosurgery, Kochi University Hospital, 185-1, Oko-cho, Kohasu, Kochi 783-8505, Japan;
| | - Giorgio Iaconetta
- Neurosurgical Clinic A.O.U. “San Giovanni di Dio e Ruggi d’Aragona”, 84131 Salerno, Italy;
| | - Felice Esposito
- Division of Neurosurgery, Department of Neuroscience and Reproductive and Odontostomatological Sciences, Università di Napoli “Federico II”, 80131 Naples, Italy; (S.C.); (L.M.C.)
| | - Luigi Maria Cavallo
- Division of Neurosurgery, Department of Neuroscience and Reproductive and Odontostomatological Sciences, Università di Napoli “Federico II”, 80131 Naples, Italy; (S.C.); (L.M.C.)
| | - Matteo de Notaris
- Neurosurgery Operative Unit, Department of Neuroscience, Coordinator Neuroanatomy Section Italian Society of Neurosurgery, G. Rummo Hospital, 82100 Benevento, Italy;
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