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Treviño-Gonzalez JL, Santos-Santillana KM, Maldonado-Chapa F, Morales-Del Angel JA. Neurovascular structures in the lateral recess of the sphenoid sinus. A computed tomography evaluation. NEUROCIRUGIA (ENGLISH EDITION) 2023; 34:105-111. [PMID: 36774255 DOI: 10.1016/j.neucie.2022.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 02/22/2022] [Indexed: 02/11/2023]
Abstract
INTRODUCTION AND OBJECTIVES Anatomical variations of the lateral recess of the sphenoid sinus and its relations with the adjacent neurovascular structures should be preoperatively evaluated to plan an adequate surgical approach and avoid iatrogenic injuries. This study aims to analyze the patterns of pneumatization of the lateral recess of the sphenoid sinus and their association with the presence of protrusion and dehiscence of the optic canal, carotid canal, vidian canal, and maxillary nerve. MATERIALS AND METHODS A retrospective evaluation of 320 sphenoid sinuses by computed tomography was performed. Studied variables included type of lateral recess, and protrusion, and dehiscence of the optic and carotid canal, and vidian and maxillary nerve. RESULTS The mean age was 45.67±17.43. A total of 55.6% (n=178) of the evaluated sphenoid sinuses corresponded to male subjects. Protrusion of the carotid canal, maxillary nerve, and vidian canal was associated with a type 3 lateral recess pneumatization, while dehiscence of these structures was most commonly observed in a type 2 lateral recess (p=<0.001). CONCLUSIONS Protrusion or dehiscence of neurovascular structures surrounding the sphenoid sinus has been associated with the extent of pneumatization of the lateral recess, increasing the risk of intraoperative injury. Preoperative identification of anatomical variations is mandatory to select the best approach for skull base lesions and avoid iatrogenic injuries.
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Affiliation(s)
- Jose Luis Treviño-Gonzalez
- Otolaryngology and Head and Neck Surgery Division, School of Medicine and University Hospital "Dr. Jose E. González", Universidad Autónoma de Nuevo León, Monterrey, Nuevo Leon, Mexico
| | - Karla Marisol Santos-Santillana
- Otolaryngology and Head and Neck Surgery Division, School of Medicine and University Hospital "Dr. Jose E. González", Universidad Autónoma de Nuevo León, Monterrey, Nuevo Leon, Mexico
| | - Felix Maldonado-Chapa
- Otolaryngology and Head and Neck Surgery Division, School of Medicine and University Hospital "Dr. Jose E. González", Universidad Autónoma de Nuevo León, Monterrey, Nuevo Leon, Mexico
| | - Josefina Alejandra Morales-Del Angel
- Otolaryngology and Head and Neck Surgery Division, School of Medicine and University Hospital "Dr. Jose E. González", Universidad Autónoma de Nuevo León, Monterrey, Nuevo Leon, Mexico.
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Zuo F, Ye S, Qian H, Liu S, Wan J. Maxillary Swing Approach for Central Skull Base Lesions in Extreme Situations: A Single-Institutional Case Series. World Neurosurg 2022; 166:e337-e344. [PMID: 35817346 DOI: 10.1016/j.wneu.2022.07.009] [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: 04/15/2022] [Revised: 07/04/2022] [Accepted: 07/04/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Radical resection of complex lesions occupying multiple compartments at the central skull base remains a significant challenge, since surgical outcomes may be compromised by insufficient exposure and inappropriate techniques. However, the efficiency of the maxillary swing approach for these lesions has not been sufficiently evaluated. Careful assessment of lesion characteristics must be performed when selecting the appropriate procedure. METHODS Between May 2006 and February 2017, 17 patients underwent resection of extensive lesions in the central skull base using the maxillary swing approach. As shown in the representative cases, data regarding clinical findings and technical considerations were reviewed. RESULTS Complete resection was achieved in all patients. The pathological findings were diverse, and the majority were schwannomas (9 cases, 52.94%), followed by meningiomas (World Health Organization II) (3 cases, 17.65%). Complications were managed as described in the case illustrations, and symptoms improved with time. The follow-up duration ranged from 62 to 192 months (median, 114 months), while 2 patients were lost to the follow-up. No mortality was observed. Two patients who experienced malignancy relapse were still under observation due to their asymptomatic status. CONCLUSIONS Our preliminary results suggest that the maxillary swing approach can be an alternative option for managing extreme cases, such as large, extensive, hypervascularized masses with fibrous or calcified consistency, or for recurrent lesions in the central skull base. En bloc resection can be successfully obtained, resulting in long-term local control.
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Affiliation(s)
- Fuxing Zuo
- Department of Neurosurgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shilu Ye
- Department of Neurosurgery, The 901st Hospital of the Joint Logistics Support Force of PLA, Hefei, China
| | - Haipeng Qian
- Department of Neurosurgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shaoyan Liu
- Department of Head and Neck Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jinghai Wan
- Department of Neurosurgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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Nunes RH, Abello AL, Zanation AM, Sasaki-Adams D, Huang BY. Imaging in Endoscopic Cranial Skull Base and Pituitary Surgery. Otolaryngol Clin North Am 2016; 49:33-62. [PMID: 26614828 DOI: 10.1016/j.otc.2015.09.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Endoscopic endonasal approaches have widely accepted techniques for managing benign and malignant processes along the entire ventral skull base with similar or better results compared with open procedures, but with lower rates of complication. Managing pathology affecting the skull base can be challenging because of complex anatomy and the proximity of critical neurovascular structures. Postoperative imaging can be challenging, because of surgical alterations of normal anatomy and the now common use of complex reconstruction techniques. Understanding the normal imaging appearance of skull base reconstruction is important for accurate postoperative interpretation and delineation between normal reconstructive tissue and recurrent neoplasm.
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Affiliation(s)
- Renato Hoffmann Nunes
- Department of Radiology, University of North Carolina at Chapel Hill, 101 Manning Drive, CB#7510, Chapel Hill, NC 27599, USA; Division of Neuroradiology, Fleury Medicina e Saúde, Santa Casa de Misericórdia de São Paulo, Rua Cincinato Braga, 282, Bela Vista, São Paulo, São Paulo 01333-910, Brazil; Santa Casa de Misericórdia de São Paulo, Serviço de Diagnostico por Imagem, Rua Dr. Cesário Motta Junior 112, Vila Buarque, São Paulo, São Paulo 01221-020, Brazil
| | - Ana Lorena Abello
- Department of Radiology, University of North Carolina at Chapel Hill, 101 Manning Drive, CB#7510, Chapel Hill, NC 27599, USA; Department of Radiology, Universidad del Valle, Calle 13#100-00 Cali, Valle del Cauca, Colombia
| | - Adam M Zanation
- Department of Neurosurgery, University of North Carolina at Chapel Hill, 170 Manning Drive, CB#7070, Chapel Hill, NC 27599, USA; Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, 170 Manning Drive, CB#7060, Chapel Hill, NC 27599, USA
| | - Deanna Sasaki-Adams
- Department of Neurosurgery, University of North Carolina at Chapel Hill, 170 Manning Drive, CB#7070, Chapel Hill, NC 27599, USA
| | - Benjamin Y Huang
- Department of Radiology, University of North Carolina at Chapel Hill, 101 Manning Drive, CB#7510, Chapel Hill, NC 27599, USA.
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García-Garrigós E, Arenas-Jiménez JJ, Monjas-Cánovas I, Abarca-Olivas J, Cortés-Vela JJ, De La Hoz-Rosa J, Guirau-Rubio MD. Transsphenoidal Approach in Endoscopic Endonasal Surgery for Skull Base Lesions: What Radiologists and Surgeons Need to Know. Radiographics 2015; 35:1170-85. [PMID: 26046941 DOI: 10.1148/rg.2015140105] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
In the last 2 decades, endoscopic endonasal transsphenoidal surgery has become the most popular choice of neurosurgeons and otolaryngologists to treat lesions of the skull base, with minimal invasiveness, lower incidence of complications, and lower morbidity and mortality rates compared with traditional approaches. The transsphenoidal route is the surgical approach of choice for most sellar tumors because of the relationship of the sphenoid bone to the nasal cavity below and the pituitary gland above. More recently, extended approaches have expanded the indications for transsphenoidal surgery by using different corridors leading to specific target areas, from the crista galli to the spinomedullary junction. Computer-assisted surgery is an evolving technology that allows real-time anatomic navigation during endoscopic surgery by linking preoperative triplanar radiologic images and intraoperative endoscopic views, thus helping the surgeon avoid damage to vital structures. Preoperative computed tomography is the preferred modality to show bone landmarks and vascular structures. Radiologists play an important role in surgical planning by reporting extension of sphenoid pneumatization, recesses and septations of the sinus, and other relevant anatomic variants. Radiologists should understand the relationships of the sphenoid bone and skull base structures, anatomic variants, and image-guided neuronavigation techniques to prevent surgical complications and allow effective treatment of skull base lesions with the endoscopic endonasal transsphenoidal approach.
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Affiliation(s)
- Elena García-Garrigós
- From the Departments of Radiology (E.G.G., J.J.A.J., J.D.L.H.R., M.D.G.R.), Otolaryngology (I.M.C.), and Neurosurgery (J.A.O.), Hospital General Universitario de Alicante, Avenida Pintor Baeza 12, 03010 Alicante, Spain; and Department of Radiology, Complejo Hospitalario la Mancha Centro, Alcázar de San Juan, Ciudad Real, Spain (J.J.C.V.)
| | - Juan José Arenas-Jiménez
- From the Departments of Radiology (E.G.G., J.J.A.J., J.D.L.H.R., M.D.G.R.), Otolaryngology (I.M.C.), and Neurosurgery (J.A.O.), Hospital General Universitario de Alicante, Avenida Pintor Baeza 12, 03010 Alicante, Spain; and Department of Radiology, Complejo Hospitalario la Mancha Centro, Alcázar de San Juan, Ciudad Real, Spain (J.J.C.V.)
| | - Irene Monjas-Cánovas
- From the Departments of Radiology (E.G.G., J.J.A.J., J.D.L.H.R., M.D.G.R.), Otolaryngology (I.M.C.), and Neurosurgery (J.A.O.), Hospital General Universitario de Alicante, Avenida Pintor Baeza 12, 03010 Alicante, Spain; and Department of Radiology, Complejo Hospitalario la Mancha Centro, Alcázar de San Juan, Ciudad Real, Spain (J.J.C.V.)
| | - Javier Abarca-Olivas
- From the Departments of Radiology (E.G.G., J.J.A.J., J.D.L.H.R., M.D.G.R.), Otolaryngology (I.M.C.), and Neurosurgery (J.A.O.), Hospital General Universitario de Alicante, Avenida Pintor Baeza 12, 03010 Alicante, Spain; and Department of Radiology, Complejo Hospitalario la Mancha Centro, Alcázar de San Juan, Ciudad Real, Spain (J.J.C.V.)
| | - Jesús Julián Cortés-Vela
- From the Departments of Radiology (E.G.G., J.J.A.J., J.D.L.H.R., M.D.G.R.), Otolaryngology (I.M.C.), and Neurosurgery (J.A.O.), Hospital General Universitario de Alicante, Avenida Pintor Baeza 12, 03010 Alicante, Spain; and Department of Radiology, Complejo Hospitalario la Mancha Centro, Alcázar de San Juan, Ciudad Real, Spain (J.J.C.V.)
| | - Javier De La Hoz-Rosa
- From the Departments of Radiology (E.G.G., J.J.A.J., J.D.L.H.R., M.D.G.R.), Otolaryngology (I.M.C.), and Neurosurgery (J.A.O.), Hospital General Universitario de Alicante, Avenida Pintor Baeza 12, 03010 Alicante, Spain; and Department of Radiology, Complejo Hospitalario la Mancha Centro, Alcázar de San Juan, Ciudad Real, Spain (J.J.C.V.)
| | - Maria Dolores Guirau-Rubio
- From the Departments of Radiology (E.G.G., J.J.A.J., J.D.L.H.R., M.D.G.R.), Otolaryngology (I.M.C.), and Neurosurgery (J.A.O.), Hospital General Universitario de Alicante, Avenida Pintor Baeza 12, 03010 Alicante, Spain; and Department of Radiology, Complejo Hospitalario la Mancha Centro, Alcázar de San Juan, Ciudad Real, Spain (J.J.C.V.)
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