Yanez-Siller Juan C, Noiphithak Raywat, Porto Edoardo, Beer-Furlan Andre L, Revuelta Barbero Juan M, Martinez-Perez Rafael, Howe Edmund, Prevedello Daniel M, Carrau Ricardo L
Department of Otolaryngology-Head and Neck Surgery, University of Missouri-Columbia, Columbia, Missouri, USA.
Department of Otolaryngology-Head and Neck Surgery, Wexner Medical Center at The Ohio State University, Columbus, Ohio, USA.
Oper Neurosurg. 2023 Jun 1;24(6):e421-e428. doi: 10.1227/ons.0000000000000637. Epub 2023 Feb 3.
The expanded endoscopic endonasal approach (EEA) is limited laterally by the internal carotid artery (ICA). The EEA to the paramedian skull base often requires complex maneuvers such as dissection of the Eustachian tube (ET) and foramen lacerum (FL), and ICA manipulation. An endoscopic contralateral transmaxillary approach (CTMA) has the potential to provide adequate exposure of the paramedian skull base while bypassing manipulation of the aforementioned anatomic structures.
To quantify and compare the surgical nuances of a CTMA and a contralateral EEA when approaching the paramedian skull base in cadaveric specimens.
Five adult cadaveric heads were dissected bilaterally (10 sides) using a contralateral EEA and a CTMA to expose targets of interest at the paramedian skull base. For each target in both approaches, the surgical freedom, angle of attack, the corridor's "perspective angle," and "turning angle" to circumvent the ICA, ET, and FL were obtained.
The CTMA achieved superior surgical freedom at all targets ( P < .05) except at the root entry point of cranial nerve XII. The CTMA provided superior vertical and horizontal angles of " attack " to the majority of targets of interest. Except when approaching the root entry point of cranial nerve XII, the CTMA " turning angle " around the ICA, ET, and FL were wider with CTMA for all targets.
A CTMA complements the EEA to access the paramedian skull base. A CTMA may limit the need for complex maneuvers such as ICA mobilization and dissection of the ET and FL when approaching the paramedian skull base.
扩大经鼻内镜入路（EEA）在外侧受到颈内动脉（ICA）的限制。经鼻内镜入路至中颅底通常需要复杂的操作，如咽鼓管（ET）和破裂孔（FL）的解剖以及ICA的操作。内镜对侧经上颌入路（CTMA）有可能在绕过上述解剖结构操作的同时，提供对中颅底的充分暴露。
量化并比较在尸体标本中采用CTMA和对侧EEA入路至中颅底时的手术细微差别。
使用对侧EEA和CTMA对5个成人尸体头部进行双侧解剖（共10侧），以暴露中颅底的感兴趣靶点。对于两种入路中的每个靶点，获取手术自由度、攻击角度、通道的“视角角度”以及绕过ICA、ET和FL的“转角”。
除了在颅神经XII的根入口点外，CTMA在所有靶点均实现了更好的手术自由度（P <.05）。CTMA为大多数感兴趣靶点提供了更好的垂直和水平“攻击”角度。除了接近颅神经XII的根入口点时，CTMA围绕ICA、ET和FL的“转角”对所有靶点都更宽。
CTMA可补充EEA以进入中颅底。在接近中颅底时，CTMA可能会减少对诸如ICA游离以及ET和FL解剖等复杂操作的需求。
