Izmir Faculty of Medicine, Department of Neurosurgery, University of Health Sciences, Izmir, Turkey.
Department of Neurosurgery, Izmir City Hospital, Laka, Bornova / Izmir, 35040, Turkey.
Surg Radiol Anat. 2024 May;46(5):625-634. doi: 10.1007/s00276-024-03344-7. Epub 2024 Mar 26.
The endoscopic trans-eustachian approach (ETETA) is a less invasive approach to the infratemporal fossa (ITF), providing superior exposure compared to traditional transcranial approaches. The anatomy of the pharyngotympanic (eustachian) tube and adjacent neurovascular structures is complex and requires in-depth knowledge to safely perform this approach. We present a cadaveric and radiological assessment of critical anatomic considerations for ETETA.
Six adult cadaveric heads were dissected alongside examination of 50 paranasal sinus CT scans. Key anatomic relationships of the pharyngotympanic tube and adjacent structures were qualitatively and quantitatively evaluated. Descriptive statistics were performed for quantitative data.
Anatomical and radiological measurements showed lateralization of the pharyngotympanic tube allows access to the ITF. The pharyngotympanic tube has bony and cartilaginous parts with the junction formed by the sphenoid spine and foramen spinosum. The bony part and tendon of the tensor tympani muscle were located at the posterior genu of the internal carotid artery. The anterior and inferior wall of the carotid canal was located between the horizontal segment of the internal carotid artery and petrous segment of the cartilaginous pharyngotympanic tube.
The combination of preoperative radiographic assessment and anatomical correlation demonstrates a safe and effective approach to ETETA, which allowed satisfactory visualization of ITF. The morphological evaluation showed that the lateralization of the pharyngotympanic tube and related structures allowed a surgical corridor to reach the ITF. Endoscopic surgery through the pharyngotympanic tube is challenging, and in-depth understanding of the key anatomic relationships is critical for performing this approach.
经咽鼓管内镜入路（ETETA）是一种对颞下窝（ITF）侵袭性较小的方法，与传统的经颅入路相比，提供了更好的显露。咽鼓管（咽鼓管）和相邻的神经血管结构的解剖结构复杂，需要深入了解才能安全地进行这种方法。我们提出了一种经咽鼓管内镜入路的关键解剖学考虑因素的尸体和影像学评估。
对 6 具成人尸体头颅进行解剖，并对 50 例鼻窦 CT 扫描进行检查。对咽鼓管和相邻结构的关键解剖关系进行定性和定量评估。对定量数据进行描述性统计。
解剖学和影像学测量显示，咽鼓管的侧化允许进入 ITF。咽鼓管有骨和软骨部分，交界处由蝶骨棘和棘孔形成。骨部和鼓膜张肌的肌腱位于颈内动脉后膝。颈动脉管的前壁和下壁位于颈内动脉水平段和软骨性咽鼓管的岩骨段之间。
术前影像学评估和解剖学相关性的结合显示了经咽鼓管内镜入路的安全有效方法，该方法允许对 ITF 进行满意的可视化。形态学评估显示，咽鼓管和相关结构的侧化允许建立到达 ITF 的手术通道。经咽鼓管内镜手术具有挑战性，深入了解关键解剖关系对于执行这种方法至关重要。
