Omura Kazuhiro, Kimple Adam J, Senior Brent A, Nomura Kazuhiro, Norris Meghan, Zeatoun Abdullah L, Klatt-Cromwell Cristine, Ebert Charles S, Otori Nobuyoshi, Thorp Brian D
Department of Otolaryngology, School of Medicine, The University of North Carolina, Chapel Hill, North Carolina.
Department of Otorhinolaryngology, The Jikei University School of Medicine, Tokyo, Japan.
J Neurol Surg B Skull Base. 2023 Jun 27;85(5):465-469. doi: 10.1055/a-2101-9910. eCollection 2024 Oct.
The anteromedial temporal region and the lateral wall of the sphenoid can be the site of an array of pathology including trigeminal schwannoma, encephalocele, cholesterol granuloma of the petrous apex, malignancy, infection, and sellar pathology extending to the lateral cavernous sinus. Approaches to this region are technically challenging and the existing approach requires sacrifice of all of the turbinates including the nasolacrimal duct, which can cause postoperative complications. We describe a novel anatomical landmark between the periorbita and the periosteum of the pterygopalatine fossa (which is located at the inferolateral periorbital periosteal line [ILPPL]). The posterior one-third of the incision line lies between the foramen rotundum and the superior orbital fissure, which is proximal to the maxillary strut. A 1.5-cm incision can divide the orbital and pterygoid contents and lead us to the posterior inferolateral orbital region, anteromedial temporal region, lateral wall of the sphenoid sinus, and lateral wall of the cavernous sinus. A combined multiangled approach to the ILPPL will enable us to preserve all of the turbinates and the septum, and the nasolacrimal duct, allowing for the preservation of the physiological function and pedicled flaps, such as the middle turbinate, inferior turbinate, and septal membrane flap. The ILPPL is a simple, effective, and novel landmark for the minimally invasive approach to the anteromedial temporal fossa.
颞叶前内侧区域和蝶骨外侧壁可能是一系列病变的发生部位，包括三叉神经鞘瘤、脑膨出、岩尖胆固醇肉芽肿、恶性肿瘤、感染以及延伸至海绵窦外侧的鞍区病变。该区域的手术入路在技术上具有挑战性，现有的入路需要牺牲包括鼻泪管在内的所有鼻甲，这可能导致术后并发症。我们描述了一种位于眶骨膜和翼腭窝骨膜之间的新的解剖标志（位于眶周骨膜下外侧线[ILPPL]）。切口线的后三分之一位于圆孔和眶上裂之间，靠近上颌支柱。一个1.5厘米的切口可以分开眼眶和翼状间隙的内容物，并将我们引向眼眶后下外侧区域、颞叶前内侧区域、蝶窦外侧壁和海绵窦外侧壁。采用联合多角度入路至ILPPL将使我们能够保留所有鼻甲和鼻中隔以及鼻泪管，从而保留生理功能和带蒂皮瓣，如中鼻甲、下鼻甲和鼻中隔黏膜瓣。ILPPL是一种简单、有效且新颖的标志，用于颞叶前内侧窝的微创入路。
