Ferlendis Luca, Watanabe Nobuyuki, Fava Arianna, Jiang Tingting, Passeri Thibault, Froelich Sebastien
Department of Neurosurgery, Lariboisière Hospital, Assistance Publique - Hopitaux de Paris, University of Paris, Paris, France.
Oper Neurosurg. 2025 Jul 10. doi: 10.1227/ons.0000000000001695.
Lower petroclival meningiomas (PCMs) and jugular tubercle meningiomas are among the most challenging tumors in neurosurgery, with the optimal approach still debated. Traditional posterior and lateral open approaches are still commonly employed but are invasive and carry significant risks due to brain retraction and neurovascular manipulation. The extended endonasal transclival approach has emerged as a less invasive alternative for midline lesions, offering direct access with early tumor devascularization and reduced manipulation of critical structures. However, limitations include lateral tumor extension, challenging skull base reconstruction, and nasal morbidity, especially when using a nasoseptal flap, which may negatively affect quality of life. To minimize both intracranial and nasal morbidities, we propose a right mononostril contralateral endonasal approach using the chopstick technique with angled scopes and instruments, combined with sphenoid sinus cranialization and rostral mucosal suturing for reconstruction.
A 33-year-old man presented with progressive headaches. Neuroimaging revealed a 29 × 39-mm PCM centered in the lower petroclival junction. Preoperative embolization was followed by tumor resection using a right mononostril endoscopic endonasal approach. Closure involved cranialization of the sphenoid sinus with rostral mucosa suturing. Postoperatively, lumbar punctures for cerebrospinal fluid depletion were conducted. No cerebrospinal fluid leakage or new neurological deficits were observed.
The mononostril endoscopic endonasal chopstick technique provides direct access to the petroclival region, enabling total resection of selected low-lying PCMs or jugular tubercle meningiomas. This minimally invasive technique, combined with rostral mucosal closure, may reduce surgical morbidity and improve postoperative quality of life.
岩斜区下部脑膜瘤（PCM）和颈静脉结节脑膜瘤是神经外科手术中最具挑战性的肿瘤之一，最佳手术入路仍存在争议。传统的后外侧开放入路仍被广泛应用，但具有侵袭性，由于脑牵拉和神经血管操作，存在重大风险。扩大经鼻内镜经斜坡入路已成为治疗中线病变的一种侵入性较小的替代方法，可直接进入病变部位，早期实现肿瘤去血管化，并减少对关键结构的操作。然而，其局限性包括肿瘤向外侧扩展、颅底重建具有挑战性以及鼻腔并发症，尤其是使用鼻中隔瓣时，这可能会对生活质量产生负面影响。为了将颅内和鼻腔并发症降至最低，我们提出一种右侧单鼻孔对侧经鼻入路，采用筷子技术，使用成角的内镜和器械，并结合蝶窦颅骨化和鼻黏膜缝合进行重建。
一名33岁男性因进行性头痛就诊。神经影像学检查显示，在岩斜区下部交界处有一个29×39mm的PCM。术前进行了栓塞，随后采用右侧单鼻孔内镜经鼻入路切除肿瘤。关闭手术包括蝶窦颅骨化和鼻黏膜缝合。术后进行了腰椎穿刺以引流脑脊液。未观察到脑脊液漏或新的神经功能缺损。
单鼻孔内镜经鼻筷子技术可直接进入岩斜区，能够完全切除部分低位PCM或颈静脉结节脑膜瘤。这种微创技术结合鼻黏膜缝合，可能会降低手术并发症，提高术后生活质量。
