From the Occipital Condyle to the Sphenoid Sinus: Extradural Extension of the Far Lateral Transcondylar Approach with Endoscopic Assistance.
World Neurosurg
; 134: e771-e782, 2020 Feb.
Article
em En
| MEDLINE
| ID: mdl-31734422
ABSTRACT
BACKGROUND:
Surgical management of extensive skull base tumors, such as chordoma and chondrosarcoma, remains very challenging. The need for gross total removal to improve survival must be weighed against the risk of injury to neurovascular structures and the loss of stability at the craniovertebral junction. In cases of tumors that are already compromising craniovertebral junction stability, the occipital condyle can be exploited as a deep keyhole to reach the clivus, petrous apex, and sphenoid sinus.METHODS:
We performed an anatomic study on 7 cadaveric specimens to describe the main landmarks and boundaries of the corridor. We also provide a clinical case to demonstrate the feasibility of the approach.RESULTS:
In all specimens, using the space provided by the condyle, it was possible to drill the petrous bone up to the posterior wall of the sphenoid sinus following the direction of the inferior petrosal sinus. To successfully complete the approach, after the hypoglossal canal was exposed, endoscopic assistance was needed to overcome the narrowing of the visual field provided by the microscope.CONCLUSIONS:
In cases of invasive skull base tumor involving the craniovertebral junction and affecting its stability, the occipital condyle can be exploited as a deep keyhole to the homolateral and contralateral petrous apex, clivus, and sphenoid sinus.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Osso Petroso
/
Seio Esfenoidal
/
Cordoma
/
Base do Crânio
/
Neoplasias da Base do Crânio
/
Fossa Craniana Posterior
/
Neuroendoscopia
Limite:
Adult
/
Humans
/
Male
Idioma:
En
Ano de publicação:
2020
Tipo de documento:
Article