학술논문
Combined Endoscopic Endonasal Transclival and Contralateral Transmaxillary Approach to the Petrous Apex and the Petroclival Synchondrosis: Working "Around the Corner" of the Internal Carotid Artery-Quantitative Anatomical Study and Clinical Applications.
Document Type
Academic Journal
Author
Donofrio CA; Department of Neurosurgery, ASST Cremona, 2610 Cremona, Italy.; Division of Biology and Genetics, Department of Molecular and Translational Medicine, Faculty of Medicine, University of Brescia, 25121 Brescia, Italy.; Corrivetti F; Laboratory of Neuroscience, EBRIS Foundation, European Biomedical Research Institute of Salerno, 84125 Salerno, Italy.; Riccio L; Department of Neurosurgery, ASST Cremona, 2610 Cremona, Italy.; Corvino S; Laboratory of Neuroscience, EBRIS Foundation, European Biomedical Research Institute of Salerno, 84125 Salerno, Italy.; Department of Neurosciences, Reproductive and Odontostomatological Sciences, Neurosurgical Clinic, School of Medicine, University of Naples 'Federico II', 80131 Naples, Italy.; Dallan I; Otorhinolaryngology, Audiology and Phoniatrics Operative Unit, Department of Surgical, Medical, Molecular Pathology and Emergency Medicine, Azienda Ospedaliero Universitaria Pisana, University of Pisa, 56124 Pisa, Italy.; Fioravanti A; Department of Neurosurgery, ASST Cremona, 2610 Cremona, Italy.; de Notaris M; Laboratory of Neuroscience, EBRIS Foundation, European Biomedical Research Institute of Salerno, 84125 Salerno, Italy.; Department of Neurosciences, Reproductive and Odontostomatological Sciences, Neurosurgical Clinic, School of Medicine, University of Naples 'Federico II', 80131 Naples, Italy.; Otorhinolaryngology, Audiology and Phoniatrics Operative Unit, Department of Surgical, Medical, Molecular Pathology and Emergency Medicine, Azienda Ospedaliero Universitaria Pisana, University of Pisa, 56124 Pisa, Italy.; Department of Neurosurgery, San Luca Hospital, Vallo della Lucania, 84078 Salerno, Italy.; Unit of Neurosurgery, University Hospital San Giovanni di Dio e Ruggi d'Aragona, University of Salerno, 84131 Salerno, Italy.
Source
Publisher: MDPI AG Country of Publication: Switzerland NLM ID: 101606588 Publication Model: Electronic Cited Medium: Print ISSN: 2077-0383 (Print) Linking ISSN: 20770383 NLM ISO Abbreviation: J Clin Med Subsets: PubMed not MEDLINE
Subject
Language
English
ISSN
2077-0383
Abstract
The endoscopic contralateral transmaxillary (CTM) approach has been proposed as a potential route to widen the corridor posterolateral to the internal carotid artery (ICA). In this study, we first refined the surgical technique of a combined multiportal endoscopic endonasal transclival (EETC) and CTM approach to the petrous apex (PA) and petroclival synchondrosis (PCS) in the dissection laboratory, and then validated its applications in a preliminary surgical series. The combined EETC and CTM approach was performed on three cadaver specimens based on four surgical steps: (1) the nasal, (2) the clival, (3) the maxillary and (4) the petrosal phases. The CTM provided a " head-on trajectory " to the PA and PCS and a short distance to the surgical field considerably furthering surgical maneuverability. The best operative set-up was achieved by introducing angled optics via the endonasal route and operative instruments via the transmaxillary corridor exploiting the advantages of a non-coaxial multiportal surgery. Clinical applications of the combined EETC and CTM approach were reported in three cases, a clival chordoma and two giant pituitary adenomas. The present translational study explores the safety and feasibility of a combined multiportal EETC and CTM approach to access the petroclival region though different corridors.