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Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas
Published on: January 17, 2018
Endoscopic endonasal surgery for petrous apex lesions
Adam M Zanation1, Carl H Snyderman, Ricardo L Carrau
1Department of Otolaryngology-Head & Neck Surgery, University of North Carolina Memorial Hospitals, Chapel Hill, North Carolina, USA.
The Laryngoscope
|January 2, 2009
Summary
Endoscopic endonasal approaches to petrous apex lesions are safe and effective. This study offers a new classification and demonstrates successful outcomes for appropriately selected patients.
Area of Science:
- Neurosurgery
- Otolaryngology
- Skull Base Surgery
Background:
- Endoscopic endonasal approaches (EEAs) to the ventral skull base utilize the sphenoid sinus for orientation.
- Surgical options for petrous apex lesions include medial, medial with internal carotid artery (ICA) lateralization, and transpterygoid infrapetrous approaches.
- Approach selection depends on lesion-ICA relationship, medial expansion, and pathology.
Purpose of the Study:
- To discuss anatomic and technical features of EEAs to the petrous apex.
- To introduce a new classification system for petrous apex approaches based on lesion-ICA relationship.
- To present outcomes data from the first 20 endoscopic petrous apex surgeries.
Main Methods:
- Retrospective clinical outcome study at a single institution.
- Review of medical records for patients undergoing EEAs for isolated petrous apex lesions.
- Exclusion of lesions not isolated to the petrous apex.
Main Results:
- Twenty patients analyzed: 13 inflammatory (9 cholesterol granulomas, 4 petrous apicitis) and 7 solid lesions (chondrosarcoma most common).
- Successful endoscopic drainage achieved in 12 of 13 cystic lesions, with symptom resolution.
- No perioperative carotid injuries or new cranial neuropathies; discussion of approach-specific advantages and limitations.
Conclusions:
- Endoscopic endonasal approach is safe and effective for select petrous apex lesions.
- Offers advantages over transtemporal/transcranial approaches by avoiding hearing and facial nerve risks.
- Provides a larger, more natural drainage pathway into the sinuses.
