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Updated: May 31, 2026
09:53
Role of Diffusion MRI Tractography in Endoscopic Endonasal Skull Base Surgery
Published on: July 5, 2021
Anatomical landmarks for transnasal endoscopic skull base surgery
Kishore Sandu1, Philippe Monnier, Philippe Pasche
1Department of Otorhinolaryngology, University Hospital CHUV, Lausanne, Switzerland. Kishore.Sandu@chuv.ch
Summary
Transnasal endoscopic approach (TEA) offers a minimally invasive route for skull base lesions, avoiding extensive neurovascular manipulation. Cadaveric dissection enhanced understanding of key anatomical landmarks for safe and effective surgical application.
Area of Science:
- Neurosurgery
- Otorhinolaryngology
- Anatomy
Background:
- Skull base lesion resection often requires extensive neurovascular manipulation.
- Transnasal endoscopic approach (TEA) is a minimally invasive alternative for select anterior skull base lesions.
Purpose of the Study:
- To elucidate the endoscopic anatomy of the orbital apex, petrous apex, and pterygopalatine fossa.
- To map critical surgical landmarks for transnasal endoscopic dissections.
Main Methods:
- Systematic dissection of six cadaveric heads (12 sides) using the transnasal endoscopic approach.
- Utilized a "2 nostril, 4 hands" technique for enhanced bimanual instrumentation.
- Detailed identification of neurovascular landmarks within the targeted skull base regions.
Main Results:
- Key landmarks for the orbital apex include the carotid artery protuberance, optic nerve canal, and V2 nerve.
- The Vidian nerve canal and V2 nerve are crucial for petrous apex identification.
- Sphenopalatine artery, V2, and foramen rotundum are vital for pterygopalatine fossa dissection.
Conclusions:
- TEA provides a direct anatomical corridor to skull base lesions, minimizing neurovascular manipulation and brain retraction compared to open approaches.
- Effective TEA requires a deep understanding of endoscopic anatomy and close collaboration between neurosurgeons and otorhinolaryngologists.
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