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Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas
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Contralateral Transmaxillary Approach to Petrous Apex Granuloma with Lateral Maxillotomy: 2-Dimensional Operative

Edoardo Porto1, Jackson Vuncannon2, J Manuel Revuelta Barbero1

  • 1Department of Neurosurgery, Emory University, Atlanta, Georgia, USA.

World Neurosurgery
|October 22, 2022
PubMed
Summary

The contralateral transmaxillary approach offers a safe and effective extension of the endoscopic endonasal approach for accessing lateral petrous apex lesions. This technique minimizes risks associated with internal carotid artery manipulation, enabling successful cholesterol granuloma resection.

Keywords:
Contralateral transmaxillary approachEndoscopic endonasal approachParaclival ICAPetrous apexPetrous apex granuloma

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Area of Science:

  • Neurosurgery
  • Otolaryngology
  • Endoscopic Skull Base Surgery

Background:

  • The endoscopic endonasal approach (EEA) is effective for medial petrous apex (PA) lesions.
  • Laterally seated PA lesions pose surgical challenges due to proximity to the internal carotid artery (ICA).
  • The contralateral transmaxillary approach extends EEA for better lateral PA access and reduced ICA manipulation risks.

Observation:

  • A 47-year-old female presented with tinnitus, hearing loss, and facial twitching.
  • MRI revealed an expansive, high-signal intensity lesion in the PA.
  • A high-riding jugular bulb precluded other approaches; a contralateral transmaxillary approach was chosen.

Findings:

  • The maxillotomy was created in the lateral maxillary sinus wall for coaxial access to the laterally positioned PA lesion.
  • The patient experienced no new postoperative neurological deficits.
  • Pathology confirmed cholesterol granuloma.

Implications:

  • The contralateral transmaxillary approach is a valuable extension of EEA for complex PA lesions.
  • Preoperative identification of critical structures (ICA, cochlea, jugular bulb) is crucial for surgical planning.
  • This approach can reduce risks in managing petrous apex cholesterol granulomas.