Combined Endoscopic Endonasal and Contralateral Transmaxillary Approach for Resection of an Anterior Petrous...

The contralateral transmaxillary corridor improves access to anterior petrous apex lesions back to the level of the internal auditory canal without the need to mobilize the paraclival internal carotid artery. In this Video 1, we present the case of 31-year-old female patient who presented with new left abducens palsy during pregnancy. Imaging revealed a heterogeneous enhancing extradural mass within the left petrous apex region extending posterior to the horizontal segment of the petrous internal carotid artery, consistent with chondrosarcoma. Chondrosarcomas are the second most common osseous malignancy but only consist of 0.2% of all intracranial tumors.^1,2 They are thought to derive from persistent cartilaginous rests retained after endochondral ossification.³ Given that surgery is a mainstay of treatment,^4-6 a combined endoscopic endonasal and contralateral transmaxillary approach was selected to achieve maximal resection. The patient consented to the procedure. A complete resection of the mass was performed with pathology demonstrating a grade 2 chondrosarcoma. The patient tolerated the procedure without any complications, the left abducens palsy resolved in follow-up by 3 weeks, and a multidisciplinary tumor board recommended postoperative observation without adjuvant therapy.⁷ An endoscopic endonasal and contralateral transmaxillary approach is a feasible option for petrous apex lesions such as chondrosarcoma.