Giuliano Silveira-Bertazzo1, Sunil Manjila2, Nyall R London3,4,5, Daniel M Prevedello6. 1. Department of Neurological Surgery, The Ohio State University, Wexner Medical Center, N-1049 Doan Hall, 410 West 10th Avenue, Columbus, OH, 43210, USA. giubertazzo@hotmail.com. 2. Department of Neurological Surgery, McLaren Hospital, Bay Region, Bay City, MI, USA. 3. Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, Wexner Medical Center, Columbus, OH, USA. 4. Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA. 5. National Institute on Deafness and Other Communication Disorders, NIH, Bethesda, MD, USA. 6. Department of Neurological Surgery, The Ohio State University, Wexner Medical Center, N-1049 Doan Hall, 410 West 10th Avenue, Columbus, OH, 43210, USA. dprevedello@gmail.com.
Abstract
BACKGROUND: Expanding the ventrolateral skull base corridor from the midline of lower clivus to the petroclival fissure is a challenging endonasal surgical task. Resection of lytic lesions like chondrosarcoma can cause cranial nerve morbidities and injury of ICA, necessitating accurate knowledge of correlative endoscopic anatomy with stereotactic landmarks. METHODS: We describe an extended endoscopic endonasal approach (EEA) for a right petroclival chondrosarcoma with the demonstration of ipsilateral surgical landmarks with contralateral normal correlates, using a stepwise comparative image-guided cadaveric dissection study. CONCLUSION: EEA for lytic lesions like chondrosarcomas needs to address brain shift and displacement of ICA, posing a chance for cranial nerve morbidities and ICA injury. Meticulous utilization of intraoperative stereotactic landmarks can help avoid and mitigate surgical complications.
BACKGROUND: Expanding the ventrolateral skull base corridor from the midline of lower clivus to the petroclival fissure is a challenging endonasal surgical task. Resection of lytic lesions like chondrosarcoma can cause cranial nerve morbidities and injury of ICA, necessitating accurate knowledge of correlative endoscopic anatomy with stereotactic landmarks. METHODS: We describe an extended endoscopic endonasal approach (EEA) for a right petroclival chondrosarcoma with the demonstration of ipsilateral surgical landmarks with contralateral normal correlates, using a stepwise comparative image-guided cadaveric dissection study. CONCLUSION:EEA for lytic lesions like chondrosarcomas needs to address brain shift and displacement of ICA, posing a chance for cranial nerve morbidities and ICA injury. Meticulous utilization of intraoperative stereotactic landmarks can help avoid and mitigate surgical complications.