Endoscopic Transnasal Approaches to Petrous Apex

Abstract

Endoscopic extended transnasal approaches to the apex of the temporal bone pyramid are rapidly developing and are widely used in our time around the world. Despite this, the problem of choosing an approach remains relevant and open not only between the "open" and "endoscopic transnasal" access groups but also within the latter. In the article, we systematized all endoscopic approaches to the pyramid of the temporal bone and divided them into three large groups: medial, inferior, and superior-in accordance with the anatomical relationship with the internal carotid artery-and also presented their various, modern (later described), modifications that allow you to work more targeted, depending on the nature of the neoplasm and the goals of surgical intervention, which in turn allows you to complete the operation with minimal losses, and improve the quality of life of the patient in the early and late postoperative period. We described the indications and limitations for these accesses and the problems that arise in the way of their implementation, which in turn can theoretically allow us to obtain an algorithm for choosing access, as well as identify growth points.

Keywords: approach; endoscope; petrous apex; temporal bone; transnasal.

Figure 1

1—internal carotid artery, 2—hypophysis, 3—clivus, 4—oculomotor nerve, 5—abducens nerve, 6—ophthalmic nerve, 7—maxillary nerve.

Figure 2

Relationship between the structures of the cavernous sinus and the Gasser node: 1—internal carotid artery, 2—oculomotor nerve, 3—trochlear nerve, 4—abducens nerve, 5—ophthalmic nerve, 6—maxillary nerve, 7—Gasser node.

Figure 3

Area highlighted in green is the group of medial approaches, that in red is the area of the lacerated foramen, that in yellow is the access to the Meckel cavity, and that in blue is the group of infrapetrosal approaches; 1—internal carotid artery, 2—Vidian nerve, 3—pharyngeal mouth of the auditory tube, 4—posterior sections of the vomer, 5—base of the pterygoid process.