Original ArticleCombined Endoscopic Transoral and Endonasal Approach to the Jugular Foramen: A Multiportal Expanded Access to the Clivus
Section snippets
Methods
Eight adult cadaveric specimens were prepared for dissection at the University of California San Francisco's Skull Base and Cerebrovascular Laboratory, following our protocol for surgical simulation.25 The endoscopic transoral and endonasal corridors were used simultaneously in each procedure.
After an oral retractor was placed, a 1.5-cm incision was made in the soft palate in the midline, beginning from the posterior edge of the hard palate (hard-to-soft palate intersection) (Figure 1A). A
Results
The extracranial, foraminal, and intradural parts of the JF were exposed in all specimens using straight endoscopic instruments. During dissection, the RCAM, carotid ridge, supracondylar groove, and alar ligament served as safety landmarks. The extent of bone resection is shown in Figure 5.
Discussion
The evidence provided in this study shows that a combined simultaneous endoscopic transoral and endonasal approach allows exposure and dissection of the intradural, foraminal, and extradural parts of the JF using straight endoscopic instrumentation while reducing resection of nasopharyngeal structures (e.g., Eustachian tube). The surgical dissections demonstrate that the anterior wall of the internal acoustic meatus in the petrous bone, the carotid sheath in the parapharyngeal space, and the
Conclusion
The simultaneous use of the endoscopic transoral and endonasal corridors, as reported in this work, allows access to the most lateral aspect of the lower clivus and is especially advantageous for exposing the ventral skull base and carotid sheath. The proposed technique compares favorably with its transcranial counterparts for lesions in the ventromedial compartment of the posterior fossa, because it does not require cerebellar retraction, transposition of CNs or the jugular tubercle, avoids a
Acknowledgments
We thank the body donors and their families, who through their altruism contributed to making this project possible.
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2019, World NeurosurgeryCitation Excerpt :The triangle that was first described by Cohen et al.1 is formed by the RCL anteriorly, superior oblique posteriorly, and a line connecting the 2 muscles along the occipital bone superiorly. The RCL and lateral atlantooccipital membrane that are attached to the transverse process of C1 are key surgical landmarks in the endoscopic endonasal approaches and posterior and anterolateral approaches to the JT.1,5,20,23-25 The RCL is a critical landmark in gaining orientation around the JF both from the posterior and lateral approaches.1,3,5,20,23,24,26