Your browser doesn't support javascript.
loading
Endoscope-assisted contralateral transmaxillary approach to the clivus and the hypoglossal canal: technical case report.
Pamias-Portalatin, Eva; Mahato, Deependra; Rincon-Torroella, Jordina; Vivas-Buitrago, Tito; Quiñones-Hinojosa, Alfredo; Boahene, Kofi O.
Affiliation
  • Pamias-Portalatin E; 1Department of Neurosurgery, University of Puerto Rico Medical Science Campus, San Juan, Puerto Rico.
  • Mahato D; 3Department of Neurosurgery, Mayo Clinic School of Medicine, Jacksonville, Florida; and.
  • Rincon-Torroella J; 3Department of Neurosurgery, Mayo Clinic School of Medicine, Jacksonville, Florida; and.
  • Vivas-Buitrago T; 2Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
  • Quiñones-Hinojosa A; 3Department of Neurosurgery, Mayo Clinic School of Medicine, Jacksonville, Florida; and.
  • Boahene KO; 4Universidad de Santander UDES, School of Medicine, Bucaramanga, Colombia.
J Neurosurg ; : 1-7, 2018 Jun 01.
Article in En | MEDLINE | ID: mdl-29932381
Clival lesions are still considered surgically complex due to their anatomical location. Critical structures, such as the internal carotid arteries (ICAs), cavernous sinuses, cranial nerves, and brainstem, may be encased within the lesion. Although advances in endoscopic endonasal approaches have provided new routes to these lesions, exposure and resection of clival tumors through the endonasal route remain a technical challenge. Here, the authors report a left-sided endoscopic transmaxillary approach to access the right aspect of the clivus and the hypoglossal canal.A 35-year-old woman presented with progressive right 6th cranial nerve palsy. MRI revealed a contrast-enhancing right petroclival chondrosarcoma that involved Meckel's cave and extended into the right hypoglossal canal. An endoscopic-contralateral-transmaxillary approach through a left sublabial incision was used to access the right petroclival region and right hypoglossal canal. A left maxillary osteoplastic flap was elevated to expose the left maxillary sinus. This was followed by a left medial maxillectomy, gaining access to the left posterior nasal cavity. The posterior third of the left inferior turbinate and nasal septum were removed to access the right side of the petroclival region. Near-total resection was achieved without any vascular or neurological complications. A thin shell of residual tumor was left behind due to involvement of vital structures, such as the ICA, and further treated with proton-beam radiotherapy.The endoscopic-contralateral-transmaxillary approach provides a direct surgical corridor and good lateral visualization of the skull base vasculature. This approach allows wide maneuverability around the ICA and hypoglossal canal, which, in this case, allowed maximal tumor resection with full preservation of neurological function.
Key words

Full text: 1 Collection: 01-internacional Database: MEDLINE Language: En Journal: J Neurosurg Year: 2018 Document type: Article Affiliation country: Puerto Rico Country of publication: United States

Full text: 1 Collection: 01-internacional Database: MEDLINE Language: En Journal: J Neurosurg Year: 2018 Document type: Article Affiliation country: Puerto Rico Country of publication: United States