Endoscopic Transpterygoid Approach to Meckel's Cave: Technical Considerations and Retrospective Analysis of a Clinical Series

被引:0
作者
Ferlendis, Luca [1 ]
Bossi, Bianca [1 ]
Barillot, Cedric [1 ]
Leocata, Antonio [1 ]
Veiceschi, Pierlorenzo [1 ]
Pozzi, Fabio [1 ]
Castelnuovo, Paolo [2 ]
Locatelli, Davide [1 ]
机构
[1] Univ Insubria, Osped Circolo & Fdn Macchi, Dept Biotechnol & Life Sci, Div Neurosurg, Varese, Italy
[2] Univ Insubria, Osped Circolo & Fdn Macchi, Dept Biotechnol & Life Sci, Div Otorhinolaryngol, Varese, Italy
关键词
Diving; Endoscopic; Meckel's cave; Schwannoma; Transpterygoid; Trigeminal; ENDONASAL APPROACH;
D O I
10.1016/j.clineuro.2024.108382
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Objective: Tumors located within the Meckel's cave (MC) pose a significant surgical challenge. Although several corridors to access this complex region have been described, the endoscopic transpterygoid approach (ETPA) and the endoscopic transorbital superior eyelid approach (ETOA) have emerged in recent years, as viable alternatives to traditional microsurgical transcranial approaches (MTA). To date, there is a limited literature on surgical series considering endoscopic-assisted approaches to the MC. Methods: We conducted a retrospective analysis of patients with primary MC tumors treated at our Institution between 2015 and 2022, specifically those managed via the ETPA assisted by intraoperative Endoscopic Diving Technique (EDT). Lesion resection extent was evaluated using pre- and post-intervention radiological images and surgical videos. Moreover, a literature review on ETPA was performed. Results: This series comprises 7 patients affected by 4 trigeminal schwannomas, 1 benign notochordal cell tumor, 1 dermoid cyst and 1 mesenchymal tumor. In 71 % of cases, trigeminal neuralgia was the presenting symptom. Post-operative clinical improvement was observed in all but one case. Notably, 85.7 % of patients achieved total or near-total resection (NTR), with the remaining case undergoing subtotal resection (STR). No significant intraoperative complications occurred, and no recurrences were observed during the mean follow-up period of 41 months. Conclusions: In selected cases, the ETPA offers a direct and safe path to lesions located into the MC. This approach circumvents complications and constraints associated with ETOA or MTA. Moreover, the use of the EDT reduces manipulation of critical neurovascular structures, enhancing the efficacy of the ETPA.
引用
收藏
页数:8
相关论文
共 50 条
[31]   Endoscopic Management of a Rare Case of Nasal Glioma in Meckel's Cave in an Adult: Case Report [J].
Kasliwal, M. K. ;
Anand, V. K. ;
Lavi, E. ;
Schwartz, T. H. .
MINIMALLY INVASIVE NEUROSURGERY, 2010, 53 (04) :191-193
[32]   Endoscopic Multiportal Approaches to Meckel's Cave: A Cadaveric Study and a Three-Dimensional Anatomical Video [J].
Salem, Eman H. ;
Abd El-Fattah, Ahmed Musaad ;
Ebada, Hisham Atef ;
van Koevering, Kyle ;
Hardesty, Douglas A. ;
Prevedello, Daniel M. ;
Al-Saddeik, Mohamed Abd El-halem ;
Carrau, Ricardo L. .
JOURNAL OF NEUROLOGICAL SURGERY PART B-SKULL BASE, 2024, 85 (06) :641-649
[33]   Anatomy of Meckel's Cave and the Trigeminal Ganglion: Anatomical Landmarks for a Safer Approach to Them [J].
Arslan, Mehmet ;
Deda, Haluk ;
Avci, Emel ;
Elhan, Alaittin ;
Tekdemir, Ibrahim ;
Tubbs, R. Shane ;
Silav, Gokalp ;
Yilmaz, Erdal ;
Baskaya, Mustafa Kemal .
TURKISH NEUROSURGERY, 2012, 22 (03) :317-323
[34]   Surgical Anatomy of the Retrosigmoid Approach with Endoscopic-Assisted Reverse Anterior Petrosectomy: Optimizing Meckel's Cave Access from the Posterior Fossa [J].
De Bonis, Alessandro ;
Torregrossa, Fabio ;
Dang, Danielle D. ;
Leonel, Luciano Cesar P. C. ;
Mortini, Pietro ;
Link, Michael ;
Colin, Driscoll ;
Peris-Celda, Maria .
JOURNAL OF NEUROLOGICAL SURGERY PART B-SKULL BASE, 2024,
[35]   Fully Endoscopic Transnasal Approach to the Jugular Foramen: Anatomic Study and Clinical Considerations [J].
Dallan, Iacopo ;
Bignami, Maurizio ;
Battaglia, Paolo ;
Castelnuovo, Paolo ;
Tschabitscher, Manfred .
NEUROSURGERY, 2010, 67 (03) :1-7
[36]   Minimally Invasive Approaches to the Lateral Cavernous Sinus and Meckel's Cave: Comparison of Transorbital and Subtemporal Endoscopic Techniques [J].
Lima, Lucas Ramos ;
Beer-Furlan, Andre ;
Prevedello, Daniel M. ;
Carrau, Ricardo L. ;
Servian-Duarte, Diego Armando ;
Galarce, Matias Gomez ;
Montaser, Alaa S. ;
de Vasconcelos, Victor Leal ;
Giannetti, Alexandre Varella .
WORLD NEUROSURGERY, 2020, 141 :E86-E96
[37]   Microsurgical Anatomy of the Endoscopy-Assisted Retrosigmoid Intradural Suprameatal Approach to the Meckel's Cave [J].
Tatagiba, Marcos S. .
OPERATIVE NEUROSURGERY, 2021, 21 (02) :47-47
[38]   Subtemporal keyhole approach to Meckel's cave epidermoid cyst: Case report and review of literature [J].
Lan, Qing ;
Tanudjaja, Jeffrey ;
Chen, Ai Lin .
INDIAN JOURNAL OF NEUROSURGERY, 2014, 3 (01) :50-53
[39]   Retrosigmoid intradural suprameatal approach to Meckel's cave and the middle fossa: surgical technique and outcome [J].
Samii, M ;
Tatagiba, R ;
Carvalho, GA .
JOURNAL OF NEUROSURGERY, 2000, 92 (02) :235-241
[40]   Strategy and Technique of Endonasal Endoscopic Bony Decompression and Selective Tumor Removal in Symptomatic Skull Base Meningiomas of the Cavernous Sinus and Meckel's Cave [J].
Sivakumar, Walavan ;
Barkhoudarian, Garni ;
Lobo, Bjorn M. ;
Zhang, Xin ;
Zhao, Fan ;
Eisenberg, Amy ;
Kesari, Santosh ;
Krauss, Howard ;
Cohan, Pejman ;
Griffiths, Chester ;
Wollman, Robert ;
Chaiken, Lisa ;
Kelly, Daniel F. .
WORLD NEUROSURGERY, 2019, 131 :E12-E22