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Carl H Snyderman - One of the best experts on this subject based on the ideXlab platform.
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Lateral transorbital versus endonasal transpterygoid approach to the Lateral Recess of the sphenoid sinus a comparative anatomic study
Operative Neurosurgery, 2019Co-Authors: Joao T Alvesbelo, Eric W Wang, Paul A Gardner, Tonya S Stefko, Juan C Fernandezmiranda, Carl H Snyderman, Joao Mangussigomes, Huy Q Truong, Salomon CohenAbstract:BACKGROUND The treatment of cerebrospinal fluid leaks of the Lateral Recess of the sphenoid sinus (LRSS) faces difficulties due to the deep location of the osseous defect. When treated with craniotomies, brain retraction is a concern. The endoscopic endonasal transpterygoid approach (EETA) is a direct and less invasive procedure; however, it may require transection of the vidian nerve (VN). OBJECTIVE To investigate the feasibility of a Lateral transorbital approach (LTOA) as an alternative pathway to the LRSS that avoids VN sacrifice. METHODS Six embalmed heads with well-pneumatized LRSS were preselected by inspecting their computed tomography scans. One LTOA and one EETA were performed on 1 side of each specimen. The approaches were compared regarding working distance and neurovascular structures being sacrificed. The working area of the LTOA was also measured. RESULTS The average working distances were 59.9 (±2.94) mm for the LTOA and 76.4 (±3.99) mm for the EETA (P < .001). The LTOA generated a working area with a diameter of 9 to 14 mm. The EETA demanded the sacrifice of VN and the sphenopalatine artery in all specimens to expose the LRSS. No neurovascular structures were found in the trajectory of the LTOA. CONCLUSION The LTOA to the LRSS is feasible, with minimal risk of injuring neurovascular structures. It offers a shorter pathway when compared to the EETA. Although the LTOA provides no options for vascularized flap reconstruction, it allows immediate access to muscle grafts. The LTOA may serve as an alternative to treating cerebrospinal fluid leaks of the LRSS.
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classification of sphenoid sinus pneumatization relevance for endoscopic skull base surgery
Laryngoscope, 2015Co-Authors: Alec Vaezi, Paul A Gardner, Carl H Snyderman, Eugenio Cardenas, Carlos D Pinheironeto, Alessandro Paluzzi, Barton F Branstetter, Juan C FernandezmirandaAbstract:Objectives/Hypothesis The goal of this study was to present a classification based on the degree of pneumatization of the sphenoid sinus in the coronal plane that can be used to instruct preoperative planning for endoscopic endonasal surgery (EES). Study Design Observational anatomical study. Methods The geometry of sphenoid sinus pneumatization was characterized (n = 204 hemisinus) on high-resolution computed tomography scans, and its associations with the location of the foramen rotundum (FR) and the vidian canal (VC) were measured. Based on these findings, we propose a simple classification of pneumatization of the sphenoid sinus relevant for EES. Results The Lateral Recess of the sphenoid sinus was pneumatized Lateral to the FR in the coronal plane in 54% of patients. The distance separating the FR and the VC correlated strongly with the depth of the Lateral Recess. Based on these findings, we propose three types of pneumatization: type I, where the pneumatization extends from the midline to the medial edge of the VC (25%); type II, where the pneumatization reaches the medial edge of the FR (39%); and type III, where the pneumatization extends beyond the medial border of the FR (37%). Conclusions The proposed sphenoid sinus pneumatization classification in the coronal plane is simple and reproducible. It predicts the distance between vidian and maxillary nerve, determines the size of the surgical window to access the middle cranial fossa transnasally, and instructs on the potential risk to neurovascular structures during surgery. Level of Evidence 4 Laryngoscope, 125:577–581, 2015
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classification of sphenoid sinus pneumatization relevance for endoscopic skull base surgery
Laryngoscope, 2015Co-Authors: Alec Vaezi, Paul A Gardner, Carl H Snyderman, Eugenio Cardenas, Carlos D Pinheironeto, Alessandro Paluzzi, Barton F Branstetter, Juan C FernandezmirandaAbstract:Objectives/Hypothesis The goal of this study was to present a classification based on the degree of pneumatization of the sphenoid sinus in the coronal plane that can be used to instruct preoperative planning for endoscopic endonasal surgery (EES). Study Design Observational anatomical study. Methods The geometry of sphenoid sinus pneumatization was characterized (n = 204 hemisinus) on high-resolution computed tomography scans, and its associations with the location of the foramen rotundum (FR) and the vidian canal (VC) were measured. Based on these findings, we propose a simple classification of pneumatization of the sphenoid sinus relevant for EES. Results The Lateral Recess of the sphenoid sinus was pneumatized Lateral to the FR in the coronal plane in 54% of patients. The distance separating the FR and the VC correlated strongly with the depth of the Lateral Recess. Based on these findings, we propose three types of pneumatization: type I, where the pneumatization extends from the midline to the medial edge of the VC (25%); type II, where the pneumatization reaches the medial edge of the FR (39%); and type III, where the pneumatization extends beyond the medial border of the FR (37%). Conclusions The proposed sphenoid sinus pneumatization classification in the coronal plane is simple and reproducible. It predicts the distance between vidian and maxillary nerve, determines the size of the surgical window to access the middle cranial fossa transnasally, and instructs on the potential risk to neurovascular structures during surgery. Level of Evidence 4 Laryngoscope, 125:577–581, 2015
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endoscopic transnasal transpterygopalatine fossa approach to the Lateral Recess of the sphenoid sinus
Laryngoscope, 2004Co-Authors: Ismail S Alnashar, Ricardo L. Carrau, Alfredo Herrera, Carl H SnydermanAbstract:Objectives Lesions affecting the Lateral Recess of the sphenoid sinus are rarely discussed in the literature as a separate entity. This region is difficult to visualize and manipulate through the transnasal routes, especially when extensive pneumatization is present. External approaches to this area involve extensive surgery and are associated with significant morbidity. The objectives of this study are to present our experience with the endoscopic transpterygopalatine fossa approach as a method for exposing and manipulating lesions of the Lateral Recess of the sphenoid and to illustrate the detailed surgical steps of the procedure. Study Design Retrospective review. Methods Clinical charts of patients who had lesions originating from or extending into the Lateral Recess of the sphenoid sinus and who were treated at our institutions from September 1995 to June 2002 were retrospectively reviewed. All these patients were managed by the endoscopic transpterygopalatine fossa approach. Results Twelve patients (7 males and 5 females) were included in the study. Lesions included seven cerebrospinal fluid (CSF) leaks and five tumors. One patient with squamous cell carcinoma (SCC) of the sphenoid died of his disease. All CSF leaks were successfully repaired, and benign tumors were removed with good local control through the follow-up period. Conclusion The endoscopic transpterygopalatine fossa approach is an excellent approach for dealing with lesions of the sphenoid Lateral Recess.
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endoscopic transnasal transpterygopalatine fossa approach to the Lateral Recess of the sphenoid sinus
Laryngoscope, 2004Co-Authors: Ismail S Alnashar, Ricardo L. Carrau, Alfredo Herrera, Carl H SnydermanAbstract:Objectives Lesions affecting the Lateral Recess of the sphenoid sinus are rarely discussed in the literature as a separate entity. This region is difficult to visualize and manipulate through the transnasal routes, especially when extensive pneumatization is present. External approaches to this area involve extensive surgery and are associated with significant morbidity. The objectives of this study are to present our experience with the endoscopic transpterygopalatine fossa approach as a method for exposing and manipulating lesions of the Lateral Recess of the sphenoid and to illustrate the detailed surgical steps of the procedure. Study Design Retrospective review. Methods Clinical charts of patients who had lesions originating from or extending into the Lateral Recess of the sphenoid sinus and who were treated at our institutions from September 1995 to June 2002 were retrospectively reviewed. All these patients were managed by the endoscopic transpterygopalatine fossa approach. Results Twelve patients (7 males and 5 females) were included in the study. Lesions included seven cerebrospinal fluid (CSF) leaks and five tumors. One patient with squamous cell carcinoma (SCC) of the sphenoid died of his disease. All CSF leaks were successfully repaired, and benign tumors were removed with good local control through the follow-up period. Conclusion The endoscopic transpterygopalatine fossa approach is an excellent approach for dealing with lesions of the sphenoid Lateral Recess.
Ricardo L. Carrau - One of the best experts on this subject based on the ideXlab platform.
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endoscopic prelacrimal approach to Lateral Recess of sphenoid sinus feasibility study
International Forum of Allergy & Rhinology, 2020Co-Authors: Daniel M Prevedello, Nyall R London, Lifeng Li, Ricardo L. CarrauAbstract:BACKGROUND: Various pathologies, including cerebrospinal fluid leaks and meningoencephaloceles, may arise in the Lateral Recess of the sphenoid sinus (LRSS), which may be accessed via an endonasal transpterygoid approach. The objective of this study was to evaluate the feasibility of accessing the LRSS via an endoscopic prelacrimal approach. Furthermore, we hypothesized that this approach may protect the pterygopalatine ganglion and vidian nerve. METHODS: Five cadaveric heads (9 sides) with a well-pneumatized LRSS were identified and an endonasal prelacrimal approach was performed. The infraorbital nerve, at the orbital floor, served as a critical landmark. After identification of the foramen rotundum at the pterygoid base, the vascular compartment of the pterygopalatine fossa and the pterygopalatine ganglion were displaced inferomedially and superomedially, respectively. Drilling of the bone inferomedial to the foramen rotundum allowed entry into the LRSS. RESULTS: The average distances from the prelacrimal window to the pterygoid base and the posterior wall of the LRSS were 6.22 ± 0.39 cm and 7.16 ± 0.50 cm, respectively. The average areas of the bony prelacrimal window and pterygoid base window were 4.33 ± 0.32 cm2 and 0.73 ± 0.10 cm2 , respectively. The LRSS could be accessed using a 0-degree endoscope, and pterygopalatine neurovascular structures, including the pterygopalatine ganglion and vidian nerve, could be preserved on all 9 sides. CONCLUSION: Our findings suggest that an endonasal prelacrimal approach provides a reasonable alternative to access the LRSS while preserving the vidian nerve and pterygopalatine ganglion.
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Endoscopic prelacrimal approach to Lateral Recess of sphenoid sinus: feasibility study.
International forum of allergy & rhinology, 2019Co-Authors: Nyall R London, Daniel M Prevedello, Ricardo L. CarrauAbstract:BACKGROUND Various pathologies, including cerebrospinal fluid leaks and meningoencephaloceles, may arise in the Lateral Recess of the sphenoid sinus (LRSS), which may be accessed via an endonasal transpterygoid approach. The objective of this study was to evaluate the feasibility of accessing the LRSS via an endoscopic prelacrimal approach. Furthermore, we hypothesized that this approach may protect the pterygopalatine ganglion and vidian nerve. METHODS Five cadaveric heads (9 sides) with a well-pneumatized LRSS were identified and an endonasal prelacrimal approach was performed. The infraorbital nerve, at the orbital floor, served as a critical landmark. After identification of the foramen rotundum at the pterygoid base, the vascular compartment of the pterygopalatine fossa and the pterygopalatine ganglion were displaced inferomedially and superomedially, respectively. Drilling of the bone inferomedial to the foramen rotundum allowed entry into the LRSS. RESULTS The average distances from the prelacrimal window to the pterygoid base and the posterior wall of the LRSS were 6.22 ± 0.39 cm and 7.16 ± 0.50 cm, respectively. The average areas of the bony prelacrimal window and pterygoid base window were 4.33 ± 0.32 cm2 and 0.73 ± 0.10 cm2 , respectively. The LRSS could be accessed using a 0-degree endoscope, and pterygopalatine neurovascular structures, including the pterygopalatine ganglion and vidian nerve, could be preserved on all 9 sides. CONCLUSION Our findings suggest that an endonasal prelacrimal approach provides a reasonable alternative to access the LRSS while preserving the vidian nerve and pterygopalatine ganglion.
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endoscopic transnasal transpterygopalatine fossa approach to the Lateral Recess of the sphenoid sinus
Laryngoscope, 2004Co-Authors: Ismail S Alnashar, Ricardo L. Carrau, Alfredo Herrera, Carl H SnydermanAbstract:Objectives Lesions affecting the Lateral Recess of the sphenoid sinus are rarely discussed in the literature as a separate entity. This region is difficult to visualize and manipulate through the transnasal routes, especially when extensive pneumatization is present. External approaches to this area involve extensive surgery and are associated with significant morbidity. The objectives of this study are to present our experience with the endoscopic transpterygopalatine fossa approach as a method for exposing and manipulating lesions of the Lateral Recess of the sphenoid and to illustrate the detailed surgical steps of the procedure. Study Design Retrospective review. Methods Clinical charts of patients who had lesions originating from or extending into the Lateral Recess of the sphenoid sinus and who were treated at our institutions from September 1995 to June 2002 were retrospectively reviewed. All these patients were managed by the endoscopic transpterygopalatine fossa approach. Results Twelve patients (7 males and 5 females) were included in the study. Lesions included seven cerebrospinal fluid (CSF) leaks and five tumors. One patient with squamous cell carcinoma (SCC) of the sphenoid died of his disease. All CSF leaks were successfully repaired, and benign tumors were removed with good local control through the follow-up period. Conclusion The endoscopic transpterygopalatine fossa approach is an excellent approach for dealing with lesions of the sphenoid Lateral Recess.
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endoscopic transnasal transpterygopalatine fossa approach to the Lateral Recess of the sphenoid sinus
Laryngoscope, 2004Co-Authors: Ismail S Alnashar, Ricardo L. Carrau, Alfredo Herrera, Carl H SnydermanAbstract:Objectives Lesions affecting the Lateral Recess of the sphenoid sinus are rarely discussed in the literature as a separate entity. This region is difficult to visualize and manipulate through the transnasal routes, especially when extensive pneumatization is present. External approaches to this area involve extensive surgery and are associated with significant morbidity. The objectives of this study are to present our experience with the endoscopic transpterygopalatine fossa approach as a method for exposing and manipulating lesions of the Lateral Recess of the sphenoid and to illustrate the detailed surgical steps of the procedure. Study Design Retrospective review. Methods Clinical charts of patients who had lesions originating from or extending into the Lateral Recess of the sphenoid sinus and who were treated at our institutions from September 1995 to June 2002 were retrospectively reviewed. All these patients were managed by the endoscopic transpterygopalatine fossa approach. Results Twelve patients (7 males and 5 females) were included in the study. Lesions included seven cerebrospinal fluid (CSF) leaks and five tumors. One patient with squamous cell carcinoma (SCC) of the sphenoid died of his disease. All CSF leaks were successfully repaired, and benign tumors were removed with good local control through the follow-up period. Conclusion The endoscopic transpterygopalatine fossa approach is an excellent approach for dealing with lesions of the sphenoid Lateral Recess.
Ismail S Alnashar - One of the best experts on this subject based on the ideXlab platform.
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endoscopic transnasal transpterygopalatine fossa approach to the Lateral Recess of the sphenoid sinus
Laryngoscope, 2004Co-Authors: Ismail S Alnashar, Ricardo L. Carrau, Alfredo Herrera, Carl H SnydermanAbstract:Objectives Lesions affecting the Lateral Recess of the sphenoid sinus are rarely discussed in the literature as a separate entity. This region is difficult to visualize and manipulate through the transnasal routes, especially when extensive pneumatization is present. External approaches to this area involve extensive surgery and are associated with significant morbidity. The objectives of this study are to present our experience with the endoscopic transpterygopalatine fossa approach as a method for exposing and manipulating lesions of the Lateral Recess of the sphenoid and to illustrate the detailed surgical steps of the procedure. Study Design Retrospective review. Methods Clinical charts of patients who had lesions originating from or extending into the Lateral Recess of the sphenoid sinus and who were treated at our institutions from September 1995 to June 2002 were retrospectively reviewed. All these patients were managed by the endoscopic transpterygopalatine fossa approach. Results Twelve patients (7 males and 5 females) were included in the study. Lesions included seven cerebrospinal fluid (CSF) leaks and five tumors. One patient with squamous cell carcinoma (SCC) of the sphenoid died of his disease. All CSF leaks were successfully repaired, and benign tumors were removed with good local control through the follow-up period. Conclusion The endoscopic transpterygopalatine fossa approach is an excellent approach for dealing with lesions of the sphenoid Lateral Recess.
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endoscopic transnasal transpterygopalatine fossa approach to the Lateral Recess of the sphenoid sinus
Laryngoscope, 2004Co-Authors: Ismail S Alnashar, Ricardo L. Carrau, Alfredo Herrera, Carl H SnydermanAbstract:Objectives Lesions affecting the Lateral Recess of the sphenoid sinus are rarely discussed in the literature as a separate entity. This region is difficult to visualize and manipulate through the transnasal routes, especially when extensive pneumatization is present. External approaches to this area involve extensive surgery and are associated with significant morbidity. The objectives of this study are to present our experience with the endoscopic transpterygopalatine fossa approach as a method for exposing and manipulating lesions of the Lateral Recess of the sphenoid and to illustrate the detailed surgical steps of the procedure. Study Design Retrospective review. Methods Clinical charts of patients who had lesions originating from or extending into the Lateral Recess of the sphenoid sinus and who were treated at our institutions from September 1995 to June 2002 were retrospectively reviewed. All these patients were managed by the endoscopic transpterygopalatine fossa approach. Results Twelve patients (7 males and 5 females) were included in the study. Lesions included seven cerebrospinal fluid (CSF) leaks and five tumors. One patient with squamous cell carcinoma (SCC) of the sphenoid died of his disease. All CSF leaks were successfully repaired, and benign tumors were removed with good local control through the follow-up period. Conclusion The endoscopic transpterygopalatine fossa approach is an excellent approach for dealing with lesions of the sphenoid Lateral Recess.
Heinz Stammberger - One of the best experts on this subject based on the ideXlab platform.
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spontaneous csf leaks and meningoencephaloceles in sphenoid sinus by persisting sternberg s canal
Rhinology, 2009Co-Authors: Peter Valentin Tomazic, Heinz StammbergerAbstract:Objectives Cerebrospinal fluid (CSF) leaks and meningoencephaloceles of the Lateral Recess of sphenoid sinuses are rare findings. A congenital bony defect in the Lateral wall of sphenoid sinus called Sternberg's canal could be the origin of these lesions. Their endoscopic transnasal management is challenging though less traumatic than transcranial approaches. The aim of this study was to define Sternberg's canal as a potential source for these rare lesions and to describe their endoscopic endonasal management. Methods In a retrospective analysis clinical charts of 27 patients with CSF-leaks and / or meningoencephaloceles operated between March 2002 and October 2008 at the University ENT-hospital Graz have been reviewed. All patients were treated by an endoscopic endonasal approach. Results Five patients (4 female / 1 male) were identified with spontaneous CSF-leaks from sphenoid sinus and meningoencephaloceles. In all five cases, Sternberg's canal was the site of leakage, with the bony and dural defects always located Laterally between the maxillary and Vidian nerves. Mean age was 51.2 years and mean body mass index (BMI) was 31.9 kg/m2. All patients were operated using a multilayer closure technique. Two patients had recurrences after 12 days and 7 months, respectively, managed by endoscopic revision surgery resulting in a 100% closure rate after one revision (mean follow-up: 6.5 months). Conclusion Persisting Sternberg's canal can be the source of spontaneous CSF-leaks and meningoencephaloceles in the Lateral Recess of sphenoid sinus especially when associated with extensive pneumatisation. Endoscopic management is technically challenging, nevertheless its advantages are a good view of the surgical field while being less traumatic than transcranial approaches.
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spontaneous csf leaks and meningoencephaloceles in sphenoid sinus by persisting sternberg s canal
Rhinology, 2009Co-Authors: Peter Valentin Tomazic, Heinz StammbergerAbstract:Objectives Cerebrospinal fluid (CSF) leaks and meningoencephaloceles of the Lateral Recess of sphenoid sinuses are rare findings. A congenital bony defect in the Lateral wall of sphenoid sinus called Sternberg's canal could be the origin of these lesions. Their endoscopic transnasal management is challenging though less traumatic than transcranial approaches. The aim of this study was to define Sternberg's canal as a potential source for these rare lesions and to describe their endoscopic endonasal management. Methods In a retrospective analysis clinical charts of 27 patients with CSF-leaks and / or meningoencephaloceles operated between March 2002 and October 2008 at the University ENT-hospital Graz have been reviewed. All patients were treated by an endoscopic endonasal approach. Results Five patients (4 female / 1 male) were identified with spontaneous CSF-leaks from sphenoid sinus and meningoencephaloceles. In all five cases, Sternberg's canal was the site of leakage, with the bony and dural defects always located Laterally between the maxillary and Vidian nerves. Mean age was 51.2 years and mean body mass index (BMI) was 31.9 kg/m2. All patients were operated using a multilayer closure technique. Two patients had recurrences after 12 days and 7 months, respectively, managed by endoscopic revision surgery resulting in a 100% closure rate after one revision (mean follow-up: 6.5 months). Conclusion Persisting Sternberg's canal can be the source of spontaneous CSF-leaks and meningoencephaloceles in the Lateral Recess of sphenoid sinus especially when associated with extensive pneumatisation. Endoscopic management is technically challenging, nevertheless its advantages are a good view of the surgical field while being less traumatic than transcranial approaches.
Alfredo Herrera - One of the best experts on this subject based on the ideXlab platform.
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endoscopic transnasal transpterygopalatine fossa approach to the Lateral Recess of the sphenoid sinus
Laryngoscope, 2004Co-Authors: Ismail S Alnashar, Ricardo L. Carrau, Alfredo Herrera, Carl H SnydermanAbstract:Objectives Lesions affecting the Lateral Recess of the sphenoid sinus are rarely discussed in the literature as a separate entity. This region is difficult to visualize and manipulate through the transnasal routes, especially when extensive pneumatization is present. External approaches to this area involve extensive surgery and are associated with significant morbidity. The objectives of this study are to present our experience with the endoscopic transpterygopalatine fossa approach as a method for exposing and manipulating lesions of the Lateral Recess of the sphenoid and to illustrate the detailed surgical steps of the procedure. Study Design Retrospective review. Methods Clinical charts of patients who had lesions originating from or extending into the Lateral Recess of the sphenoid sinus and who were treated at our institutions from September 1995 to June 2002 were retrospectively reviewed. All these patients were managed by the endoscopic transpterygopalatine fossa approach. Results Twelve patients (7 males and 5 females) were included in the study. Lesions included seven cerebrospinal fluid (CSF) leaks and five tumors. One patient with squamous cell carcinoma (SCC) of the sphenoid died of his disease. All CSF leaks were successfully repaired, and benign tumors were removed with good local control through the follow-up period. Conclusion The endoscopic transpterygopalatine fossa approach is an excellent approach for dealing with lesions of the sphenoid Lateral Recess.
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endoscopic transnasal transpterygopalatine fossa approach to the Lateral Recess of the sphenoid sinus
Laryngoscope, 2004Co-Authors: Ismail S Alnashar, Ricardo L. Carrau, Alfredo Herrera, Carl H SnydermanAbstract:Objectives Lesions affecting the Lateral Recess of the sphenoid sinus are rarely discussed in the literature as a separate entity. This region is difficult to visualize and manipulate through the transnasal routes, especially when extensive pneumatization is present. External approaches to this area involve extensive surgery and are associated with significant morbidity. The objectives of this study are to present our experience with the endoscopic transpterygopalatine fossa approach as a method for exposing and manipulating lesions of the Lateral Recess of the sphenoid and to illustrate the detailed surgical steps of the procedure. Study Design Retrospective review. Methods Clinical charts of patients who had lesions originating from or extending into the Lateral Recess of the sphenoid sinus and who were treated at our institutions from September 1995 to June 2002 were retrospectively reviewed. All these patients were managed by the endoscopic transpterygopalatine fossa approach. Results Twelve patients (7 males and 5 females) were included in the study. Lesions included seven cerebrospinal fluid (CSF) leaks and five tumors. One patient with squamous cell carcinoma (SCC) of the sphenoid died of his disease. All CSF leaks were successfully repaired, and benign tumors were removed with good local control through the follow-up period. Conclusion The endoscopic transpterygopalatine fossa approach is an excellent approach for dealing with lesions of the sphenoid Lateral Recess.
