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J Neurol Surg B Skull Base 2014; 75(03): 187-197
DOI: 10.1055/s-0033-1364165
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Dual-Port 2D and 3D Endoscopy: Expanding the Limits of the Endonasal Approaches to Midline Skull Base Lesions with Lateral Extension

Andre Beer-Furlan
1   Department of Neurological Surgery, Weill Cornell Medical College, Cornell University, New York, New York, United States
2   Department of Neurosurgery, University of São Paulo Medical School (FMUSP), São Paulo, Brazil
,
Alexander I. Evins
1   Department of Neurological Surgery, Weill Cornell Medical College, Cornell University, New York, New York, United States
,
Luigi Rigante
1   Department of Neurological Surgery, Weill Cornell Medical College, Cornell University, New York, New York, United States
,
Giulio Anichini
1   Department of Neurological Surgery, Weill Cornell Medical College, Cornell University, New York, New York, United States
,
Philip E. Stieg
1   Department of Neurological Surgery, Weill Cornell Medical College, Cornell University, New York, New York, United States
,
Antonio Bernardo
1   Department of Neurological Surgery, Weill Cornell Medical College, Cornell University, New York, New York, United States
› Author Affiliations
Further Information

Publication History

03 September 2013

14 November 2013

Publication Date:
12 March 2014 (online)

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Abstract

Objective To investigate a novel dual-port endonasal and subtemporal endoscopic approach targeting midline lesions with lateral extension beyond the intracavernous carotid artery anteriorly and the Dorello canal posteriorly.

Methods Ten dual-port approaches were performed on five cadaveric heads. All specimens underwent an endoscopic endonasal approach from the sella to middle clivus. The endonasal port was combined with an anterior or posterior endoscopic extradural subtemporal approach. The anterior subtemporal port was placed directly above the middle third of the zygomatic arch, and the posterior port was placed at its posterior root. The extradural space was explored using two-dimensional and three-dimensional endoscopes.

Results The anterior subtemporal port complemented the endonasal port with direct access to the Meckel cave, lateral sphenoid sinus, superior orbital fissure, and lateral and posterosuperior compartments of the cavernous sinus; the posterior subtemporal port enhanced access to the petrous apex. Endoscopic dissection and instrument maneuverability were feasible and performed without difficulty in both the anterior and posterior subtemporal ports.

Conclusion The anterior and posterior subtemporal ports enhanced exposure and control of the region lateral to the carotid artery and Dorello canal. Dual-port neuroendoscopy is still minimally invasive yet dramatically increases surgical maneuverability while enhancing visualization and control of anatomical structures.

Keywords

3D - dual port - subtemporal - endoscopy - endonasal
 

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