Contralateral Transcaruncular Transorbital Endoscopic Approach to Petrous Apex: A Feasibility Cadaver Study

Objective: Petrous apex of the temporal bone is an anatomically challenging area to access. Traditionally sub temporal open approach is the. Nowadays in suitable cases minimal invasive ventral approaches is the preferred approach. The aim of this anatomic study is to compare and combine endoscopic contralateral medial transorbital approach with EEA to get full access to the petrous apex and to direct visualization of the surgical field describe technical notes

Methods: A total of 10 human cadaver heads (20 sides) were dissected. Predissection CT scans of each specimen were done to plan the approach. Endoscopic dissection through purely endonasal endoscopic route and a combined with contralateral transorbital route were done. No ethical approval was required.

Results: The two minimally invasive approach (endonasal endoscopic and contralateral transorbital) to petrous apex let us have different visualization to the petrous apex. Contralateral transorbital approach to petrous apex makes it possible to visualize ICA better and widely and can give a direct access to the petrous apex. Contralateral transorbital route mostly allows to visualize and manipulate superior portions petrous apex. A combined approach makes it possible to reach and remove petrous apex fully without a need for a curved drill.

Conclusion: Surgical approach to petrous apex is challenging. Combined approach with endonasal and contralateral transorbital route provides a good access to control to petrous apex and internal carotid artery even without curved instruments. This combined approach may be especially useful if there is no access to curved endoscopic instruments and drills. Possibly pioneer clinical applications are necessary.

Publikationsverlauf

Artikel online veröffentlicht:
07. Februar 2025