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Contents
https://t.me/med1917
21.3 Common Pathologies of
Craniovertebral Junction . . . . . . . . . . . . .
225
21.4 Complications and Their Avoidance . . . . 229
22 The “Far Medial” (Transcondylar/Transtubercular) Approach to the Inferior
Third of the Clivus. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Martin Corsten, Srikant S. Chakravarthi, Juanita M. Celix, Sammy Khalili, Melanie Fukui, Richard Rovin,
Amin Kassam
Introduction . . . . . . . . . . . . . . . . . . . . . . . .
22.1 Surgical Technique . . . . . . . . . . . . . . . . . . 232
22.2 Complications, Tips and Tricks . . . . . . . . 235
232
22.3 Case Example . . . . . . . . . . . . . . . . . . . . . . . 235
22.4 Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . 235
231
23 Jugular Foramen Approach . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 239
Muhamad A. Amine, Vijay K. Anand, Tomasz Dziedzic, Theodore H. Schwartz
Introduction . . . . . . . . . . . . . . . . . . . . . . . .
23.1 Indications . . . . . . . . . . . . . . . . . . . . . . . . . 240
240
23.2 Surgical Steps (Including Tips and
Tricks, Technique, and Important
Landmarks) . . . . . . . . . . . . . . . . . . . . . . . .
240
Section 6 Pterygopalatine and Infratemporal Fossa . . . . . . . . . . . . . . . . . . . . . . . . . . . 247
24 Endoscopic Endonasal Approach to Pterygopalatine Fossa. . . . . . . . . . . . . . . . . . . . . . . . . 250
Paolo Battaglia, Mario Turri-Zanoni, Paolo Castelnuovo
Introduction . . . . . . . . . . . . . . . . . . . . . . . .
250
24.4 Complications . . . . . . . . . . . . . . . . . . . . . . 256
24.1 Indications . . . . . . . . . . . . . . . . . . . . . . . . . 250
24.2 Surgical Steps . . . . . . . . . . . . . . . . . . . . . . . 250
24.3 Instruments Required. . . . . . . . . . . . . . . . 256
24.5 Case Example . . . . . . . . . . . . . . . . . . . . . . . 256
24.6 Tips and Tricks . . . . . . . . . . . . . . . . . . . . . . 256
25 Infratemporal Approach . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 259
Lee A. Zimmer, Almaz Kurbanov
Introduction . . . . . . . . . . . . . . . . . . . . . . . .
25.1 Indications . . . . . . . . . . . . . . . . . . . . . . . . . 260
25.2 Infratemporal Fossa Limits. . . . . . . . . . . . 260
25.3 Surgical Steps . . . . . . . . . . . . . . . . . . . . . . . 260
260
25.4 Case Examples . . . . . . . . . . . . . . . . . . . . . . 263
25.5 Complications . . . . . . . . . . . . . . . . . . . . . . 263
25.6 Tips and Tricks . . . . . . . . . . . . . . . . . . . . . . 265
26 Nasopharyngectomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 267
Raewyn G. Campbell, Daniel M. Prevedello, Ricardo L. Carrau
Introduction . . . . . . . . . . . . . . . . . . . . . . . . 268
26.1 Indications for an Expanded Endonasal
26.2 Contraindications to an Expanded
26.3 Surgical Steps . . . . . . . . . . . . . . . . . . . . . . . 268
Approach
Endonasal Approach . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 268
268
26.4 Reconstruction. . . . . . . . . . . . . . . . . . . . . . 273
26.5 Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . 274
26.6 Contraindications to Surgery and
26.7 Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . 276
Complications . . . . . . . . . . . . . . . . . . . . . .
275
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Section 7 Combined Endoscopic–Transcranial Approaches . . . . . . . . . . . . . . . . . . . . .
279
27 Transbasal/Subfrontal-Transcribriform Approach to Anterior Skull Base . . . . . . . . . . . . . 282
Iacopo Dallan, Mario Turri-Zanoni, Stefano Sellari–Franceschini
Introduction . . . . . . . . . . . . . . . . . . . . . . . .
27.1 Indications . . . . . . . . . . . . . . . . . . . . . . . . . 282
27.2 Surgical Steps . . . . . . . . . . . . . . . . . . . . . . . 282
27.3 Case Example . . . . . . . . . . . . . . . . . . . . . . . 290
282
27.4 Complications . . . . . . . . . . . . . . . . . . . . . . 292
27.5 Instruments Required. . . . . . . . . . . . . . . . 292
27.6 Tips and Tricks . . . . . . . . . . . . . . . . . . . . . . 292
28 Retrosigmoid–Transclival Approach . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 293
Diego Mazzatenta, Matteo Zoli, Ernesto Pasquini, Giorgio Frank
Introduction . . . . . . . . . . . . . . . . . . . . . . . .
28.1 Indications . . . . . . . . . . . . . . . . . . . . . . . . . 294
294
28.2 Surgical Steps . . . . . . . . . . . . . . . . . . . . . . . 294
28.3 Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 302
29 Far Lateral-Craniovertebral Approach . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 303
Giuseppe Catapano, Matteo de Notaris, Giuseppe Di Nuzzo, Nelido Gonzalez Fernandez, Iacopo Dallan,
29.1 Far Lateral Approach. . . . . . . . . . . . . . . . .
Alberto Prats-Galino
304 29.2 Extended Endoscopic Endonasal
Transclival Approach to the Ventrolateral
Brain Stem . . . . . . . . . . . . . . . . . . . . . . . . .
307
30 Anterior Transpetrosal Approach versus EEA Transclival Approach. . . . . . . . . . . . . . . . . . 315
Jun Muto, Leo F. S. Ditzel Filho, Bradley A. Otto, Ricardo L. Carrau, Daniel M. Prevedello
Introduction . . . . . . . . . . . . . . . . . . . . . . . .
30.1 Indications . . . . . . . . . . . . . . . . . . . . . . . . . 316
30.2 Surgical Steps . . . . . . . . . . . . . . . . . . . . . . . 316
316
30.3 Complications . . . . . . . . . . . . . . . . . . . . . . . . . . . 318
30.4 Tips and Tricks . . . . . . . . . . . . . . . . . . . . . . . . . . 319
30.5 Case Example. . . . . . . . . . . . . . . . . . . . . . . . . . . . 320
Section 8 Basic Landmarks in Expanded Endoscopic Skull Base Surgery . . . . . . . . . . 321
31 Intracranial Vascular Anatomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 324
Paolo Castelnuovo, Apostolos Karligkiotis, Iacopo Dallan
Introduction . . . . . . . . . . . . . . . . . . . . . . . .
31.1 Internal Carotid Artery . . . . . . . . . . . . . . . 324
31.2 Superior and Inferior Intercavernous
Sinuses (and Cavernous Sinuses) . . . . . .
324
335
32 Anteromedial Corridors to the Cranial Nerves. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 347
Juanita M. Celix, Srikant S. Chakravarthi, Nishit Shah, Martin Corsten, Sammy Khalili, Amin Kassam,
Introduction . . . . . . . . . . . . . . . . . . . . . . . . 348
32.1 Surgical Steps . . . . . . . . . . . . . . . . . . . . . . . 348
Melanie Fukui, Richard Rovin
31.3 Superior and Inferior Petrosal Sinuses. . 338
31.4 Basilar Artery (and Vertebrobasilar
32.2 Tips and Tricks . . . . . . . . . . . . . . . . . . . . . . 357
System including Vertebral Arteries) . . .
339
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33 Bony Landmarks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 359
Ali Jamshidi, Leo F. S. Ditzel Filho, Edward Kerr, Brad A. Otto, Ricardo L. Carrau, Daniel M. Prevedello
Introduction . . . . . . . . . . . . . . . . . . . . . .
33.1 Parapharyngeal ICA and the Eustachian
Tube. . . . . . . . . . . . . . . . . . . . . . . . . . . . .
33.2 Petrous ICA and the Vidian Canal . . . . . 360
360
360
33.3 Paraclival ICA and the Clival Recess
33.4 Tips and Tricks . . . . . . . . . . . . . . . . . . . . 364
and the Foramen Rotundum . . . . . . . . .
361
Section 9 Reconstruction Techniques . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 367
34 The Pedicled Nasoseptal Flap . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 370
Gustavo Hadad, Roldán Roberto, Juan Pablo Demaría, Miguel Mural
Introduction . . . . . . . . . . . . . . . . . . . . . . . .
34.1 Definition . . . . . . . . . . . . . . . . . . . . . . . . . . 370
34.2 Indications . . . . . . . . . . . . . . . . . . . . . . . . . 370
34.3 Tips and Tricks . . . . . . . . . . . . . . . . . . . . . . 370
34.4 Advantages. . . . . . . . . . . . . . . . . . . . . . . . . 370
370
35 Middle and Inferior Turbinate Flaps. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 379
Raewyn G. Campbell, Bradley A. Otto, Daniel M. Prevedello, Ricardo L. Carrau
Introduction . . . . . . . . . . . . . . . . . . . . . . . .
35.1 Reconstruction Technique . . . . . . . . . . . . 380
34.5 Surgical Steps . . . . . . . . . . . . . . . . . . . . . . . 371
34.6 Complications . . . . . . . . . . . . . . . . . . . . . . 371
34.7 Tips and Tricks to Prevent
Complications . . . . . . . . . . . . . . . . . . . . . .
34.8 Tips and Tricks . . . . . . . . . . . . . . . . . . . . . . 374
34.9 Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . 375
380
35.3 Middle Turbinate Flap. . . . . . . . . . . . . . . . 382
35.4 Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . 383
371
35.2 Inferior Turbinate Flap . . . . . . . . . . . . . . . 380
36 Anterior and Posterior Pedicle Lateral Nasal Wall Flaps. . . . . . . . . . . . . . . . . . . . . . . . . . . . 385
Carlos M. Rivera-Serrano, Ricardo L. Carrau
Introduction . . . . . . . . . . . . . . . . . . . . . . . .
36.1 Indications . . . . . . . . . . . . . . . . . . . . . . . . . 386
36.2 Surgical Steps . . . . . . . . . . . . . . . . . . . . . . . 386
386
36.3 Complications . . . . . . . . . . . . . . . . . . . . . . 388
36.4 Tips and Tricks . . . . . . . . . . . . . . . . . . . . . . 390
37 Pericranial and Temporoparietal Fascia Flaps . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 393
Raewyn G. Campbell, Hafiz Patwa, Bradley A. Otto, Daniel M. Prevedello, Ricardo L. Carrau
Introduction . . . . . . . . . . . . . . . . . . . . . . . .
37.1 Anatomy of the Frontal and
Temporal Scalp. . . . . . . . . . . . . . . . . . . . . .
37.2 Transfrontal Pericranial Flap . . . . . . . . . . 394
394
394
37.3 Transpterygoid Temporoparietal
37.4 Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . 400
Fascia Flap. . . . . . . . . . . . . . . . . . . . . . . . . .
397
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 403
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Preface
https://t.me/med1917
Working as a trainee at the Johannes-Gutenberg University Hospital in Mainz, Germany, I had the opportunity in
the mid-1980s to learn firsthand how to perform an endoscopic sinus surgery under the supervision of Prof. Ralf
Reck. While one surgeon looked through the endoscope,
another checked through an angulated “spy” adapted to
an image split, and vice versa. No cameras or monitors
were available.
Little did I know back then that this would become my
greatest “hobby” within ENT. In 1990, my former chief,
late Prof. Henning Hildmann, allowed me to organize the
first FESS course (in Spanish!) while I was at the Elisabeth-Hospital, at the Ruhr-University Bochum, Germany,
as a consultant. Among others, late Johannes Lang, Wolfgang Draf, Karl Hörmann, Werner Hosemann, Carlos Suarez, and Humberto Massegur were invited.
Back in Spain, in 1992, together with a few rhinologists
(Ademá and Massegur, pioneers for FESS here), the surgical techniques were progressively introduced not only
in Spain, but (advantage of the language!) also in South
America. We became members of a kind of a “FESS circus.” Interestingly, FESS was not received immediately
with a “warm welcome,” by those favoring the microscope—not a problem, as long as the endonasal approach
was chosen—but more by those not acknowledging the
advantages of an endonasal approach. Nevertheless, all
courses, with or without cadaver dissection, were always
fully booked, and live surgery was performed around the
country specifically to convince the “Sauluses.”
After many courses (and some decades later), technology
has allowed us to perform FESS with navigational systems
and/or powered instrumentation, better cameras, HD
and even 4K monitors, and wide-angled endoscopes.
Also, the indications became considerably, if not radically, changed. Our initial slides from presentations dealing
with “indications and contraindications” had to be updated almost on a yearly basis. Nowadays, almost nothing is
impossible through the nose.
After moving to Barcelona, in February 1998, it took me
some years to convince our neurosurgeons to build up a
team to approach the full skull base and beyond. With the
incorporation of Joaquim Enseñat, now the Head of the
Department of Neurosurgery, and the hard work of my
co-worker, Dr. Isam Alobid, the Skull Base Unit became a
reality. Meanwhile, in Pittsburgh mainly the Kassam–Carrau team was pushing strongly, showing us the way. Now,
nose and paranasal sinuses became the surgical corridors
to the different approaches to the skull base. Certainly,
the vast experience acquired along the previous decades
on endoscopic sinus surgery set the basis that allowed to
proceed further.
We now proudly look back to over a decade of expanded endoscopic skull base surgery. Numerous dissection
courses behind us together with the best of our experts
and friends, has been presented here.
We hope this book will become a true contribution and
page-turner for all those interested in endoscopic surgery
of the paranasal sinuses and skull base. In that sense, I
would like to thank all authors and co-authors for their
valuable contributions.
Manuel Bernal-Sprekelsen
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Preface
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Endoscopic sinus and skull base surgery have undergone many changes over the past two decades based
on increasing knowledge of anatomy and technological
advances in endoscopes, resolution of cameras and TV
screens, and navigation systems. Extended approaches
to skull base have allowed for the management of complex lesions in a minimally invasive fashion, resulting in
improved outcomes, reduced morbidity, and decreased
hospital stays. Advances in skull base reconstruction have
also played a crucial role to the progression of this field.
This book covers the basic concepts of endoscopic surgery of the paranasal sinuses and skull base, endoscopic
anatomy, preoperative and postoperative diagnosis, instrumentation, anesthesia, and patient positioning. The
intention of this text is to present in a unique way basic
landmarks of the anatomy of sinuses and skull base. This
overview is also followed by clinical and practical case
examples that bring more insights about management of
pathologies and tumors involving this area.
We are very grateful to the leading experts from around
the world who have shared their experience, skills, and
tips and tricks in this book to help our patients and to
improve their quality of life through our work.
The manual is divided into 37 chapters. Each one was
built on the anatomical exposure and identification
of anatomical landmarks developed in the preceding
dissection. Our goal is to provide rhinologists, neurosurgeons, head and neck and maxillofacial surgeons,
fellows, residents, and medical students who are interested in the topics covered here with a broad understanding of the potential minimum invasive approach to
the skull base.
We hope this book really can serve as guide for young
surgeon in daily practice and help to build a multidisciplinary team in their centers.
Isam Alobid
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Acknowledgments
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We are very grateful to Stephan Konnry, Thieme Editorial in
Stuttgart, for supporting this project from the very beginning. We would also like to sincerely thank Sapna Rastogi
and co-workers in Noida, for their excellent job in gathering all chapters, figures, and drawings from the authors and
reviewing them to find what was missing.
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