Surgical Anatomy for the Endoscopic Endonasal Approach to the Ventrolateral Skull Base

Kenichi OYAMA; Shigeyuki TAHARA; Toshio HIROHATA; Yudo ISHII; Daniel M PREVEDELLO; Ricardo L CARRAU; Sebastien FROELICH; Akira TERAMOTO; Akio MORITA; Akira MATSUNO

doi:10.2176/nmc.ra.2017-0039

Review Articles

Surgical Anatomy for the Endoscopic Endonasal Approach to the Ventrolateral Skull Base

Kenichi OYAMA, Shigeyuki TAHARA, Toshio HIROHATA, Yudo ISHII, Daniel M PREVEDELLO, Ricardo L CARRAU, Sebastien FROELICH, Akira TERAMOTO, Akio MORITA, Akira MATSUNO

Author information

Kenichi OYAMA
Department of Neurosurgery, Pituitary & Endoscopic Surgery Center, Teikyo University School of Medicine
Shigeyuki TAHARA
Department of Neurological Surgery, Nippon Medical School
Toshio HIROHATA
Department of Neurosurgery, Pituitary & Endoscopic Surgery Center, Teikyo University School of Medicine
Yudo ISHII
Department of Neurosurgery, Pituitary & Endoscopic Surgery Center, Teikyo University School of Medicine
Daniel M PREVEDELLO
Department of Neurological Surgery, the Ohio State University
Ricardo L CARRAU
Department of Otolaryngology/Head & Neck Surgery, the Ohio State University
Sebastien FROELICH
Department of Neurosurgery, Lariboisière Hospital, Paris VII-Diderot University
Akira TERAMOTO
Japan Labor Health and Safety Organization, Tokyo Rosai Hospital
Akio MORITA
Department of Neurological Surgery, Nippon Medical School
Akira MATSUNO
Department of Neurosurgery, Pituitary & Endoscopic Surgery Center, Teikyo University School of Medicine

Keywords: endoscopic endonasal approach, cavernous sinus, orbit, petrous apex, Meckel’s cave, infratemporal fossa

JOURNAL OPEN ACCESS

2017 Volume 57 Issue 10 Pages 534-541

DOI https://doi.org/10.2176/nmc.ra.2017-0039

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Abstract

The authors describe the surgical anatomy for the endoscopic endonasal approach (EEA) to the ventrolateral skull base. The ventrolateral skull base can be divided into two segments: the upper lateral and lower lateral skull base. The upper lateral skull base includes the cavernous sinus and the orbit, while the lower lateral skull base includes the petrous apex, Meckel’s cave, parapharyngeal space, infratemporal fossa, etc. To gain access to the upper lateral skull base, a simple opening of the ethmoid sinus provides sufficient exposure of this area. To reach the lower lateral skull base, a transpterygoid approach, following ethmoidectomy, is a key procedure providing wide exposure of this area. Understanding of surgical anatomy is mandatory for treating ventrolateral skull base lesions via EEA. An appropriate, less-invasive approach should be applied depending on the size, location, and type of lesion.

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