Artikel
Anatomical considerations of the transnasal approaches to the central skull base
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Autoren
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Márton Eördögh
- Klinikum Region Hannover GmbH, Krankenhaus Nordstadt, Neurochirurgische Klinik, Hannover, Deutschland
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Gábor Baksa
- Semmelweis University, Department of Anatomy, Histology and Embryology, Laboratory of Applied and Clinical Anatomy, Budapest, Hungary
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Lajos Patonay
- Semmelweis University, Department of Anatomy, Histology and Embryology, Laboratory of Applied and Clinical Anatomy, Budapest, Hungary
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Islam Gawish
- Klinikum Region Hannover GmbH, Krankenhaus Nordstadt, Neurochirurgische Klinik, Hannover, Deutschland
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I. Erol Sandalcioglu
- Klinikum Region Hannover GmbH, Krankenhaus Nordstadt, Neurochirurgische Klinik, Hannover, Deutschland
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Hans Rudolf Briner
- Klinik Hirslanden, Zentrum für Ohren-, Nasen-, Hals- und plastische Gesichtschirurgie, Zürich, Switzerland
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Robert Reisch
- Klinik Hirslanden, Zentrum für endoskopische und minimalinvasive Neurochirurgie, Zürich, Switzerland
| Veröffentlicht: | 9. Juni 2017 |
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Gliederung
Text
The transnasal-transsphenoidal endoscopic approach to the skull base has a clear advantage both in surgical visualisation and manipulation, offering not only ideal representation of patho-anatomical details, but also unhindered surgical dissection. Nevertheless, important functional structures of the nasal cavity (e.g. the posterosuperior part of the nasal septum, the nasal turbinates) are often removed during transnasal surgical procedures in order to create the necessary space for the further course of the operation. This surgical invasiveness frequently causes unacceptable postoperative rhinological complications with impaired nasal function.
In this study, performed on fresh human cadavers, formalin-fixated cadaveric heads and macerated skulls, we describe the combined transethmoidal-paraseptal approach to the central skull base that meet the requirements to achieve wide exposure without extensive nasal damage.
After unilateral ethmoidectomy, the sphenoid sinus is approached laterally from the superior turbinate, directly through the posterior ethmoidal cells. Thereafter, the middle turbinate is lateralised and the sphenoethmoidal recess exposed. Here, limited sphenoidal rostrectromy is performed, allowing wide bilateral exposure of the sphenoid sinus and central skull base.
Our anatomical data showed optimal transnasal endoscopic exposure with limited approach-related traumatization of the nasal cavity. In our interdisciplinary rhino-neurosurgical skull base centre, this approach was successfully introduced in the daily routine, allowing minimal sinonasal traumatization.
