gms | German Medical Science

Objective: Various microsurgical approaches to the pyramid tip offer safe resections in this area. Over the last few years, endoscopic skull base surgery has come progressively more into focus. The endoscopic transphenoidal approach was extended by bony resection of the clivus or the pyramid to reach pathologies of the pyramid tip. The aim of this report is to show the feasibility of this approach and its advantages and disadvantages.

Methods: A pure endoscopic transnasal navigated approach was used in 6 operations. Entities included chordoma, chondrosarcoma, adenoidcystic carcinoma, Rathke’s cyst, epidermoid, and cholesterol granuloma. The four hand and two nostril technique with a 4 mm endoscope at 0° to 45° was used. A thin-slice CT was used for neuronavigation, combined with CT-angiography or fusion with MR carotid artery-sensitive series; registration was achieved with surface matching.

Results: Processes at the pyramid tip can be reached endoscopically transnasally. Bony resection can be achieved only in a straight trajectory from the contralateral nostril to the medial wall of the carotid artery. Soft tissue can be resected up to the inner auditory canal and jugular foramen with angled curettes. No bleeding, csf fistula, nor new neurologic deficit was encountered.

Conclusions: The transnasal pure endoscopic approach is suitable for different pathologic processes of the pyramid tip. In this small series, the complication rate was low, only minor side effects were observed. Bony resection is limited by the course of the carotid artery. Soft tissue tumors are the candidates for this approach.