Abstract
During endoscopic trans-sphenoidal treatment of petrous apex cholesterol granuloma,
the challenge for the surgeon is to drill the posterior wall of the sphenoid sinus
to reach the lesion while attempting to avoid the internal carotid artery (ICA). A
refined neuronavigation technique is presented that diminishes bonework needed for
exposure and marsupialization, and simultaneously minimizes risks of accidental harm
to the ICA. The technique utilizes real-time intraoperative instrument tracking of
a drill, enabling safe creation of a direct canal toward the cyst just medial to the
paraclival ICA and of a curette for entirely image-guided marsupialization of the
cyst's deep areas through the canal.
Keywords
endoscopy - neuronavigation - minimal invasive - petrous bone - skull base
