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J Neurol Surg B Skull Base 2015; 76(01): 080-086
DOI: 10.1055/s-0034-1390398
Original Article
Georg Thieme Verlag KG Stuttgart · New York

The Pterional Port in Dual-Port Endoscopy: A 2D and 3D Cadaveric Study

André Beer-Furlan
1   Department of Neurological Surgery, Weill Cornell Medical College, Cornell University, New York, United States
2   Department of Neurosurgery, University of São Paulo Medical School (FMUSP), São Paulo, Brazil
,
Alexander I. Evins
1   Department of Neurological Surgery, Weill Cornell Medical College, Cornell University, New York, United States
,
Luigi Rigante
1   Department of Neurological Surgery, Weill Cornell Medical College, Cornell University, New York, United States
,
Giulio Anichini
1   Department of Neurological Surgery, Weill Cornell Medical College, Cornell University, New York, United States
,
Philip E. Stieg
1   Department of Neurological Surgery, Weill Cornell Medical College, Cornell University, New York, United States
,
Antonio Bernardo
1   Department of Neurological Surgery, Weill Cornell Medical College, Cornell University, New York, United States
› Author Affiliations
Further Information

Publication History

17 March 2014

21 July 2014

Publication Date:
29 September 2014 (online)

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Abstract

Objective We propose a novel dual-port endonasal and pterional endoscopic approach targeting midline lesions of the anterior cranial fossa with lateral extension beyond the optic nerve.

Methods Ten dual-port approaches were performed on five cadaveric heads. All specimens underwent an endoscopic transtuberculum/transplanum approach followed by placement of a pterional port. The endonasal port was combined with an endoscopic extradural pterional keyhole craniectomy. The pterional port was placed at the intersection of the sphenoparietal and coronal sutures. The extradural space was explored using two-dimensional and three-dimensional endoscopes.

Results The superolateral access provided by the pterional port may improve the ability to achieve a gross total resection of tumors with lateral extensions. The complete opening of the optic canal achieved through the dual-port approach may enable resection of the intracanalicular portion of a tumor, a crucial step in improvement of visual function and reduction of tumor recurrence.

Conclusion The pterional port may enhance control of midline anterior skull base lesions with lateral extension beyond the optic nerve and optic canal. Dual-port endoscopy maintains minimally invasiveness and dramatically increases the working limits and control of anatomical structures well beyond what is attainable through single-port neuroendoscopy.

Keywords

3D - dual port - cadaver - endoscopy - endonasal - pterional
 

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