Precise Identification of Key Anatomical Structures for the Extended Endoscopic Endonasal Skull Base Surgical Approach to the Midline Middle Cranial Fossa: Anatomical Study

Objectives: To describe the precise key anatomical structures for the execution of an extended endoscopic endonasal skull base surgical approach (EEEA) to the midline MIDDLE cranial fossa.

Background: With the EEEA we can access the different anatomical compartments of the midline skull base from frontal sinus to cranio-vertebral junction. Precise identification of key anatomical structures allows us to perform a safe and effective extended endoscopic endonasal approach to the midline middle cranial fossa.

Methods: We performed anatomical dissections through an EEEA in six formalin fixed and colored latex injected human biological specimens at the Surgical Neuroanatomy Laboratory at the Mexican Faculty of Medicine of the La Salle University in Mexico City. We used a high-definition endoscopy system, an endoscopic endonasal skull base surgical instrument set, a high-speed electric drill system with minimal invasive surgery attachments, and a portable suction device.

Results: During the EEEA to the midline middle skull base we identify five surgical modules: trans-sellar, trans-cavernous sinus, trans-pterygoid, trans-middle fossa, and trans-infratemporal fossa. Key anatomical structures that reference each of the surgical modules are: sellar prominence, tubercular recess, carotico-sellar point, medial optic-carotid recess, lateral optic-carotid recess, carotid prominence, optic prominence, superior orbital fissure, maxillary strut, lingula sphenoidale, foramen rotundum, foramen ovale, vidian canal, pterygoid process, medial pterygoid plate, lateral pterygoid plate, pterygopalatine fossa, palate-sphenoidal canal, sphenopalatine foramen, sphenoidal process of the palatine, vaginal process of the sphenoid, and crista ethmoidalis.

Conclusion: The EEEA to the midline skull base has key anatomical structures that through a stepwise and progressive dissection can easily be identified allowing us to approach each surgical module in a safe and effective manner. Performing frequent anatomical dissections in human biological specimens helps extend our anatomical knowledge and fine tunes our surgical training for a precise surgical execution.

Publikationsverlauf

Artikel online veröffentlicht:
01. Februar 2023