目的:微创内镜经鼻多端口入路可创造额外的观察角度来治疗颅底病变。唇下对侧经上颌(CTM)入路和上眼睑外侧经眶入路,现在经常使用,当与鼻内镜入路(EEA)一起使用时,被称为“第三端口”。内窥镜经眶内侧对侧对侧(cMTO)走廊,另一方面,是一个未被认可但独特的端口,已用于修复源自蝶窦外侧隐窝的CSF鼻漏。然而,没有解剖学可行性研究或临床经验来评估其益处并证明其在多端口内窥镜进入其他对侧颅底区域中的潜在作用.在这项研究中,作者探讨了多端口EEA结合内窥镜cMTO入路(EEA/cMTO)在对侧颅底三个目标区域的应用和潜在用途:蝶窦外侧凹陷(LRSS),岩尖(PA)和岩区,和颈动脉后斜视海绵间隙(CCS)。
方法:在立体定向导航引导下双侧解剖10个尸体标本(20侧),以通过EEA/cMTO进入对侧LRSS。仅通过EEA暴露PA和岩斜区以及颈动脉后CCS,EEA/cMTO,和EEA结合唇下CTM方法(EEA/CTM)。定性和定量评估,包括与PA的工作距离和可视化角度,被记录下来。EEA/cMTO的临床应用已在蝶窦外侧CSF渗漏修复中得到证实。
结果:在定性评估期间,多端口EEA/cMTO提供优越的可视化从一个高的有利位置和更好的仪器可操作性比多端口EEA/CTMPA和颈动脉后CCS,同时保持类似的横向轨迹。与CTM方法和EEA相比,cMTO方法到所有三个目标区域的工作距离明显更短。到LRSS的平均距离,PA,颈动脉后CCS为50.69±4.28mm(p<0.05),67.11±5.05mm(p<0.001),50.32±3.6mm(p<0.001),分别。通过多端口EEA/cMTO和EEA/CTM获得的PA的平均可视化角度为28.4°±3.27°和24.42°±5.02°(p<0.005),分别。
结论:对侧LRSS的多端口EEA/cMTO提供了保留翼腭窝内容物和翼点神经的优势,在经翼体方法中经常被牺牲。与EEA/CTM相比,该方法还提供了出色的可视化和更好的仪器可操作性,以靶向岩斜区和颈动脉后CCS。
Minimally invasive endoscopic endonasal multiport approaches create additional visualization angles to treat skull base pathologies. The sublabial contralateral transmaxillary (CTM) approach and superior eyelid lateral transorbital approach, frequently used nowadays, have been referred to as the \"third port\" when used alongside the endoscopic endonasal approach (EEA). The endoscopic precaruncular contralateral medial transorbital (cMTO) corridor, on the other hand, is an underrecognized but unique port that has been used to repair CSF rhinorrhea originating from the lateral sphenoid sinus recess. However, no anatomical feasibility studies or clinical experience exists to assess its benefits and demonstrate its potential role in multiport endoscopic access to the other contralateral skull base areas. In this study, the authors explored the application and potential utility of multiport EEA combined with the endoscopic cMTO approach (EEA/cMTO) to three target areas of the contralateral skull base: lateral recess of sphenoid sinus (LRSS), petrous apex (PA) and petroclival region, and retrocarotid clinoidocavernous space (CCS).
Ten cadaveric specimens (20 sides) were dissected bilaterally under stereotactic navigation guidance to access contralateral LRSS via EEA/cMTO. The PA and petroclival region and retrocarotid CCS were exposed via EEA alone, EEA/cMTO, and EEA combined with the sublabial CTM approach (EEA/CTM). Qualitative and quantitative assessments, including working distance and visualization angle to the PA, were recorded. Clinical application of EEA/cMTO is demonstrated in a lateral sphenoid sinus CSF leak repair.
During the qualitative assessment, multiport EEA/cMTO provides superior visualization from a high vantage point and better instrument maneuverability than multiport EEA/CTM for the PA and retrocarotid CCS, while maintaining a similar lateral trajectory. The cMTO approach has significantly shorter working distances to all three target areas compared with the CTM approach and EEA. The mean distances to the LRSS, PA, and retrocarotid CCS were 50.69 ± 4.28 mm (p < 0.05), 67.11 ± 5.05 mm (p < 0.001), and 50.32 ± 3.6 mm (p < 0.001), respectively. The mean visualization angles to the PA obtained by multiport EEA/cMTO and EEA/CTM were 28.4° ± 3.27° and 24.42° ± 5.02° (p < 0.005), respectively.
Multiport EEA/cMTO to the contralateral LRSS offers the advantage of preserving the pterygopalatine fossa contents and the vidian nerve, which are frequently sacrificed during a transpterygoid approach. This approach also offers superior visualization and better instrument maneuverability compared with EEA/CTM for targeting the petroclival region and retrocarotid CCS.