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The feasibility of three port endonasal, transorbital, and sublabial approach to the petroclival region: neurosurgical audit and multiportal anatomic quantitative investigation

  • Original Article - Neurosurgical Anatomy
  • Published:
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Abstract

Purpose

The petroclival region represents the “Achille’s heel” for the neurosurgeons. Many ventral endoscopic routes to this region, mainly performed as isolated, have been described.

The aim of the present study is to verify the feasibility of a modular, combined, multiportal approach to the petroclival region to overcome the limits of a single approach, in terms of exposure and working areas, brain retraction and manipulation of neurovascular structures.

Methods

Four cadaver heads (8 sides) underwent endoscopic endonasal transclival, transorbital superior eyelid and contralateral sublabial transmaxillary-Caldwell-Luc approaches, to the petroclival region. CT scans were obtained before and after each approach to rigorously separate the contribution of each osteotomy and subsequentially to build a comprehensive 3D model of the progressively enlarged working area after each step.

Results

The addition of the contralateral transmaxillary and transorbital corridors to the extended endoscopic endonasal transclival in a combined multiportal approach provides complementary paramedian trajectories to overcome the natural barrier represented by the parasellar and paraclival segments of the internal carotid artery, resulting in significantly greater area of exposure than a pure endonasal midline route (8,77 cm2 and 11,14 cm2 vs 4,68 cm2 and 5,83cm2, extradural and intradural, respectively).

Conclusion

The use of different endoscopic “head-on” trajectories can be combined in a wider multiportal extended approach to improve the ventral route to the most inaccessible petroclival regions. Finally, by combining these approaches and reiterating the importance of multiportal strategy, we quantitatively demonstrate the possibility to reach “far away” paramedian petroclival targets while preserving the neurovascular structures.

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Data availability

Data of the current original research are available from the corresponding author on reasonable request.

Abbreviations

ICA:

Internal carotid artery

TOA:

Transorbital approach

EEEA:

Extended endoscopic endonasal approach

CTM:

Contralateral transmaxillary

CL:

Caldwell-Luc

CT:

Computerized tomography

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Funding

This study has been funded by the Instituto de Salud Carlos III (ISCIII) through the project PI19/00592 and co-funded by the European Union; it has also been funded by the “Fundació La Marató de TV3” (Reg. 95/210; Codi projecte 201914).

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Authors and Affiliations

  1. Division of Neurosurgery, Department of Neurosciences and Reproductive and Odontostomatological Sciences, Università Degli Studi Di Napoli Federico II, Naples, Italy

    Sergio Corvino, Ilaria Bove, Domenico Solari & Luigi Maria Cavallo

  2. Laboratory of Surgical Neuroanatomy, Faculty of Medicine, Universitat de Barcelona, Barcelona, Spain

    Giulia Guizzardi, Alberto Prats-Galino & Alberto Di Somma

  3. Department of Neurosurgery, “Riuniti” Hospital, Foggia, Italy

    Matteo Sacco & Antonio Colamaria

  4. Department of Neurosurgery, San Luca Hospital, Vallo Della Lucania, Salerno, Italy

    Francesco Corrivetti

  5. Laboratory of Neuroscience, EBRIS Foundation, European Biomedical Research Institute of Salerno, Salerno, Italy

    Francesco Corrivetti & Matteo de Notaris

  6. Departments of Neurological Surgery, Hospital Clínic de Barcelona, Barcelona, Spain

    Joaquim Enseñat & Alberto Di Somma

  7. Neurosurgery Operative Unit, Department of Neuroscience, “San Pio” Hospital, Benevento, Italy

    Matteo de Notaris

Authors
  1. Sergio Corvino
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  2. Giulia Guizzardi
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  3. Matteo Sacco
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  11. Alberto Di Somma
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All authors contributed equally to the work.

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Correspondence to Alberto Di Somma.

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Corvino, S., Guizzardi, G., Sacco, M. et al. The feasibility of three port endonasal, transorbital, and sublabial approach to the petroclival region: neurosurgical audit and multiportal anatomic quantitative investigation. Acta Neurochir 165, 1821–1831 (2023). https://doi.org/10.1007/s00701-023-05498-6

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