Endoscope-assisted contralateral transmaxillary approach to the clivus and the hypoglossal canal: Technical case report

Eva Pamias-Portalatin, Deependra Mahato, Jordina Rincon-Torroella, Tito Vivas-Buitrago, Alfredo Quinones-Hinojosa, Kofi O. Boahene

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Clival lesions are still considered surgically complex due to their anatomical location. Critical structures, such as the internal carotid arteries (ICAs), cavernous sinuses, cranial nerves, and brainstem, may be encased within the lesion. Although advances in endoscopic endonasal approaches have provided new routes to these lesions, exposure and resection of clival tumors through the endonasal route remain a technical challenge. Here, the authors report a left-sided endoscopic transmaxillary approach to access the right aspect of the clivus and the hypoglossal canal. A 35-year-old woman presented with progressive right 6th cranial nerve palsy. MRI revealed a contrast-enhancing right petroclival chondrosarcoma that involved Meckel’s cave and extended into the right hypoglossal canal. An endoscopic-contralateral-transmaxillary approach through a left sublabial incision was used to access the right petroclival region and right hypoglossal canal. A left maxillary osteoplastic flap was elevated to expose the left maxillary sinus. This was followed by a left medial maxillectomy, gaining access to the left posterior nasal cavity. The posterior third of the left inferior turbinate and nasal septum were removed to access the right side of the petroclival region. Near-total resection was achieved without any vascular or neurological complications. A thin shell of residual tumor was left behind due to involvement of vital structures, such as the ICA, and further treated with proton-beam radiotherapy. The endoscopic-contralateral-transmaxillary approach provides a direct surgical corridor and good lateral visualization of the skull base vasculature. This approach allows wide maneuverability around the ICA and hypoglossal canal, which, in this case, allowed maximal tumor resection with full preservation of neurological function.

Original languageEnglish (US)
Pages (from-to)1609-1615
Number of pages7
JournalJournal of neurosurgery
Volume130
Issue number5
DOIs
StatePublished - May 1 2019

Fingerprint

Posterior Cranial Fossa
Endoscopes
Internal Carotid Artery
Abducens Nerve Diseases
Nasal Septum
Cranial Nerve Diseases
Turbinates
Cavernous Sinus
Chondrosarcoma
Cranial Nerves
Maxillary Sinus
Nasal Cavity
Skull Base
Residual Neoplasm
Brain Stem
Blood Vessels
Protons
Neoplasms
Radiotherapy

Keywords

  • Chondroscarcoma
  • Clivus
  • Contralateral
  • Endoscope
  • Hypoglossal canal
  • Pituitary surgery
  • Skull base
  • Transmaxillary
  • Tumor

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Endoscope-assisted contralateral transmaxillary approach to the clivus and the hypoglossal canal : Technical case report. / Pamias-Portalatin, Eva; Mahato, Deependra; Rincon-Torroella, Jordina; Vivas-Buitrago, Tito; Quinones-Hinojosa, Alfredo; Boahene, Kofi O.

In: Journal of neurosurgery, Vol. 130, No. 5, 01.05.2019, p. 1609-1615.

Research output: Contribution to journalArticle

Pamias-Portalatin, Eva ; Mahato, Deependra ; Rincon-Torroella, Jordina ; Vivas-Buitrago, Tito ; Quinones-Hinojosa, Alfredo ; Boahene, Kofi O. / Endoscope-assisted contralateral transmaxillary approach to the clivus and the hypoglossal canal : Technical case report. In: Journal of neurosurgery. 2019 ; Vol. 130, No. 5. pp. 1609-1615.
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abstract = "Clival lesions are still considered surgically complex due to their anatomical location. Critical structures, such as the internal carotid arteries (ICAs), cavernous sinuses, cranial nerves, and brainstem, may be encased within the lesion. Although advances in endoscopic endonasal approaches have provided new routes to these lesions, exposure and resection of clival tumors through the endonasal route remain a technical challenge. Here, the authors report a left-sided endoscopic transmaxillary approach to access the right aspect of the clivus and the hypoglossal canal. A 35-year-old woman presented with progressive right 6th cranial nerve palsy. MRI revealed a contrast-enhancing right petroclival chondrosarcoma that involved Meckel’s cave and extended into the right hypoglossal canal. An endoscopic-contralateral-transmaxillary approach through a left sublabial incision was used to access the right petroclival region and right hypoglossal canal. A left maxillary osteoplastic flap was elevated to expose the left maxillary sinus. This was followed by a left medial maxillectomy, gaining access to the left posterior nasal cavity. The posterior third of the left inferior turbinate and nasal septum were removed to access the right side of the petroclival region. Near-total resection was achieved without any vascular or neurological complications. A thin shell of residual tumor was left behind due to involvement of vital structures, such as the ICA, and further treated with proton-beam radiotherapy. The endoscopic-contralateral-transmaxillary approach provides a direct surgical corridor and good lateral visualization of the skull base vasculature. This approach allows wide maneuverability around the ICA and hypoglossal canal, which, in this case, allowed maximal tumor resection with full preservation of neurological function.",
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