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REVIEW  THE LIMITS OF ENDOSCOPIC ENDONASAL APPROACHES 

Journal of Neurosurgical Sciences 2018 June;62(3):347-55

DOI: 10.23736/S0390-5616.18.04356-4

Copyright © 2018 EDIZIONI MINERVA MEDICA

lingua: Inglese

Reanalyzing the “far medial” (transcondylar-transtubercular) approach based on three anatomical vectors: the ventral posterolateral corridor

Srikant CHAKRAVARTHI, Alejandro MONROY-SOSA, Lior GONEN, Melanie FUKUI, Richard ROVIN, Nathaniel KOJIS, Mark LINDSAY, Sammy KHALILI, Juanita CELIX, Martin CORSTEN, Amin B. KASSAM

Aurora Neuroscience Innovation Institute, Aurora St. Luke’s Medical Center, Milwaukee, WI, USA


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Endoscopic endonasal access to the jugular foramen and occipital condyle - the transcondylar-transtubercular approach - is anatomically complex and requires detailed knowledge of the relative position of critical neurovascular structures, in order to avoid inadvertent injury and resultant complications. However, access to this region can be confusing as the orientation and relationships of osseous, vascular, and neural structures are very much different from traditional dorsal approaches. This review aims at providing an organizational construct for a more understandable framework in accessing the transcondylar-transtubercular window. The region can be conceptualized using a three-vector coordinate system: vector 1 represents a dorsal or ventral corridor, vector 2 represents the outer and inner circumferential anatomical limits; in an “onion-skin” fashion, key osseous, vascular, and neural landmarks are organized based on a 360-degree skull base model, and vector 3 represents the final core or target of the surgical corridor. The creation of an organized “global-positioning system” may better guide the surgeon in accessing the far-medial transcondylar-transtubercular region, and related pathologies, and help understand the surgical limits to the occipital condyle and jugular foramen - the ventral posterolateral corridor - via the endoscopic endonasal approach.


KEY WORDS: Endoscopy - Nasal surgical procedures - Skull base

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