Lateral Transorbital Approach for Repair of Lateral Sphenoid Sinus Meningoencephaloceles in Proximity to Foramen Rotundum: Cadaveric Study and Case Report

Author:

Mathios Dimitrios1ORCID,Bobeff Ernest J.123ORCID,Longo Davide1,Tabaee Abtin4,Anand Vijay K.4,Godfrey Kyle J.15ORCID,Schwartz Theodore H.14ORCID

Affiliation:

1. Department of Neurosurgery, Weill Cornell Medicine and New York Presbyterian Hospital, New York, New York, USA;

2. Department of Neurosurgery, Barlicki University Hospital, Lodz, Poland;

3. Department of Sleep Medicine and Metabolic Disorders, Medical University of Lodz, Lodz, Poland

4. Department of Otolaryngology, Weill Cornell Medicine and New York Presbyterian Hospital, New York, New York, USA;

5. Department of Ophthalmology, Weill Cornell Medicine and New York Presbyterian Hospital, New York, New York, USA;

Abstract

BACKGROUND: The repair of lateral sphenoid sinus cerebrospinal fluid leaks is routinely accomplished through the use of the endonasal endoscopic approach (EEA) with a transpterygoidal extension. This approach can incur sinus morbidity, damage to the vidian, palatine and trigeminal nerves, and the contents of the pterygopalatine fossa, particularly if the encephalocele is lateral to the foramen rotundum (FR) and V2. OBJECTIVE: To investigate the use of the lateral transorbital approach (LTOA) as an alternative approach for repair of lateral sphenoid sinus encephaloceles that avoids the potential morbidity of EEA. METHODS: We performed cadaveric dissections of 2 specimens (4 sides) and present one of the first cases of a lateral sphenoid sinus encephalocele repair lateral to the FR in a patient through an ipsilateral LTOA. RESULTS: We find that the LTOA provides a shorter distance to target compared with the EEA (56 vs 89.5 mm, P = .002). The LTOA field of view also affords excellent visualization of both the medial and lateral aspects of V2, whereas the EEA is less effective at exposing lateral to V2, even after sacrifice of the vidian nerve and maximal pterygopalatine fossa content retraction. We report a case of LTOA to repair a meningoencephalocele lateral to V2 in the sphenoid sinus. CONCLUSION: The LTOA to the foramen rotundum is a more direct approach that minimizes the morbidity associated with EEA to repair meningoencephaloceles both medial and lateral to foramen rotundum.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Neurology (clinical),Surgery

Reference25 articles.

1. Low incidence of true Sternberg’s canal defects among lateral sphenoid sinus encephaloceles;Hanz;Acta Neurochir (Wien),2020

2. Surgical approaches to the cavernous sinus: a microsurgical study;Inoue;Neurosurgery,1990

3. The endoscopic, endonasal, transmaxillary transpterygoid approach to the pterygopalatine fossa, infratemporal fossa, petrous apex, and the Meckel cave;Hofstetter;J Neurosurg,2010

4. Endoscopic cranial base surgery: classification of operative approaches;Schwartz;Neurosurgery,2008

5. Surgical anatomy, technique and application of endoscopic endonasal transpterygoid approach in skull base surgery;Liu;Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi,2015

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