Cristian Naudy

A Road Map to the Internal Carotid Artery in Expanded Endoscopic Endonasal Approaches to the Ventral Cranial Base

BACKGROUND: Injuring the internal carotid artery (ICA) is a feared complication of endoscopic endonasal approaches. OBJECTIVE: To introduce a comprehensive ICA classification scheme pertinent to safe endoscopic endonasal cranial base surgery. METHODS: Anatomic dissections were performed in 33 cadaveric specimens (bilateral). Anatomic correlations were analyzed. RESULTS: Based on anatomic correlations, the ICA may be described as 6 distinct segments: (1) parapharyngeal (common carotid bifurcation to ICA foramen); (2) petrous (carotid canal to posterolateral aspect of foramen lacerum); (3) paraclival (posterolateral foramen lacerum to the superomedial aspect of the petrous apex); (4) parasellar (superomedial petrous apex to the proximal dural ring); (5) paraclinoid (from the proximal to the distal dural rings); and (6) intradural (distal ring to ICA bifurcation). Corresponding surgical landmarks included the Eustachian tube, the fossa of Rosenmüller, and levator veli palatini for the parapharyngeal segment; the vidian canal and V3 for the petrous segment; the fibrocartilage of foramen lacerum, foramen rotundum, maxillary strut, lingular process of the sphenoid bone, and paraclival protuberance for the paraclival segment; the sellar floor and petrous apex for the parasellar segment; and the medial and lateral opticocarotid and lateral tubercular recesses, as well as the distal osseous arch of the carotid sulcus for the paraclinoid segment. CONCLUSION: The proposed endoscopic classification outlines key anatomic reference points independent of the vessels geometry or the sinonasal pneumatization, thus serving as (1) a practical guide to navigate the ventral cranial base while avoiding injury to the ICA and (2) further foundation for a modular access system. ABBREVIATIONS: DOA, distal osseous arch EEA, expanded endoscopic approach ICA, internal carotid artery LOCR, lateral opticocarotid recess LTR, lateral tubercular recess MOCR, medial opticocarotid recess SOF, superior orbital fissure

Retrosigmoid approach for resection of petrous apex meningioma.

We present the case of a 50-year-old female with a 1-year history of right-side facial numbness, as well as an electric shock-like sensation on the right-side of the face and tongue. She was previously diagnosed with vertigo and trigeminal neuralgia. MRI was obtained showing a large right cerebellopontine angle mass. A retrosigmoid approach was performed and total removal was achieved after dissection of tumor from brainstem and cranial nerves IV, V, VI, VII and VIII. Pathology confirmed the diagnosis of a meningioma (WHO Grade I). The patient was discharged neurologically intact on the third postoperative day free of complications. The video can be found here: http://youtu.be/-tR0FtMiUDg .

Endonasal anatomy of the olfactory neural network: Surgical implications: Endonasal Anatomy of the Olfactory Network

Define the anatomic distribution of the olfactory filaments within specific mucosal regions of the nasal cavity.