Iranian Journal of Otorhinolaryngology

Iranian Journal of Otorhinolaryngology

Ipsilateral Nasoseptal Flap Pedicle for Transpterygoid Approach: Technical Note

Document Type : Original

Authors
Pasquale Anania 1
Marco Ceraudo 1
Alessandro Prior 1
Pietro Fiaschi 2
Gianluigi Zona 1
Frank Rikki Canevari 3
Diego Criminelli Rossi 1
1 Department of Neurosurgery, Policlinico San Martino Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy.
2 Department of Neurosurgery, Policlinico San Martino Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy. and Department of Neurosciences, Rehabilitation, Ophtalmology, Genetics, Maternal and Children(DINOGMI), University of Genoa, Genoa, Italy
3 Department of Otorhinolaryngology-Head and Neck Surgery, University of Genoa, Genoa, Italy.
10.22038/ijorl.2021.54687.2866
Abstract
Introduction:
Transpterygoid approach is an expanded endonasal approach (EEA) that allows surgical access to the medial infratemporal fossa, to the skull base area of petrous bone and to the Meckel’s cave. During this approach, a sacrifice of sphenopalatine artery is often required, leading to the need of contralateral Hadad-Bassagasteguy flap (HBF) or alternative reconstructive techniques.
 
Materials and Methods:
We report a case of spontaneous CSF leak due to a meningo-encephalocele in the left lateral recess of sphenoid sinus, in which an ispilateral nasoseptal flap was harvest and sphenopalatine artery was preserved.
 
Results:
We described the surgical technique adopted to preserve the ipsilateral nasoseptal vascular pedicle during transpterygoid approach and we performed a review of the pertinent literature.
Conclusion:
Wide exposure of the pterygoid base through transpterygoid approach could be obtained preserving the sphenopalatine artery, allowing skull base reconstruction with ipsilateral nasoseptal flap.
Keywords
Endoscopy
Endonasal
Ipsilateral
Nasoseptal
Reconstruction
Skull base
Transpterygoid
  1. Kassam AB, Gardner PA, Snyderman CH, Mintz A, Carrau R. Expanded Endonasal Approach: Fully Endoscopic, Completely Transnasal Approach to the Middle Third of the Clivus, Petrous Bone, Middle Cranial Fossa, and Infratemporal Fossa. Neurosurg Focus. 2005;19(1):E6.
  2. Zanation AM, Snyderman CH, Carrau RL, Gardner PA, Prevedello DM, Kassam AB. Endoscopic endonasal surgery for petrous apex lesions. The Laryngoscope. gennaio 2009;119(1):19–25.
  3.  Pinheiro-neto JC, Fernandez-miranda CD, Prevedello DM, Carrau RL, Gardner PA, Snyderman CH. Transposition of the Pterygopalatine Fossa during Endoscopic Endonasal Transpterygoid Approaches. J Neurol Surg B 2013;74:266–270. 2013; 74:266–70.
  4.  Anania P, Mirapeix-Lucas R, Zona G, Prior A, Cortes CA, Muñoz Hernandez F. Middle Cranial Fossa Approach: Anatomical Study on Skull Base Triangles as a Landmark for a Safe Anterior Petrosectomy. Journal of Neurological Surgery Part B: Skull Base. 12 settembre 2019;
  5.  Tubbs RS, Menendez J, Loukas M, Shoja MM, Shokouhi G, Salter EG, et al. The petrosal nerves: Anatomy, pathology, and surgical considerations. Clinical Anatomy. 6 luglio 2009;22(5):537–44.
  6.  Hadad G, Bassagasteguy L, Carrau RL, Mataza JC, Kassam A, Snyderman CH, et al. A Novel Reconstructive Technique After Endoscopic Expanded Endonasal Approaches: Vascular Pedicle Nasoseptal Flap. The Laryngoscope. ottobre 2006; 116(10): 1882–6.
  7.  Ajler P, Beltrame SA, Campero A, Garategui L, Plou P, Yampolsky C. Safety margin for the preservation of the nasoseptal artery during transnasal endoscopic approach. J Neurosurg Sci. 2019;
  8.  Schmidt RF, Choudhry OJ, Raviv J, Baredes S, Casiano RR, Eloy JA, et al. Surgical nuances for the endoscopic endonasal transpterygoid approach to lateral sphenoid sinus encephaloceles. Neurosurgical Focus. giugno 2012;32(6):E5.
  9.  Pinheiro-neto CD, Paluzzi A, Fernandez-miranda JC, Scopel TF, Wang EW, Gardner PA, et al. Extended Dissection of the Septal Flap Pedicle for Ipsilateral Endoscopic Transpterygoid Approaches. 2014;(February):391–6.
  10.  Fortes FSG, Sennes LU, Carrau RL, Brito R, Ribas GC, Yasuda A, et al. Endoscopic Anatomy of the Pterygopalatine Fossa and the Transpterygoid Approach : Development of a Surgical Instruction Model. 2008;(January):44–9.
  11.  Cavallo LM, Solari D, Somma T, Cappabianca P. The 3F (Fat, Flap, and Flash) Technique For Skull Base Reconstruction After Endoscopic Endonasal Suprasellar Approach. World Neurosurgery. giugno 2019;126:439–46.
  12.  Ajlan A, Soudry E, Hwang PH. Spontaneous Sphenoid Wing Meningoencephaloceles with Lateral Sphenoid Sinus Extension : The Endoscopic Transpterygoid Approach. 2014;314–23.
  13.  Alexander NS, Chaaban MR, Riley KO, Woodworth BA. Treatment Strategies for Lateral Sphenoid Sinus Recess Cerebrospinal Fluid Leaks. 2020; 138(5):471–8.
  14. Almeida N, Bruno M, Pinto B, Augusto P, Filho M, Dantas M, et al. Lateral sphenoid sinus recess cerebrospinal fluid leak : a case series. 2014;2587–94.
  15.  Kim J-S, Kim D-H, Yoon W-S, Kim Y. Endoscopic Endonasal Transpterygoid Approach Using Pedicled Nasoseptal Flap for Petrous Apex Cholesterol Granuloma With Intraoperative Video. Journal of Craniofacial Surgery. settembre 2019; 30(6):1833–5.
  16.  Ulu MO, Aydin S, Kayhan A, Ozoner B, Kucukyuruk B, Ugurlar D, et al. Surgical Management of Sphenoid Sinus Lateral Recess Cerebrospinal Fluid Leaks: A Single Neurosurgical Center Analysis of Endoscopic Endonasal Minimal Transpterygoid Approach. World Neurosurgery. ottobre 2018;118:e473–82.
  17.  Kaligkiotis A, Bignami M, Terranova P, Ciniglio-Appiani M, Shawkat A, Verrilaud B, et al. Use of the pedicled nasoseptal flap in the endoscopic management of cholesterol granulomas of the petrous apex. Int Forum Allergy Rhinol. 2015;5(8):747–53.
  18. Babu AR, Prakash BG, Kadlimatti VI, Sandhya D, Kamath S. Contrasting Surgical Management of CSF Leak from Lateral Recess of Sphenoid Sinus and Its Surgical Outcomes: Our Experience. Indian Journal of Otolaryngology and Head & Neck Surgery. 26 dicembre 2019;71(4):531–6.
  19.  Ceraudo M, Prior A, Balestrino A, Anania P, Camera M, Fiaschi P, et al. Ultra-short antibiotic prophylaxis guided by preoperative microbiological nasal swabs in endoscopic endonasal skull base surgery. Acta Neurochir (Wien). 8 settembre 2020;
  20.  Ceraudo M, Anania P, Prior A, Rossi DC, Zona G. Modified Endoscopic Diving Technique without the Traditional Irrigation System in Endoscopic Cranial Base Surgery: Technical Note. World Neurosurgery. luglio 2019;127:146–9.
  21.  Fiaschi P, Prior A, Ceraudo M, Zona G, Criminelli Rossi D. Use of 4K resolution in endoscopic endonasal neurosurgery. Journal of Neurosurgical Sciences. gennaio 2020;63(6).
  22.  Kassam AB, Thomas A, Carrau RL, Snyderman CH, Vescan A, Prevedello D, et al. Endoscopic Reconstruction of the Cranial Base Using a Pedicled Nasoseptal Flap. Operative Neurosurgery. 1 luglio 2008;63(suppl_1):ONS44–53.
  23.  Ulu MO, Aydin S, Kayhan A, Ozoner B, Kucukyuruk B, Ugurlar D, et al. Surgical Management of Sphenoid Sinus Lateral Recess Cerebrospinal Fluid Leaks: A Single Neurosurgical Center Analysis of Endoscopic Endonasal Minimal Transpterygoid Approach. World Neurosurgery. 2018; 118:e473–82.
  24. Kasemsiri P, Solares CA, Carrau RL, Prosser JD, Prevedello DM, Otto BA, et al. Endoscopic endonasal transpterygoid approaches: Anatomical landmarks for planning the surgical corridor. The Laryngoscope. aprile 2013;123(4):811–5.
Iranian Journal of Otorhinolaryngology
Volume 33, Issue 6
November and December 2021
Pages 361-367