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      Anatomical Study on Meckel Cave with Endoscopic Endonasal, Endo-Maxillary Sinus, and Endo-Pterygoid Process Approaches

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          Abstract

          Objective

          To study anatomical structures related to Meckel cave with endonasal endoscopic approach and to provide an anatomical basis for endoscopic surgery in Meckel cave.

          Methods

          Meckel cave of 5 adult skulls (10 sides) were fixed with 10% formalin. The anatomical structures of Meckel cave and the related zones adjacent to Meckel cave were observed and measured with endoscopic endonasal approach.

          Results

          Endoscopic endonasal, endo-maxillary sinus, and endo-pterygoid process approaches were successfully applied in observation of the anatomical structures of meckel cave and the rerated zones adjacent to Meckel cave and in measurement of distances between related anatomical structures for each case of samples. The relevant data were obtained. The distance between the front mouth of palatovaginal canal and vidian canal was 21.4±7 mm, the distance between opening of sphenoid sinus to the upper margin of the choana was 22.3±2.8 mm, the distance between the opening of vidian and foramen rotundum was 7.57±0.7 mm and the length of the pterygoid canal was 13.3±1.2 mm. Based on these data, the positions of the related important structures can be roughly located during surgical operation and various important structures in Meckel cave and its adjacent zones can be found out in a convenient and safe way.

          Conclusion

          1) It is feasible to use endonasal endoscopic approach to perform surgical operation in Meckel cave; 2) Use of endonasal endoscopic approach can protect and fully take the advantage of the vidian nerve to locate the position of foramina lacerum of the internal carotid artery during surgical operation; and 3) the observational and experimental data obtained with this approach can provide the rational basis for clinical operation procedures.

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          Most cited references27

          • Record: found
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          Surgical approaches to the cavernous sinus: a microsurgical study.

          William A Rhoton, Tooru Inoue, D Theele … (1990)
          The surgical approaches to the cavernous sinus were examined in 50 adult cadaveric cavernous sinuses using magnification of X3 to X40. The following approaches were examined: 1) the superior intradural approach directed through a frontotemporal craniotomy and the roof of the cavernous sinus; 2) the superior intradural approach combined with an extradural approach for removing the anterior clinoid process and unroofing the optic canal and orbit; 3) the superomedial approach directed through a supraorbital craniotomy and subfrontal exposure to the wall of the sinus adjacent to the pituitary gland; 4) the lateral intradural approach directed below the temporal lobe to the lateral wall of the sinus; 5) the lateral extradural approach for exposure of the internal carotid artery in the floor of the middle cranial fossa proximal to the sinus; 6) the combined lateral and inferolateral approach, in which the infratemporal fossa was opened and the full course of the petrous carotid artery and the lateral wall of the sinus were exposed and; 7) the inferomedial approach, in which the medial wall of the sinus was exposed by the transnasal-transsphenoidal route. It was clear that a single approach was not capable of providing access to all parts of the sinus. The intracavernous structures best exposed by each route are reviewed. The osseous relationships in the region were examined in dry skulls. Anatomic variants important in exposing the cavernous sinus are reviewed.
          Article 0 comments Cited 45 times – based on 0 reviews     Review now
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            Trigeminal neurinomas extending into multiple fossae: surgical methods and review of the literature.

            T Kawase, Kenta Yoshida (1999)
            Since 1974, 27 patients with trigeminal neurinomas (TNs) have been treated at Keio University Hospital and ancillary institutes. In the present study the clinical features and developmental patterns of these 27 cases are analyzed, and the clinical features of 402 cases reported in the literature are reviewed. Based on the analysis of the developmental patterns of the TNs, the surgical strategy for a one-stage removal of TNs involving multiple fossae is described. Trigeminal neurinomas are classified into six types according to tumor location. Types M, P, and E are tumors involving a single compartment, that is, the middle fossa, posterior fossa, or extracranial space, respectively. Types MP (middle and posterior fossae), ME (middle fossa and extracranial space), or MPE (middle and posterior fossae and extracranial space) are tumors involving multiple compartments. Advances in neuroimaging technologies, such as magnetic resonance imaging, have revealed a high incidence of TNs extending into multiple fossae, namely 36.2% in cases reported since 1983 and 59% in the authors' series. All but one of the most recent 19 patients in this series underwent skull base surgery, whereas the remaining nine patients were surgically treated via the conventional subdural approach. The rate of total tumor removal and the clinical outcome were significantly better in those patients treated by skull base surgery than those treated by conventional surgery. The TNs extending into multiple fossae can be totally removed using the following single-stage surgical techniques: Type MP by the anterior transpetrosal approach; Type ME by the zygomatic or orbitozygomatic infratemporal approach; and Type MPE by the zygomatic transpetrosal approach. In 12 of 13 cases involving multiple fossae in this series, total tumor removal was achieved using single-stage skull base surgery.
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              Retrosigmoid intradural suprameatal approach to Meckel's cave and the middle fossa: surgical technique and outcome.

              M Tatagiba, Setareh M. Samii, Roberta G. Carvalho (2000)
              The goal of this study was to determine whether some petroclival tumors can be safely and efficiently treated using a modified retrosigmoid petrosal approach that is called the retrosigmoid intradural suprameatal approach (RISA). The RISA was introduced in 1983, and since that time 12 patients harboring petroclival meningiomas have been treated using this technique. The RISA includes a retrosigmoid craniotomy and drilling of the suprameatus petrous bone, which is located above and anterior to the internal auditory meatus, thus providing access to Meckel's cave and the middle fossa. Radical tumor resection (Simpson Grade I or II) was achieved in nine (75%) of the 12 patients. Two patients underwent subtotal resection (Simpson Grade III). and one patient underwent complete resection of tumor at the posterior fossa with subtotal resection at the middle fossa. There were no deaths or severe complications in this series; all patients did well postoperatively, being independent at the time of their last follow-up examinations (mean 5.6 years). Neurological deficits included facial paresis in one patient and worsening of hearing in two patients. The approach described here is a useful modification of the retrosigmoid approach, which allows resection of large petroclival tumors without the need for supratentorial craniotomies. Although technically meticulous, this approach is not time-consuming; it is safe and can produce good results. This is the first report on the use of this approach for petroclival meningiomas.
              Article 0 comments Cited 31 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Luo Zhang: Role: Editor
                Journal
                Journal ID (nlm-ta): PLoS One
                Journal ID (iso-abbrev): PLoS ONE
                Journal ID (publisher-id): plos
                Journal ID (pmc): plosone
                Title: PLoS ONE
                Publisher: Public Library of Science (San Francisco, USA )
                ISSN (Electronic): 1932-6203
                Publication date Collection: 2014
                Publication date (Electronic): 10 March 2014
                Volume: 9
                Issue: 3
                Electronic Location Identifier: e91444
                Affiliations
                [1]Department of Neurosurgery, the Second Hospital affiliated to Nantong University, Nantong University, Nantong, Jiangsu, China
                Beijing Institiute of Otolaryngology, China
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Conceived and designed the experiments: XW HY. Performed the experiments: XW ZC. Analyzed the data: ZW BM. Contributed reagents/materials/analysis tools: ZW ZY. Wrote the paper: XW YZ.

                Article
                Publisher ID: PONE-D-13-42516
                DOI: 10.1371/journal.pone.0091444
                PMC ID: 3948847
                PubMed ID: 24614159
                SO-VID: 83587466-91cb-4792-a918-0ca19b8901b5
                Copyright statement: Copyright @ 2014
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                Date received : 16 October 2013
                Date accepted : 12 February 2014
                Page count
                Pages: 5
                Funding
                These authors have no support or funding to report.
                Categories
                Subject: Research Article
                Subject: Medicine
                Subject: Anatomy and Physiology
                Subject: Neurological System
                Subject: Nerve Tissue
                Subject: Comparative Anatomy
                Subject: Sensory Systems
                Subject: Clinical Research Design
                Subject: Surgery
                Subject: Minimally Invasive Surgery
                Subject: Endoscopy
                Subject: Head and Neck Surgery
                Subject: Neurosurgery
                Subject: Trauma Surgery

                ScienceOpen disciplines: Uncategorized
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                ScienceOpen disciplines: Uncategorized

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