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Endoscopic orientation of the parasellar region in sphenoid sinus with ill-defined bony landmarks: an anatomic study.

ABSTRACT: The sphenoid bony landmarks are important for endoscopic orientation in skull base surgery but show a wide range of variations. We aimed to describe an instructional model for the endoscopic parasellar anatomy in sphenoid sinuses with ill-defined bony landmarks. Five preserved injected cadaveric heads and four sides of dry skulls were studied endoscopically via transethmoid, transsphenoidal approach. The parasellar region was exposed by drilling along the maxillary nerve (V2) canal [the length of the foramen rotundum (FR) between the middle cranial fossa and the pterygopalatine fossa]. This was achieved by drilling in the inferior part of the lateral wall of posterior ethmoids immediately above the sphenopalatine foramen. Cavernous V2 was traced to the paraclival internal carotid artery (ICA). Cavernous sinus (CS) apex was exposed by drilling a triangle bounded by V2 and its canal inferiorly, bone between FR and superior orbital fissure (SOF) anteriorly, and ophthalmic nerve (V1) superiorly. Drilling was continued toward the annulus of Zinn (AZ) and optic nerve superiorly and over the intracavernous ICA posteriorly. Endoscopic measurements between V2, SOF, AZ, and opticocarotid recess were obtained. Endoscopic systematic orientation of parasellar anatomy is presented that can be helpful for approaching sphenoid sinus with ill-defined bony landmarks.

SUBMITTER: Amin SM

PROVIDER: S-EPMC3134822 | biostudies-other | 2010 Nov

REPOSITORIES: biostudies-other

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Project description:In this study, we introduce an arthroscopic acromioplasty technique based on original bony landmarks, namely biplanar acromioplasty. This technique focuses on smoothing both the coronal and transverse plane of acromion, corresponding to the anterior and inferior acromial surface, and restores the acromion to its original shape. We believe this technique is effective, time-saving, and reproducible. Technique Video Video 1 This video demonstrates the procedure of the biplanar acromioplasty. Operation is performed with the patient under interscalene anesthesia and in the lateral decubitus position. With posterior portal working as viewing portal, a radiofrequency device is introduced through the anterolateral (AL) portal. Subacromial bursa is adequately debrided until the acromioclavicular (AC) joint and undersurface of acromion are clearly visualized. Inspect the spurs arising from undersurface and anterior margin of acromion. After debridement, landmarks for biplanar acromioplasty are then picked to delimit the resection area. The anterior landmark (Landmarkat) is the front edge of acromion lateral to the AC joint, medial to the spurs of anterior acromion. The Landmarkat is a short line, marking the boundary of coronal plane smoothing. To show the landmark in this video, we mark the spot with a needle. The landmark of the acromial undersurface (Landmarkud) is the flat acromion slope posteromedial to the “heel-shaped” spurs. The Landmarkud is a flat surface, acting as the mark for the transverse plane sweeping. A motorized burr is introduced through the AL portal. Aiming at the Landmarkud, the burr advances and smooths the undersurface of acromion. The same “aiming and smoothing” process is applied to the anterior acromion, and projections beyond the Landmarkat are resected. The attachment of deltoid muscle is preserved during the procedure. The transition from Landmarkat to the anterolateral edge of the acromion should be smooth after acromioplasty.

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Endoscopic orientation of the parasellar region in sphenoid sinus with ill-defined bony landmarks: an anatomic study.

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