Endoscopic Endonasal Transclival Approach to the Jugular Tubercle
Endoscopic Endonasal Transclival Approach to the Jugular Tubercle
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DOI：
10.1227/neu.0b013e3182438915
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发表时间：
2012-09-01
期刊：
影响因子：
4.8
通讯作者：
Gardner, Paul
中科院分区：
文献类型：
--
作者：
Fernandez-Miranda, Juan C.;Morera, Victor A.;Gardner, Paul
背景：颈静脉结节是一个圆形的骨性突起，起源于斜坡的下外侧边缘。在以前的出版物中，我们描述了扩大的经鼻入路到颈静脉结节的手术解剖。目的：为了说明实验室工作的翻译，描述经鼻入路到颈静脉结节的解剖和技术细微差别。方法：我们回顾了相关的外科解剖需要执行鼻内途径的颈静脉结节，结果：在第一例中，暴露颈静脉结节并部分钻孔对于脑膜瘤获得足够的通道，尤其是其下外侧边缘是至关重要的。这使得早期断流术，安全的囊外剥离，并保留周围的神经血管结构。此外，颈静脉结节骨质增生，其切除，沿着与慷慨的硬脑膜切除，提供了一个I级辛普森肿瘤切除。在第二（软骨肉瘤）和第三（脉络膜）的情况下，颈静脉结节浸润的肿瘤，因此，其完整的切除是必要的，以实现全肿瘤切除。在最后一个病例中，一个不寻常的促肾上腺皮质激素分泌腺瘤在颈静脉结节区域复发，这里提出的经肝叶入路的技术改进成功地应用于实现完全切除和库欣病缓解。经颈静脉结节扩大鼻内经斜坡入路允许直接进入下斜坡腹外侧病变，岩斜区无大脑或小脑回缩，或颅神经操作过程中。
BACKGROUND: The jugular tubercle is a rounded bony prominence that arises from the inferolateral margin of the clivus. In a previous publication, we described the surgical anatomy of the expanded endonasal approach to the jugular tubercle.OBJECTIVE: To illustrate the translation of laboratory work to the operating room describing the anatomic and technical nuances of the endonasal approach to the jugular tubercle.METHODS: We review the relevant surgical anatomy needed to perform an endonasal approach to the jugular tubercle, and we select 4 different lesions to illustrate the application of our laboratory findings.RESULTS: In the first case, exposure and partial drilling of the jugular tubercle was critical to gain an adequate corridor to the meningioma, particularly to its inferolateral margin. This allowed for early devascularization, safe extracapsular dissection, and preservation of surrounding neurovascular structures. In addition, the jugular tubercle was hyperostotic and its resection, along with generous dural removal, provided a grade I Simpson tumor resection. In the second (chondrosarcoma) and third (chordoma) cases, the jugular tubercle was infiltrated by tumor, and consequently its complete resection was essential to achieve total tumor removal. In the last case, an unusual adrenocorticotropic hormone-secreting adenoma recurrence at the jugular tubercle region, the technical modification of the transclival approach presented here was successfully applied to achieve complete resection and Cushing disease remission.CONCLUSION: The transjugular tubercle variant of the expanded endonasal transclival approach allows for direct access to ventrolateral lesions in the inferior clival/petroclival region with no cerebral or cerebellar retraction, or cranial nerve manipulation during the approach.