Premium
Pharyngobasilar fascia as a landmark in endoscopic skull base surgery: The triangulation technique
Author(s) -
Servian Diego A.,
BeerFurlan André,
Lima Lucas Ramos,
Montaser Alaa S.,
Galarce Matias Gomez,
Carrau Ricardo L.,
Prevedello Daniel M.
Publication year - 2019
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.27608
Subject(s) - medicine , otorhinolaryngology , general surgery , neurosurgery , surgery
The well-described endoscopic endonasal approach to the petrous apex region is still a challenge for the experienced skull base surgeon. It involves extensive drilling and dissection around the petrous, lacerum, and cavernous (paraclival) segments of the internal carotid artery (ICA). The vidian nerve has been previously described, and it is the main reference to the anterior genu of the horizontal segment of the petrous ICA and lacerum ICA. Although the vidian nerve has proven to be a consistent anatomical landmark, following it proximally by drilling the vidian canal until the lacerum ICA is time consuming and poses high risk of nerve damage. This is particularly evident when operating on patients with poor sphenoid sinus pneumatization or when dealing with distorted-anatomy secondary tumor displacement or previous surgery. The surgical experience led us to identify the usefulness of another constant landmark to the lacerum ICA, the pharyngobasilar fascia (PBF). Used solely or in combination with other landmarks, the PBF is very helpful for reducing time and increasing the accuracy in the localization of the lacerum ICA.