ECR 2009 / C-721
Imaging and the expanded endonasal approach to the skull base: What the neurosurgeons need to know
Type:
Educational Exhibit
Authors:
N. J. Klitsch, V. Agarwal, W. T. Rothfus, M. M. Rahman, A. B. Kassam, P. A. Gardner, D. M. S. Prevedello; Pittsburgh, PA/US
DOI:
10.1594/ecr2009/C-721
Conclusion
- Expanded endonasal approach (EEA) is a new and rapidly evolving minimally invasive technique for treating skull base pathology.
- Preoperative planning and intraoperative guidance using a combination of CT and MRI helps to identify the relationship of skull base lesions to important neurovascular structures and to the posterior paranasal sinuses.
- A key anatomic landmark is the medial opticocarotid recess (mOCR), an osseous indentation between the carotid canal and optic canal as viewed from the sphenoid sinus. The mOCR marks the middle clinoid process, the lateral border of the anterior sella.
- Normal postoperative MRI after EEA shows the osseous skull base defect covered by enhancing "C"-shaped soft tissue, which represents a vascularized nasoseptal mucosal flap.