Objective: To evaluate the application of combination use of endoscopic endonasal approach combined with the frontotemporal orbitozygomatic approach microscopically in skull base tumor with intra and extra-cranial involvement. Methods: A total of 7 patients (4 males and 3 females, aging from 27 to 65 years old, with a medium age of 48) undergone complicated skull base surgeries via endoscopic endonasal approach combined with the frontotemporal orbitozygomatic approach microscopically from May 2016 to January 2018 were reviewed respectively. The patients included 2 cases of recurrent invasive pituitary adenoma, 3 cases of basal skull meningiomas, 1 case of clivus chondrosarcoma, and 1 case of recurrent nasopharyngeal carcinoma. The lesion extensively infiltrated nasal cavity, extending to the paranasal sinus, bilateral cavernous sinus, sellar region, suprasellar, superior clivus, temporal lobe, pterygopalatine fossa, infratemporal fossa and important intracranial vessels. All the 7 patients were treated under general anesthesia by endoscopic endonasal approach combined with frontotemporal orbitozygomatic approach under the microscope. Total excision rate, intraoperative and postoperative complications and postoperative curative effect were observed. All of them were followed up for 6 to 12 months. The Glasgow Outcome Scale (GOS) was used to evaluate the prognosis. Result: Total tumor removal was performed in 5 cases, subtotal removel in 2 cases. There was no complication during the operation. Postoperative severe complications occurred in 2 cases, including 1 case of cerebrospinal fluid rhinorrhea and intracranial infection, which was cured by lumbar cistern drainage and intrathecal injection; 1 case occurred oculomotor nerve paralysis, which recovered during follow-up. Postoperative complications occurred in 1 case of trochlear nerve dysfunction, 2 cases of facial numbness, and 1 case of tinnitus. During follow-up, all patients recovered to varying degrees. There was no bleeding and death after the operation. No tumor recurred during the follow-up period. All patients were recovered well with GOS grade Ⅳ-Ⅴ. Conclusions: Endoscopic transnasal approach combined with microscopic frontotemporal orbitozygomatic approach can remove tumors in one stage, reduce surgical complications and improve surgical effect. It has good application prospects and is suitable for excising complex intracranial and extracranial communicating tumors of widely involving sellar, clivus and petrous apex area.
Adult ; Aged ; Endoscopy ; Female ; Humans ; Male ; Meningeal Neoplasms ; Meningioma ; Middle Aged ; Pterygopalatine Fossa ; Retrospective Studies ; Skull Base/surgery* ; Skull Base Neoplasms/surgery*

BACKGROUND: The endoscopic transnasal approach has been proven to have advantages on the removal of the tumors in pterygopalatine fossa (PPF) and infratemporal fossa (ITF). Herein, this study aimed to describe a modified approach for resection of the tumors in these areas, both in cadaveric specimen and clinical patients. METHODS: The 20 adult cadaveric specimens and five patients with tumors in PPF and ITF were enrolled in this study. For the cadaveric specimens, ten were simulated anterior transmaxillary approach and ten were performed modified endoscopic transnasal transmaxillary approach. The exposure areas were compared between two groups and main anatomic structure were measured. Surgery was operated in the five patients with tumors of PPF and ITF to verify the experience from the anatomy. Perioperative management, intraoperative findings and postoperative complications were recorded and analyzed. RESULTS: The modified endoscopic transnasal transmaxillary approach provided as enough surgical exposure and high operability to the PPF and ITF as the anterior transmaxillary approach did. The diameter of maxillary artery in the PPF was 3.77 ± 0.78 mm (range: 2.06-4.82 mm), the diameter of middle meningeal artery in the ITF was 2.79 ± 0.61 mm (range: 1.54-3.78 mm). Four patients who suffered schwannoma got total removal and one of adenocystic carcinoma got subtotal removal. The main complications were facial numbness and pericoronitis of the wisdom tooth. No permanent complication was found. CONCLUSIONS With the widespread use of neuroendoscopy, the modified endoscopic transnasal transmaxillary approach is feasible and effective for the resection of tumors located in PPF and ITF, which has significant advantages on less trauma and complications to the patients.
Adult ; Female ; Humans ; Infratentorial Neoplasms ; pathology ; surgery ; Male ; Middle Aged ; Neuroendoscopy ; Perioperative Care ; Postoperative Complications ; Pterygopalatine Fossa ; pathology ; surgery

Immunoglobulin G4-related disease (IgG4-RD) is an immune-mediated systemic condition affecting diverse organs which lately has been increasingly recognized. A 40-year-old male presents intractable trigeminal neuralgia lasting more than a year even with numerous pain medication, which lead further evaluation. The infiltrative lesion was found involving left pterygopalatine fossa where maxillary nerve locates. We report a case of IgG4-RD with a sole manifestation of intractable unilateral trigeminal neuralgia which was improved by steroid treatment.
Adult ; Facial Pain ; Humans ; Immunoglobulins ; Male ; Maxillary Nerve ; Pterygopalatine Fossa ; Trigeminal Neuralgia

The sphenopalatine ganglion (SPG) is a parasympathetic ganglion, located in the pterygopalatine fossa. The SPG block has been used for a long time for treating headaches of varying etiologies. For anesthesiologists, treating postdural puncture headaches (PDPH) has always been challenging. The epidural block patch (EBP) was the only option until researchers explored the role of the SPG block as a relatively simple and effective way to treat PDPH. Also, since the existing evidence proving the efficacy of the SPG block in PDPH is scarce, the block cannot be offered to all patients. EBP can be still considered if an SPG block is not able to alleviate pain due to PDPH.
Blood Patch, Epidural ; Ganglia, Parasympathetic ; Ganglion Cysts ; Headache ; Humans ; Pain Management ; Post-Dural Puncture Headache* ; Pterygopalatine Fossa ; Sphenopalatine Ganglion Block*

With the increasing use of stereotactic radiosurgery, recent reports have suggested that stereotactic radiosurgery may induce secondary malignancies. While the risk of secondary malignancy after conventional radiotherapy is well known, its development after stereotactic radiosurgery has been reported in only a few cases. Here we present the case of a 56-year-old female with visual disturbance of sudden onset. She underwent trans-sphenoidal surgery for a pituitary adenoma 13 years earlier. Imaging studies revealed a newly developed pituitary mass invading the right carvenous sinus. Gross total resection of the tumor was performed using a trans-sphenoidal and pterygopalatine fossa approach. The histological diagnosis was pituitary epithelioid osteosarcoma. Clinicians should be aware of the rare occurrence of radiation-induced pituitary sarcoma as a potentially fatal late complication of stereotactic radiosurgery.
Diagnosis ; Female ; Humans ; Middle Aged ; Osteosarcoma* ; Pituitary Neoplasms* ; Pterygopalatine Fossa ; Radiosurgery ; Radiotherapy ; Sarcoma

Endoscopy ; Humans ; Pterygopalatine Fossa ; surgery

OBJECTIVE: As   a   guide   to   the   clinical   practice   of   infiltration   of   local   anesthesia   into   the pterygopalatine fossa via the greater palatine canal, this study sought to determine and record the  mean  CT  scan  measurements  of  the  following:  1)  palatal  mucosal  thickness,  2)  length  and width  of  greater  palatine  canal,  and  3)  length  and  width  of  pterygopalatine  fossa  among  adult patients in a private tertiary hospital in Quezon City.
METHODS:
Design: Retrospective, Descriptive Study
Setting: Tertiary Private Hospital
Subjects: Paranasal Sinus (PNS) CT Scans of 113 adult patients from January 2014 to May 2014 were reviewed and evaluated. Excluded were images with pathology that distorted the anatomy of the sinuses and surrounding structures.
RESULTS: Our study showed average CT scan measurements of 5.98 mm palatal mucosal thickness, 16.99  mm  greater  palatine  canal  length,  18.75  mm  pterygopalatine  fossa  length,  2.37  mm greater palatine canal width and 2.58 mm pterygopalatine fossa width. Comparison of average measurements  by  sex  was  not  statistically  significant.  There  was  statistical  significance  when comparing the right palatal mucosal thickness of 5.86 mm with the left which was 6.11 mm with p-value of 0.001. Comparison between the length of the right pterygopalatine fossa of 18.48 mm with the  left side at 19.01 mm showed statistical significance with p-value of 0.01.
CONCLUSION: As the average measurement of the mucosal palatal thickness combined with the length of the greater palatine canal was 22.97 mm, we recommend bending the needle 23 mm from  the  tip  in  a  45  degree  angle  for  adult  patients  who  will  undergo  sinus surgery,  control  of posterior epistaxis, trigeminal nerve block and minor oral cavity surgeries.

Human ; Male ; Female ; Adult ; Pterygopalatine Fossa ; Anesthesia, Local ; Needles ; Epistaxis ; Palate ; Paranasal Sinuses ; Mouth ; Trigeminal Nerve ; Palate ; Nose

As an important landmark, the posterolateral wall of maxillary sinus can help to locate numbers of significant signs such as maxillary artery and its branches, maxillary nerve and infraorbital nerve, infratemporal fossa and pterygopalatine fossa etc. in the endoscopic surgery for paranasal sinuses and lateral skull base. This article reviewed related researches about the anatomy and endoscopic surgery of posterolateral wall of maxillary sinus.
Endoscopy ; Humans ; Maxillary Artery ; Maxillary Nerve ; Maxillary Sinus ; anatomy & histology ; Nasal Surgical Procedures ; Pterygopalatine Fossa

OBJECTIVE: To summarize the clinical experience with endoscopic transnasal resection of nasal skull- base neoplasms, which involved anterior skull base, pterygopalatine fossa, nfratemporal fossa. METHOD: Clinical data from 73 patients performed on endoscopic transnasal resection of nasal skull-base neoplasms were analyzed retrospectively. RESULT: Total tumor removal was obtained in 54 cases, subtotal removal in 19 cases. In 16 cases of benign tumor, the postoperative survival rate was 100%; Malignancy in 57 cases, of which 16 patients were died, and half-year survival rate was 71.9%. CONCLUSION Endoscopic endonasal approach be able to fully reveal and re- moval of lesions involving the anterior skull base, pterygopalatine fossa and infratemporal fossa. The approach is feasible and safe.
Endoscopy ; Humans ; Nose ; surgery ; Postoperative Period ; Pterygopalatine Fossa ; Retrospective Studies ; Skull Base ; Skull Base Neoplasms ; surgery

Endoscopy ; methods ; Female ; Humans ; Meningocele ; surgery ; Middle Aged ; Pterygopalatine Fossa ; surgery