Contralateral Transmaxillary and Ipsilateral Transpterygoid Approaches: A Balanced Evaluation for Enhanced Endoscopic Petrosectomy Safety
Notice bibliographique
Résumé
Introduction: Traditional approaches to addressing the intricate regions of the petrous apex (PA) and petroclival region have predominantly relied on transtemporal and middle fossa transpetrosal strategies. The endoscopic endonasal approach, bolstered by advancements in endoscopic techniques, has proven effective in reaching lesions within this segment of the skull base. While the medial petrous apex presents lesser challenges, accessing the posterior and superior PA segments requires lateral mobilization of the paraclival segment of the internal carotid artery (ICA), a maneuver elevating the risk of arterial injury. The ipsilateral transpterygoid (ITP) approach is commonly utilized; however, while previous studies have advocated for the use of a contralateral transmaxillary (CTM. Corridor to minimize ICA mobilization, direct qualitative and quantitative anatomical comparisons between the two approaches remain limited. This study aims to precisely delineate the boundaries of endoscopic petrosectomy, comparing the visualization, angle of attack, reach and safety of the ITP and CTM approaches. Methods: Using image-guidance alongside 0° and 30° rigid endoscopes, ITP and CTM approaches were implemented bilaterally on three cadaveric specimens. We evaluated and recorded the visualization, and reach into the defined petrous bone segments—lateral petrous apex anteriorly (LPAA), lateral petrous apex posteriorly (LPAP), and inferior petrous apex (IPA). Thereafter, a consensus between two experienced endoscopic surgeons ensured a pragmatic safety analysis of drilling these segments, primarily focusing on the traction on the paraclival carotid. Quantitative analysis of the attack angles from the axis of the petrous segment of the ICA was performed using the GNU Image Manipulation Program (GIMP). Results: The ITP facilitated drilling reach into the LPAA, LPAP, and IPA in 5, 5, and 6 out of 6 petrosectomies, with “safe” drilling being affirmed in 1, 4, and 6 out of 6 instances, respectively. Conversely, the CTM approach consistently allowed “safe” drilling in all segments during every petrosectomy. Visualization comparisons using a 0° endoscope favored CTM for LPAP (6/6 vs. 3/6 in ITP) and showed no significant difference in LPAA and IPA visualization. The employment of a 30° endoscope nullified visualization differences between the approaches. Quantitative findings highlighted a reduced angle of attack for CTM (20.8° ± 1.5°) as against ITP (41.4° ± 2.3°). Conclusions: Both ITP and CTM approaches demonstrated extensive reach into the delineated petrous bone compartments, showcasing equivalent visualization capabilities with a 30° endoscope. The CTM approach availed a perceived heightened safety in LPAA drilling, situated posterior to the paraclival ICA, presumably due to a reduced angle of attack and less retraction on the paraclival carotid. The CTM emerges as a potentially favorable strategy when engaging with hard lesions behind the paraclival carotid where simple curettage is inadequate. The selection between ITP and CTM is nuanced, potentially hinging on intraoperative assessments of lesion consistency and its adherence to the carotid, rather than preoperative imaging alone. This underscores the imperative for a dynamic, intraoperative decision-making strategy to optimize outcomes in PA and petroclival region surgeries. Publication History Article published online: 05 February 2024 © 2024. Thieme. All rights reserved. Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,004 | 0,007 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,001 |
| Bibliométrie | 0,002 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,001 |
| Communication savante | 0,001 | 0,002 |
| Science ouverte | 0,000 | 0,001 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,004 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».