The endoscopic transpterional port approach: anatomy, technique, and initial clinical experience

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OBJECTIVE

The evolution of microsurgical and endoscopic techniques has allowed the development of less invasive transcranial approaches. The authors describe a purely endoscopic transpterional port craniotomy to access lesions involving the cavernous sinus and the anterolateral skull base.

METHODS

Through single- or dual-port incisions and with direct endoscopic visualization, the authors performed an endoscopic transpterional port approach (ETPA) using a 4-mm straight endoscope in 8 sides of 4 formalin-fixed cadaveric heads injected with colored latex. A main working port incision is made just below the superior temporal line and behind the hairline. An optional 0.5- to 1-cm second skin port incision is made on the lateral supraorbital region, allowing multiangle endoscopic visualization and maneuverability. A 1.5- to 2-cm craniotomy centered over the pterion is done through the main port, which allows an extradural exposure of the cavernous sinus region and extra/intradural exposure of the frontal and temporal cranial fossae. The authors present a pilot surgical series of 17 ETPA procedures and analyze the surgical indications and clinical outcomes retrospectively.

RESULTS

The initial stage of this work on cadavers provided familiarity with the technique, standardized its steps, and showed its anatomical limits. The clinical ETPA was applied to gain access into the cavernous sinus, as well as for aneurysm clipping and meningioma resection. Overall, perioperative complications occurred in 1 patient (6%), there was no mortality, and at last follow-up all patients had a modified Rankin Scale score of 0 or 1.

CONCLUSIONS

The ETPA provides a less invasive, focused, and direct route to the cavernous sinus, and to the frontal and temporal cranial fossae, and it is feasible in clinical practice for selected indications with good results.

ABBREVIATIONS ACoA = anterior communicating artery; CN = cranial nerve; ETPA = endoscopic transpterional port approach; ICA = internal carotid artery; MCA = middle cerebral artery; mRS = modified Rankin Scale; PCoA = posterior communicating artery; SAH = subarachnoid hemorrhage.
Article Information

Contributor Notes

Correspondence Hugo Andrade-Barazarte: Toronto Western Hospital, Krembil Brain Institute, University of Toronto, ON, Canada. hugoandrade2@yahoo.es.INCLUDE WHEN CITING Published online February 22, 2019; DOI: 10.3171/2018.10.JNS171898.Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this
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