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Fully Endoscopic Transnasal Approach to the Jugular Foramen: Anatomic Study and Clinical Considerations

Dallan, Iacopo MD; Bignami, Maurizio MD; Battaglia, Paolo MD; Castelnuovo, Paolo MD*; Tschabitscher, Manfred MD*

Neurosurgery:
doi: 10.1227/01.NEU.0000354351.00684.B9
ANATOMIC REPORT: Anatomic Report
Abstract

BACKGROUND AND IMPORTANCE: To describe a transnasal endoscopic route to the jugular foramen and the endoscopic anatomy of the infratemporal fossa.

CLINICAL PRESENTATION: Endoscopic transnasal dissection of the infratemporal fossa was performed in 3 injected fresh heads (1 head only in arteries and 2 heads in arteries and veins). Two other double-injected specimens were dissected externally (2 of them side laterally and 1 anteriorly) to compare the different views and better understand the 3-dimensionality of the region.

Detailed endoscopic anatomy of the infratemporal fossa was clearly observed. The realization of a septal and posterior maxillary window allows surgeons to gain space to the jugular foramen. The ability to manage the vessels, especially the veins, and identify the muscles is mandatory. The fundamental role of the vidian canal in targeting the anterior genu of the internal carotid artery is confirmed. The role of the maxillary and mandibular branches of the trigeminal nerve and the eustachian tube in this kind of approach is critical.

CONCLUSION: A fully transnasal endoscopic route to the jugular foramen is feasible. The most important landmark for this kind of approach is the eustachian tube.

Author Information

Ears, Nose, and Throat Unit, Azienda Ospedaliero, Universitaria Pisana, Pisa, Italy (Dallan)

Ears, Nose, and Throat Unit, Azienda Ospedaliero, Universitaria Ospedale di Circolo e, Fondazione Macchi, Varese, Italy (Bignami) (Battaglia) (Castelnuovo)

Department of Systematic Anatomy, Medical University of Vienna, Vienna, Austria (Tschabitscher)

Reprint requests: Iacopo Dallan, MD, ENT Unit, Azienda Ospedaliero, Universitaria Pisana, Via Savi, 10, 56126 Pisa, Italy., E-mail: iacopodallan@tiscali.it

*These authors contributed to this work equally.

Received, December 10, 2008.

Accepted, May 18, 2009.

Copyright © by the Congress of Neurological Surgeons