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A 3-Dimensional Transnasal Endoscopic Journey Through the Paranasal Sinuses and Adjacent Skull Base: A Practical and Surgery-Oriented Perspective

Bolzoni Villaret, Andrea MD*; Battaglia, Paolo MD; Tschabitscher, Manfred MD, PhD§; Mattavelli, Davide MD*; Turri-Zanoni, Mario MD; Castelnuovo, Paolo MD; Nicolai, Piero MD*

doi: 10.1227/NEU.0000000000000172
Surgical Anatomy and Technique

An endoscopic approach through the transnasal corridor is currently the treatment of choice in the management of benign sinonasal tumors, cerebrospinal fluid leaks, and pituitary lesions. Moreover, this approach can be considered a valid option in the management of selected sinonasal malignancies extending to the skull base, midline meningiomas, parasellar lesions such as craniopharyngioma and Rathke cleft cyst, and clival lesions such as chordoma and ecchordosis.

Over the past decade, strict cooperation between otorhinolaryngologists and neurosurgeons and acquired surgical skills, together with high-definition cameras, dedicated instrumentation, and navigation systems, have made it possible to broaden the indications of endoscopic surgery. Despite these improvements, depth perception, as provided by the use of a microscope, was still lacking with this technology.

The aim of the present project is to reveal new perspectives in the endoscopic perception of the sinonasal complex and skull base thanks to 3-dimensional endoscopes, which are well suited to access and explore the endonasal corridor. In the anatomic dissection herein, this innovative device came across with sophisticated and long-established fresh cadaver preparation provided by one of the most prestigious universities of Europe. The final product is a 3-dimensional journey starting from the nasal cavity, reaching the anterior, middle, and posterior cranial fossae, passing through the ethmoidal complex, paranasal sinuses, and skull base. Anatomic landmarks, critical areas, and tips and tricks to safely dissect delicate anatomic structures are addressed through audio comments, figures, and their captions.

ABBREVIATIONS: CS, cavernous sinus

ET, eustachian tube

ICA, internal carotid artery

MMA, middle meningeal artery

MN, mandibular nerve

*Department of Otorhinolaryngology, University of Brescia, Brescia, Italy;

Department of Otorhinolaryngology, University of Insubria, Varese, Italy;

§Department of Systematic Anatomy, Medical University of Wien, Wien, Austria

Correspondence: Andrea Bolzoni Villaret, MD, Department of Otorhinolaryngology—Head and Neck Surgery, University of Brescia, Spedali Civili of Brescia, P.zza Spedali Civili, 1, 25123, Brescia, Italy. E-mail:

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Received April 18, 2013

Accepted September 10, 2013

Copyright © by the Congress of Neurological Surgeons