Skip to main content
Log in

Endoscopic Endonasal Approach to Selected Lesions of the Petrous Apex

  • OTOLOGY: Tumors of the Ear and Lateral Skull Base (G Danesi, Section Editor)
  • Published:
Current Otorhinolaryngology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Surgery of the petrous apex lesions is considered a surgical challenge. We report our experience and review the literature highlighting current indications and limits in the management of benign and malignant lesions with special focus on the endoscopic approaches.

Recent Findings

Over the last years, indications and limits of the extended endonasal approaches range from inflammatory disease of the paranasal sinuses to the management of various diseases involving the skull base such as CSF leak, pituitary tumors, ethmoid tumors, petrous apex lesions, and purely intracranial lesions thanks to the development of dedicated surgical instrumentation, the improvement of skull base reconstruction techniques, and a better knowledge of the anatomy.

Summary

Extended endonasal approach to petrous apex lesions is a safe and effective procedure for appropriately selected patients in the hands of experienced endoscopic skull base surgeons. Nowadays, referral centers equipped by surgical teams with expertise to both endoscopic and lateral skull base routes represent the most safe and effective way of treatment of those diseases.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Schaberg MR, Evans JJ, Rosen MR. Endoscopic approaches to the petrous apex. Oper Tech Otolaryngol. 2011;22:269–73.

    Article  Google Scholar 

  2. Aubry K, Kania R, Sauvaget E, Huy PTB, Herman P. Endoscopic transsphenoidal approach to petrous apex cholesteatoma. Skull Base. 2010;20(4):305–8.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Zanation AM, Snyderman CH, Carrau RL, Gardner PA, Prevedello DM, Kassam AB. Endoscopic endonasal surgery for petrous apex lesions. Laringoscope. 2009;119(1):19–25.

    Article  Google Scholar 

  4. Gore MR, Zanation AM, Ebert CS, Senior BA. Cholesterol granuloma of the petrous apex. Otolaryngol Clin N Am. 2011;44(5):1043–58.

    Article  Google Scholar 

  5. Eytan DF, Kshettry VR, Sindwani R, Woodard TD, Recinos PF. Surgical outcome after endoscopic management of cholesterol granulomas of the petrous apex. Neurosurg Focus. 2014;37(4):E14.

    Article  PubMed  Google Scholar 

  6. Georgalas C, Kania R, Guichard JP, et al. Endoscopic transsphenoidal surgery for cholesterol, granuloma involving the petrous apex. Clin Otolaryngol. 2007;33(1):38–42.

    Article  Google Scholar 

  7. Gacek RR. Diagnosis and management of primary tumors of the petrous apex. Ann Otol Rhinol Laryngol. 1975;84(1Pt 2 Suppl 18):1–20.

    Article  CAS  PubMed  Google Scholar 

  8. Ichimura S, Yoshida K, Sutiono AB, Horiguchi T, Sasaki H, Kawase T. Greater petrosal nerve schwannomas-analysis of four cases and review of the literature. Neurosurg Rev. 2010;33:477–82.

    Article  PubMed  Google Scholar 

  9. • Raghavan D, Lee TC, Curtin HD. Cholesterol granuloma of the petrous apex: a 5-year review of radiology reports with follow-up of progression and treatment. J Neurol Sure B Skull Base. 2015;76(4):266–71. The importance of the radiologic description of the lesions in the petrous apex and correlation to the surgical route.

    Article  Google Scholar 

  10. Abdel Aziz KM, Sanna A, van Loverten HR, et al. Petroclival meningiomas: predictive parameters for transpetrosal approaches. Neurosurgery. 2000;47:139–50.

    CAS  PubMed  Google Scholar 

  11. • Shimony N, Gonen L, Shofty B, et al. Surgical resection of skull-base chordomas: experience in case selection for surgical approach according to anatomical compartments and reviews of the literature. Acta Neurochir. 2016;16:3032–9. Clear description of approaches for skull base chordomas.

    Google Scholar 

  12. Sbaihat A, Bacciu A, Pasanisi E, Sanna M. Skull base chondrosarcomas: surgical treatment and results. Ann Otol Rhinol Laryngol. 2013;122(12):763–70.

    Article  PubMed  Google Scholar 

  13. Brackmann DE, Toh EH. Surgical management of petrous apex cholesterol granulomas. Otol Neurotol. 2002;23:529–33.

    Article  PubMed  Google Scholar 

  14. Brodkey JA, Robertson JH, Shea JJ 3rd, Gardner G. Cholesterol granuloma of the petrous apex: combined neurosurgical and otological management. J Neurosurg. 1996;85:625–33.

    Article  CAS  PubMed  Google Scholar 

  15. Mosnier I, Cyna-Gorse F, Grayeli AB, Fraysse B, Martin C, Robier A, et al. Management of cholesterol granuloma of the petrous apex based on clinical and radiologic evaluation. Otol Neurotol. 2002;23:522–8.

    Article  PubMed  Google Scholar 

  16. • Russo FY, De Seta D, Mosnier I, et al. Surgical management of petrous apex cholesterol granulomas by an infralabyrinthine approach: our experience with 14 cases. Clin Otolaryngol. 2017;42(4):871–5. Describes the simplicity and possible solutions of an infralabyrinthine approach.

    Article  CAS  PubMed  Google Scholar 

  17. Kassam AB, Vescan AD, Carrau RL, Prevedello DM, Gardner P, Mintz AH, et al. Expanded endonasal approach: Vivian canal as a landmark to the petrous internal carotid artery. J Neurosurg. 2008;108(1):177–83.

    Article  PubMed  Google Scholar 

  18. Hadad G, Bassagasteguy L, Carrau RL, Mataza JC, Kassam A, Snyderman CH, et al. A novel reconstructive technique after endoscopic expanded approaches: vascular pedicle nasoseptal flap. Laryngoscope. 2006;116(10):1882–6.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Georgios Giourgos.

Ethics declarations

Conflict of Interest

The authors declare that they have no competing interests.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on OTOLOGY: Tumors of the Ear and Lateral Skull Base

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Giourgos, G., Bizzoni, A. & Danesi, G. Endoscopic Endonasal Approach to Selected Lesions of the Petrous Apex. Curr Otorhinolaryngol Rep 7, 73–78 (2019). https://doi.org/10.1007/s40136-019-00228-y

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40136-019-00228-y

Keywords

Navigation