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This article discusses the use of intraoperative ultrasound (IUS) as an adjunct to the endoscopic endonasal approach (EEA) for the surgical resection of skull base lesions. The authors present a case study where a novel small-probe IUS was used to assist in the resection of a recurrent Rathke's cleft cyst (RCC) located in an atypical retrosellar region. The small-probe IUS provided real-time imaging feedback and enhanced visualization, allowing for accurate localization of the cyst and surrounding neurovascular structures. The authors conclude that IUS is a promising surgical adjunct that can potentially increase the extent of resection and decrease operation times. [Extracted from the article]

This article compares two surgical approaches, the endoscopic endonasal approach (EEA) and the midline suboccipital subtonsillar approach (STA), for accessing the jugular tubercle (JT) in the treatment of JT meningiomas. The study conducted on human cadaveric specimens measured three morphological variables: angle of attack (AoA), surgical freedom, and angle of endoscopic exposure (AoEE). The results showed that while STA offered greater surgical freedom, EEA provided superior visualization and AoEE. The choice of surgical approach should also consider the position of the lower cranial nerves in relation to the lesion. [Extracted from the article]

This article compares two different approaches for accessing the petrous apex through endoscopic endonasal surgery. The traditional approach, called the sublabial contralateral transmaxillary (CTM) corridor, has limitations such as instrument interference and increased nasal morbidity. The study introduces a new approach, the precaruncular contralateral medial transorbital (cMTO) corridor, which offers advantages such as a shorter distance to the target, a wider visualization angle, and better maneuverability for surgical instruments. The study was conducted on cadaveric specimens and further clinical studies are needed to validate these findings in patients. [Extracted from the article]

Objectives Endoscopic and endoscopic-assisted approaches to the parapharyngeal space have been reported; however, their potential for vascular exposure has not been previously assessed. This study aims to compare the potential exposure and control of the parapharyngeal internal carotid artery (ppICA) via various approaches. Design and Main Outcome Measures Ten cadaveric specimens were dissected bilaterally, exposing the ppICA via endonasal, transoral, and transcervical approaches. Length of the exposed vessel and potential control were assessed (feasibility and time required to place an encircling suture). Results Endoscopic transoral and transcervical-transmandibular approaches expose a significantly longer segment of the ppICA (6.89 and 7.09 cm) than the transoral and endonasal approaches. Vascular control was achieved via endoscopic-endonasal, endoscopic- transoral, and open techniques in 121.6, 64.8, and 5.2 seconds, respectively. Conclusion Histopathology, goals of surgery, and familiarity of the surgeon with each technique may ultimately determine the choice of approach; however, this study suggests that exposure of the ppICA by endoscopic-assisted transoral approach is comparable to that of a transcervical-transmandibular approach. Vascular controlwas feasible under elective circumstances. However, the difficulty varied widely, potentially reflecting the challenges of controlling an injured ppICA. However, one must note that active bleeding obscures the surgical field in ways that may impair ppICA control. Furthermore, the results may not reflect clinical scenarios where tumor distorts the surgical field. Nonetheless, the study suggests that, in properly selected patients, the endoscopicassisted transoral approach avoids problems associated with unsightly scars, mandibular osteotomy, and facial nerve manipulation, whereas, the transcervical--transmandibular approach offers the swiftest vascular control. [ABSTRACT FROM AUTHOR]