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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]

Background: The sphenoidal spine protrudes from the roof of the infratemporal fossa (ITF). This study aims to assess the anatomic relationships among the sphenoidal spine and other structures within the ITF from the perspective of an endoscopic endonasal access (EEA), and to explore the implications of these relationships. Methods: An EEA to the ITF was completed on six cadaveric specimens (12 sides). The anatomical relationships among the sphenoidal spine and adjacent structures were explored and associated distances from each other were measured using a navigation system. Results: The foramen spinosum is located anterosuperior to the sphenoidal spine, whereas the chorda tympani courses caudal and medial to the sphenoidal spine and the Eustachian tube and parapharyngeal internal carotid artery (pICA) are at its posterior aspect. Two virtual vertical planes, at the anterior and posterior aspects of the sphenoidal spine, respectively, correspond to the posterior trunk of V3 and middle meningeal artery, and the stylopharyngeal aponeurosis. The average length of sphenoidal spine was 8.5 ± 2.43 mm, and the distance from distal apex of the sphenoidal spine to the foramen ovale, foramen spinosum, and pICA were 10.82 ± 0.83 mm, 6.42 ± 0.52 mm, and 5.02 ± 0.54 mm, respectively. Conclusions: The sphenoidal spine is a meaningful landmark for endonasal approaches to the ITF. Measurements and conceptualization of vertical planes prior and posterior to the sphenoidal spine are beneficial to better appreciate the anatomic relationships in the ITF. [ABSTRACT FROM AUTHOR]

Background The quadrangular space permits an anterior entry into Meckel's cave while obviating the need for cerebral or cranial nerve retraction. This avenue is intimately associated with the cavernous sinus; thus, from this ventral perspective, it is feasible to visualize the anteromedial, anterolateral, and Parkinson triangles. Methods Twenty middle cranial fossae were dissected endonasally under direct endoscopic visualization. Measurements of the surface area of the quadrangular space and the ventrally accessible cavernous sinus triangles were performed using 3 coordinates under image-guided navigation. Results The surface area of the quadrangular space was 16.36 mm2 (±2.89 mm2). The anterolateral triangle was the largest (47.27 ± 5.37 mm2), whereas Parkinson's was the smallest (22.46 ± 5.54 mm2); the anteromedial triangle presented an average surface area 36.07 mm2 (±4.15 mm2). Conclusion The trajectory of the internal carotid artery (ICA) significantly impacts the quadrangular space area and may be a potential parameter for defining the feasibility of this corridor. © 2016 Wiley Periodicals, Inc. Head Neck 38: E1680-E1687, 2016 [ABSTRACT FROM AUTHOR]