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Plou P, Serioli S, Alexander AY, Leonel LCPC, Peris-Celda M, Pinheiro-Neto CD. Full-Extension Eyebrow Approach with Supraorbital Nerve Preservation for Frontal Sinus Tumors. Laryngoscope 2024; 134:1633-1637. [PMID: 37676076 DOI: 10.1002/lary.31011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 07/18/2023] [Accepted: 08/07/2023] [Indexed: 09/08/2023]
Abstract
Frontal sinus surgery still represents a challenge due to its complex and highly variable anatomy. In this manuscript, we present a detailed anatomical description of an eyebrow approach that allows full exposure of the frontal sinus with a large osteoplastic bone flap and preservation of the supraorbital nerve. Laryngoscope, 134:1633-1637, 2024.
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Affiliation(s)
- Pedro Plou
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurosurgery and Department of Otolaryngology - Head and Neck Surgery, Mayo Clinic Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Rochester, Minnesota, USA
- Department of Neurosurgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Simona Serioli
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurosurgery and Department of Otolaryngology - Head and Neck Surgery, Mayo Clinic Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Rochester, Minnesota, USA
- Division of Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences And Public Health, University of Brescia, Brescia, Italy
| | - Alex Y Alexander
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurosurgery and Department of Otolaryngology - Head and Neck Surgery, Mayo Clinic Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Rochester, Minnesota, USA
| | - Luciano C P C Leonel
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurosurgery and Department of Otolaryngology - Head and Neck Surgery, Mayo Clinic Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Rochester, Minnesota, USA
| | - Maria Peris-Celda
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurosurgery and Department of Otolaryngology - Head and Neck Surgery, Mayo Clinic Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Rochester, Minnesota, USA
- Department of Otorhinolaryngology Head and Neck Surgery Mayo Clinic, Rochester, Minnesota, USA
| | - Carlos D Pinheiro-Neto
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurosurgery and Department of Otolaryngology - Head and Neck Surgery, Mayo Clinic Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Rochester, Minnesota, USA
- Department of Otorhinolaryngology Head and Neck Surgery Mayo Clinic, Rochester, Minnesota, USA
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Agosti E, Alexander AY, Plou P, Leonel LCPC, De Bonis A, Bauman MMJ, García-Lliberós A, Piazza A, Torregrossa F, Pinheiro Neto CD, Peris Celda M. 360° around the orbit: key surgical anatomy of the microsurgical and endoscopic cranio-orbital and orbitocranial approaches. Neurosurg Focus 2024; 56:E2. [PMID: 38560949 DOI: 10.3171/2024.1.focus23866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 01/30/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVE Several pathologies either invade or arise within the orbit. These include meningiomas, schwannomas, and cavernous hemangiomas among others. Although several studies describing various approaches to the orbit are available, no study describes all cranio-orbital and orbitocranial approaches with clear, surgically oriented anatomical descriptions. As such, this study aimed to provide a comprehensive guide to the microsurgical and endoscopic approaches to and through the orbit. METHODS Six formalin-fixed, latex-injected cadaveric head specimens were dissected in the surgical anatomy laboratory at the authors' institution. In each specimen, the following approaches were modularly performed: endoscopic transorbital approaches (ETOAs), including a lateral transorbital approach and a superior eyelid crease approach; endoscopic endonasal approaches (EEAs), including those to the medial orbit and optic canal; and transcranial approaches, including a supraorbital approach, a fronto-orbital approach, and a 3-piece orbito-zygomatic approach. Each pertinent step was 3D photograph-documented with macroscopic and endoscopic techniques as previously described. RESULTS Endoscopic endonasal approaches to the orbit afforded excellent access to the medial orbit and medial optic canal. Regarding ETOAs, the lateral transorbital approach afforded excellent access to the floor of the middle fossa and, once the lateral orbital rim was removed, the cavernous sinus could be dissected and the petrous apex drilled. The superior eyelid approach provides excellent access to the anterior cranial fossa just superior to the orbit, as well as the dura of the lesser wing of the sphenoid. Craniotomy-based approaches provided excellent access to the anterior and middle cranial fossa and the cavernous sinus, except the supraorbital approach had limited access to the middle fossa. CONCLUSIONS This study outlines the essential surgical steps for major cranio-orbital and orbitocranial approaches. Endoscopic endonasal approaches offer direct medial access, potentially providing bilateral exposure to optic canals. ETOAs serve as both orbital access and as a corridor to surrounding regions. Cranio-orbital approaches follow a lateral-to-medial, superior-to-inferior trajectory, progressively allowing removal of protective bony structures for proportional orbit access.
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Affiliation(s)
- Edoardo Agosti
- 1Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, Minnesota
- 2Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
- 3Division of Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Italy
| | - A Yohan Alexander
- 1Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, Minnesota
- 2Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
- 4Medical School, University of Minnesota, Minneapolis, Minnesota
| | - Pedro Plou
- 1Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, Minnesota
- 2Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
- 5Department of Neurosurgery, Hospital Italiano de Buenos Aires, Argentina
| | - Luciano C P C Leonel
- 1Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, Minnesota
- 2Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Alessandro De Bonis
- 1Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, Minnesota
- 2Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
- 6Department of Neurosurgery and Gamma Knife Radiosurgery, I.R.C.C.S. San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Megan M J Bauman
- 1Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, Minnesota
- 2Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Ainhoa García-Lliberós
- 1Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, Minnesota
- 2Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
- 7Department of Otolaryngology, Valencia University General Hospital, Valencia, Spain
| | - Amedeo Piazza
- 1Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, Minnesota
- 2Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
- 8Department of Neuroscience, "Sapienza" University, Rome, Italy
| | - Fabio Torregrossa
- 1Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, Minnesota
- 2Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
- 9Neurosurgical Unit, Department of Biomedicine, Neurosciences and Advanced Diagnostics (BiND), University of Palermo, Italy; and
| | - Carlos D Pinheiro Neto
- 1Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, Minnesota
- 2Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
- 10Department of Otolaryngology/Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
| | - Maria Peris Celda
- 1Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, Minnesota
- 2Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
- 10Department of Otolaryngology/Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
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Bauman MMJ, Leonel LCPC, Graepel S, Peris Celda M, Shin AY, Spinner RJ. The 2-by-2 Inch "Key Window" in the Upper Extremity: An Anatomical Appraisal of the Accessibility and Proximity of the Major Nerves and Vessels. World Neurosurg 2024:S1878-8750(24)00434-0. [PMID: 38508385 DOI: 10.1016/j.wneu.2024.03.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 03/09/2024] [Accepted: 03/11/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND The brachial plexus is a network of nerves located between the neck and axilla, which receives input from C5-T1. Distally, the nerves and blood vessels that supply the arm and forearm form a medial neurovascular bundle. The purpose of this study was to illustrate that a peripheral nerve dissection via a 2 × 2 inch window would allow for identification and isolation of the major nerves and blood vessels that supply the arm and forearm. METHODS A right side formalin-fixed latex-injected cadaveric arm was transected at the proximal part of the axillary fold and included the scapular attachments. Step-by-step anatomical dissection was carried out and documented with three-dimensional digital imaging. RESULTS A 2 × 2 inch window centered 2 inches distal to the axillary fold on the medial surface of the arm enabled access to the major neurovascular structures of the arm and forearm: the median nerve, ulnar nerve, medial antebrachial cutaneous nerve, radial nerve and triceps motor branches, musculocutaneous nerve and its biceps and brachialis branches and lateral antebrachial cutaneous nerve, basilic vein and brachial artery and vein, and profunda brachii artery. CONCLUSIONS Our study demonstrates that the majority of the neurovascular supply in the arm and forearm can be accessed through a 2 × 2 inch area in the medial arm. Although this "key window" may not be entirely utilized in the operative setting, our comprehensive didactic description of peripheral nerve dissection in the cadaver laboratory can help in safer identification of complex anatomy encountered during surgical procedures.
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Affiliation(s)
- Megan M J Bauman
- Mayo Clinic Alix School of Medicine, Rochester, Minnesota, USA; Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA; Mayo Clinic Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Rochester, Minnesota, USA
| | - Luciano C P C Leonel
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA; Mayo Clinic Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Rochester, Minnesota, USA
| | - Stephen Graepel
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Maria Peris Celda
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA; Mayo Clinic Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Rochester, Minnesota, USA; Department of Otolaryngology/Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Alexander Y Shin
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Robert J Spinner
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA; Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.
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Vilany L, Leonel LCPC, Flemming KD, Lanzino G, Peris-Celda M. Translamina Access Using a Bifrontal Approach to a Hypothalamic Cavernous Malformation: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2024; 26:359. [PMID: 38358286 DOI: 10.1227/ons.0000000000000961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 09/08/2023] [Indexed: 02/16/2024] Open
Affiliation(s)
- Larissa Vilany
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
- Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, Minnesota, USA
| | - Luciano C P C Leonel
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
- Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, Minnesota, USA
| | - Kelly D Flemming
- Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Giuseppe Lanzino
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
- Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, Minnesota, USA
| | - Maria Peris-Celda
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
- Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, Minnesota, USA
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
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Agosti E, Rezende NC, Leonel LCPC, Alexander AY, Pinheiro-Neto CD, Peris-Celda M. Anatomical Step-by-Step Dissection of Complex Skull Base Approaches for Trainees: Surgical Anatomy of the Endoscopic Endonasal and Endoscopic-Assisted Transmaxillary Transpterygoid Approaches. J Neurol Surg B Skull Base 2024; 85:81-94. [PMID: 38274480 PMCID: PMC10807960 DOI: 10.1055/s-0042-1759874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 11/07/2022] [Indexed: 12/30/2022] Open
Abstract
Introduction The endoscopic endonasal transpterygoid approach (EETPA) with or without the addition of the endoscopic-assisted sublabial anterior transmaxillary approach (ESTA) has become increasingly utilized for lesions posterior to the pterygopalatine fossa (PPF), including infratemporal fossa (ITF), lateral recess of the sphenoid sinus, Meckel's cave, petrous apex, and parapharyngeal space. The main goal of this study is to develop an educational resource to learn the steps of the EETPA for trainees. Methods EETPA and ESTA were performed in 12 specimens by neurosurgery trainees, under supervision from the senior authors. One EETPA and one ESTA were performed on each specimen on opposite sides. Dissections were supplemented with representative cases. Results After a wide unilateral sphenoidotomy, ethmoidectomy, and partial medial maxillectomy, the anteromedial bone limits of the PPF were identified and drilled out. The pterygoid progress was modularly removed. By enlarging the opening of the posterior and lateral walls of the maxillary sinus through EETPA and ESTA, respectively, the neurovascular and muscular compartments of the PPF and ITF were better identified. The EETPA opens direct corridors to the PPF, medial ITF, middle cranial fossa, cavernous sinus, Meckel's cave, petrous apex, and internal carotid artery. If a more lateral exposure of the ITF is needed, the ESTA is an appropriate addition. Conclusion Despite the steep learning curve of the EETPA, granular knowledge of its surgical anatomy and basic surgical steps are vital for those advancing their learning in complex endoscopic approaches to the ventral skull base when expanding the approach laterally in the coronal plane.
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Affiliation(s)
- Edoardo Agosti
- Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, Minnesota, United States
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
- Division of Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Natália Cerqueira Rezende
- Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, Minnesota, United States
- Department of Otolaryngology/Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, United States
| | - Luciano C. P. C. Leonel
- Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, Minnesota, United States
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
| | - A. Yohan Alexander
- Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, Minnesota, United States
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
| | - Carlos D. Pinheiro-Neto
- Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, Minnesota, United States
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
- Department of Otolaryngology/Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, United States
| | - Maria Peris-Celda
- Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, Minnesota, United States
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
- Department of Otolaryngology/Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, United States
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Nizzola M, Leonel LCPC, Peris-Celda M. Neurosurgery for the rhinologist. Curr Opin Otolaryngol Head Neck Surg 2024; 32:40-49. [PMID: 38193519 DOI: 10.1097/moo.0000000000000950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
PURPOSE OF REVIEW The purpose of this review is to provide a comprehensive anatomical appraisal of the neurosurgical anatomy exposed through the endonasal and paranasal sinuses routes, focusing on the most common expanded endonasal approaches (EEAs) as well as recent advances in this surgical field. RECENT FINDINGS The EEAs are redefining the management of skull base pathology. Neurovascular structures previously considered a limitation, can be now approached through these surgical corridors. Advances in this field include the development of new surgical techniques and routes that allow better visualization and access to pathologies located in the ventral skull base. Understanding the surgical anatomy related to EEAs is essential not only for neurosurgeons but also for rhinologists. SUMMARY Knowledge of the surgical anatomy of the most common EEAs that utilize paranasal sinuses as a surgical corridor enables more effective management of complex skull base pathologies. Comprehensive anatomical knowledge of these corridors and the surrounding neurovascular structures is crucial to maximize benefits of EEAs and improve outcomes.
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Affiliation(s)
- Mariagrazia Nizzola
- Mayo Clinic Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurosurgery and Gamma Knife radiosurgery, Vita-Salute San Raffaele University and IRCCS San Raffaele Scientific Institute, Milan, Italy
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
| | - Luciano C P C Leonel
- Mayo Clinic Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
| | - Maria Peris-Celda
- Mayo Clinic Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
- Department of Otolaryngology/Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
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Bauman MMJ, Leonel LCPC, Peris-Celda M, Rhoton-Vlasak AS. The Mayo, Cushing, and Osler Influence on A. L. Rhoton: A Historical Vignette of the Interconnectedness Between Highly Influential Neurosurgery Leaders over 100 Years. World Neurosurg 2024; 181:137-144. [PMID: 37683925 DOI: 10.1016/j.wneu.2023.08.143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 08/29/2023] [Accepted: 08/31/2023] [Indexed: 09/10/2023]
Abstract
The careers of the Mayo brothers, Harvey Cushing, and Sir William Osler greatly shaped medical and surgical practice in the late 19th century and early 20th century and created a legacy to influence decades of physicians to follow. Additionally, these individuals were instrumental in the founding of neurosurgery as a distinct surgical specialty. Alongside these great men, Dr. Albert L. Rhoton Jr., revolutionized neurosurgical practice through his study of neuroanatomy and development of microsurgical technique in the second half of the 20th century. This review of the interactions and relationships between the Mayo brothers, Cushing, and Osler and their influences on Rhoton highlights the 100-year-long interconnectedness shared between these giants in the history of neurosurgery.
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Affiliation(s)
- Megan M J Bauman
- Mayo Clinic Alix School of Medicine, Rochester, Minnesota, USA; Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Luciano C P C Leonel
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA; Mayo Clinic Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Rochester, Minnesota, USA
| | - Maria Peris-Celda
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA; Mayo Clinic Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Rochester, Minnesota, USA
| | - Alice S Rhoton-Vlasak
- Department of Obstetrics and Gynecology, University of Florida, Gainesville, Florida, USA.
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Serioli S, Plou P, Leonel LCPC, Graepel S, Buffoli B, Rezzani R, Fontanella MM, Poliani PL, Doglietto F, Link MJ, Pinheiro-Neto CD, Peris-Celda M. The "candy wrapper" of the pituitary gland: a road map to the parasellar ligaments and the medial wall of the cavernous sinus. Acta Neurochir (Wien) 2023; 165:3431-3444. [PMID: 37594638 DOI: 10.1007/s00701-023-05736-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 07/24/2023] [Indexed: 08/19/2023]
Abstract
PURPOSE The anatomy of the medial wall of the cavernous sinus (MWCS) and parasellar ligaments (PLs) has acquired increasing importance in endoscopic endonasal (EE) surgery of the cavernous sinus (CS), including resection of the MWCS in functioning pituitary adenomas (FPAs). Although anatomical studies have been published, it represents a debated topic due to their complex morphology. The aim is to offer a description of the PLs that originate from the MWCS and reach the lateral wall of the cavernous sinus (LWCS), proposing the "candy wrapper" model. The relationships between the neurovascular structures and histomorphological aspects were investigated. METHODS Forty-two CSs from twenty-one human heads were studied. Eleven specimens were used for EE dissection; five underwent a microscopic dissection. Five specimens were used for histomorphological analysis. RESULTS Two groups of PLs with a fan-shaped appearance were encountered. The anterior group included the periosteal ligament (55% sides) and the carotico-clinoid complex (100% sides), formed by the anterior horizontal and the carotico-clinoid ligaments. The posterior group was formed by the posterior horizontal (78% sides), and the inferior hypophyseal ligament (34% sides). The periosteal ligament originated inferiorly from the MWCS, reaching the periosteal dura. The anterior horizontal ligament was divided in a superior and inferior branch. The superior one continued as the carotid-oculomotor membrane, and the inferior branch reached the CN VI. The carotico-clinoid ligament between the middle and anterior clinoid was ossified in 3 sides. The posterior horizontal ligament was related to the posterior genu and ended at the LWCS. The inferior hypophyseal ligament followed the homonym artery. The ligaments related to the ICA form part of the adventitia. CONCLUSION The "candy wrapper" model adds further details to the previous descriptions of the PLs. Understanding this complex anatomy is essential for safe CS surgery, including MWCS resection for FPAs.
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Affiliation(s)
- Simona Serioli
- Division of Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
- Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, MN, USA
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Pedro Plou
- Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, MN, USA
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
- Neurosurgery Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Luciano C P C Leonel
- Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, MN, USA
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Stephen Graepel
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Barbara Buffoli
- Section of Anatomy and Physiopathology, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Rita Rezzani
- Section of Anatomy and Physiopathology, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Marco Maria Fontanella
- Division of Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Pietro Luigi Poliani
- Vita-Salute San Raffaele University and Pathology Unit, IRCCS San Raffaele, Milan, Italy
| | - Francesco Doglietto
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Catholic University School of Medicine, Rome, Italy
| | - Michael J Link
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
- Department of Otolaryngology/Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA
| | - Carlos D Pinheiro-Neto
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
- Department of Otolaryngology/Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA
| | - Maria Peris-Celda
- Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, MN, USA.
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA.
- Department of Otolaryngology/Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA.
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García-Lliberós A, Martin-Jimenez DI, Mondesir RJ, Agosti E, Alexander AY, Leonel LCPC, Choby G, Peris-Celda M, Pinheiro-Neto CD. Endoscopic-assisted en-bloc pterygomaxillectomy: Identifying an efficient and safe location for the pterygoid osteotomy. Head Neck 2023; 45:2718-2729. [PMID: 37458605 DOI: 10.1002/hed.27465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 05/10/2023] [Accepted: 07/05/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND For aggressive maxillary sinus and pterygopalatine fossa (PPF) tumors, an en-bloc pterygomaxillectomy may be indicated. METHODS Five head specimens were used to study the feasibility of an en-bloc pterygomaxillectomy. Eighty-five non-pathological CT scans were used to compare the superior edge of the inferior turbinate (IT) and the middle turbinate tail (MT) as landmarks for the pterygoid osteotomy. RESULTS Through a combined sublabial-subperiosteal incision and transoral route, a mid-sagittal osteotomy through the hard palate and an axial osteotomy below the infraorbital foramen were performed. For the endoscopic pterygoid osteotomy, an infra-vidian transpterygoid approach was performed, subsequently removing the pterygomaxillectomy en-bloc. As landmarks, the osteotomies at the level of the MT tail and IT resected the pterygoid plates completely, but the IT osteotomy was further away from the vidian canal (7.5 vs. 6 mm). CONCLUSIONS The endoscopic-assisted en-bloc pterygomaxillectomy is feasible. The IT landmark is safe and ensures complete resection of the pterygoid plates.
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Affiliation(s)
- Ainhoa García-Lliberós
- Department of Otolaryngology, Valencia University General Hospital, Valencia, Spain
- Rhoton Neurosurgery and Otolaryngology Anatomy Program, Mayo Clinic, Rochester, Minnesota, USA
| | - Daniel I Martin-Jimenez
- Rhoton Neurosurgery and Otolaryngology Anatomy Program, Mayo Clinic, Rochester, Minnesota, USA
- Department of Otolaryngology, University Hospital Virgen Macarena, Seville, Spain
| | - Ronsard J Mondesir
- Rhoton Neurosurgery and Otolaryngology Anatomy Program, Mayo Clinic, Rochester, Minnesota, USA
- Department of Otolaryngology, Mayo Clinic, Rochester, Minnesota, USA
| | - Edoardo Agosti
- Rhoton Neurosurgery and Otolaryngology Anatomy Program, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
- Division of Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - A Yohan Alexander
- Rhoton Neurosurgery and Otolaryngology Anatomy Program, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
- Medical School, University of Minnesota, Minneapolis, Minnesota, USA
| | - Luciano C P C Leonel
- Rhoton Neurosurgery and Otolaryngology Anatomy Program, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Garret Choby
- Department of Otolaryngology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Maria Peris-Celda
- Rhoton Neurosurgery and Otolaryngology Anatomy Program, Mayo Clinic, Rochester, Minnesota, USA
- Department of Otolaryngology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Carlos D Pinheiro-Neto
- Rhoton Neurosurgery and Otolaryngology Anatomy Program, Mayo Clinic, Rochester, Minnesota, USA
- Department of Otolaryngology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
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Serioli S, Nizzola M, Plou P, De Bonis A, Meyer J, Leonel LCPC, Tooley AA, Wagner LH, Bradley EA, Van Gompel JJ, Benini ME, Dallan I, Peris-Celda M. Surgical Anatomy of the Microscopic and Endoscopic Transorbital Approach to the Middle Fossa and Cavernous Sinus: Anatomo-Radiological Study with Clinical Applications. Cancers (Basel) 2023; 15:4435. [PMID: 37760405 PMCID: PMC10527149 DOI: 10.3390/cancers15184435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 08/30/2023] [Accepted: 09/01/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND The transorbital approaches (TOAs) have acquired growing notoriety, thanks to their ability to offer alternative corridors to the skull base. However, the limited access and the unfamiliarity with this surgical perspective make recognition of key landmarks difficult, especially for less experienced surgeons. The study wants to offer a detailed description of the anatomy to comprehend the potential and limitations of TOAs. METHODS Measurements of the orbit region and the surrounding areas were performed on two hundred high-resolution CT scans and thirty-nine dry skulls. Five specimens were dissected to illustrate the TOA, and one was used to perform the extradural clinoidectomy. Three clinical cases highlighted the surgical applications. RESULTS A step-by-step description of the key steps of the TOA was proposed and a comparison with the transcranial anterior clinoidectomy was discussed. The mean work distance was 6.1 ± 0.4 cm, and the lateral working angle increased 20 ± 5.4° after removing the lateral orbital rim. CONCLUSIONS TOAs are indicated in selected cases when tumor involves the lateral portion of the cavernous sinus or the middle skull base, obtaining a direct decompression of the optic nerve and avoiding excessive manipulation of the neurovascular structures. Comprehension of surgical anatomy of the orbit and its surrounding structures is essential to safely perform these approaches.
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Affiliation(s)
- Simona Serioli
- Division of Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, 25123 Brescia, Italy;
- Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, MN 55905, USA; (M.N.); (P.P.); (A.D.B.); (J.M.); (L.C.P.C.L.)
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, USA;
| | - Mariagrazia Nizzola
- Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, MN 55905, USA; (M.N.); (P.P.); (A.D.B.); (J.M.); (L.C.P.C.L.)
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, USA;
- Department of Neurosurgery and Gamma Knife Radiosurgery, I.R.C.C.S. San Raffaele Scientific Institute, Vita-Salute University, 20132 Milan, Italy
| | - Pedro Plou
- Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, MN 55905, USA; (M.N.); (P.P.); (A.D.B.); (J.M.); (L.C.P.C.L.)
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, USA;
- Neurosurgery Department, Hospital Italiano de Buenos Aires, Buenos Aires C1199, Argentina
| | - Alessandro De Bonis
- Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, MN 55905, USA; (M.N.); (P.P.); (A.D.B.); (J.M.); (L.C.P.C.L.)
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, USA;
- Department of Neurosurgery and Gamma Knife Radiosurgery, I.R.C.C.S. San Raffaele Scientific Institute, Vita-Salute University, 20132 Milan, Italy
| | - Jenna Meyer
- Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, MN 55905, USA; (M.N.); (P.P.); (A.D.B.); (J.M.); (L.C.P.C.L.)
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, USA;
- Department of Neurologic Surgery, Mayo Clinic, Phoenix, AZ 85054, USA
| | - Luciano C. P. C. Leonel
- Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, MN 55905, USA; (M.N.); (P.P.); (A.D.B.); (J.M.); (L.C.P.C.L.)
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, USA;
| | - Andrea A. Tooley
- Department of Ophthalmology, Mayo Clinic, Rochester, MN 55905, USA; (A.A.T.); (L.H.W.); (E.A.B.)
| | - Lilly H. Wagner
- Department of Ophthalmology, Mayo Clinic, Rochester, MN 55905, USA; (A.A.T.); (L.H.W.); (E.A.B.)
| | - Elizabeth A. Bradley
- Department of Ophthalmology, Mayo Clinic, Rochester, MN 55905, USA; (A.A.T.); (L.H.W.); (E.A.B.)
| | - Jamie J. Van Gompel
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, USA;
- Department of Otolaryngology/Head and Neck Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | - Maria Elena Benini
- Department of Neurosurgery—Head and Neck Surgery, Azienda Ospedaliero-Universitaria Pisana, 56126 Pisa, Italy;
| | - Iacopo Dallan
- Department of Otolaryngology—Head and Neck Surgery, Azienda Ospedaliero-Universitaria Pisana, 56126 Pisa, Italy;
| | - Maria Peris-Celda
- Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, MN 55905, USA; (M.N.); (P.P.); (A.D.B.); (J.M.); (L.C.P.C.L.)
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, USA;
- Department of Otolaryngology/Head and Neck Surgery, Mayo Clinic, Rochester, MN 55905, USA
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11
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Dang DD, Rechberger JS, Leonel LCPC, Rindler RS, Nesvick CL, Graepel S, Link MJ, Daniels DJ, Peris Celda M. Anatomical step-by-step dissection of common approaches to the third ventricle for trainees: surgical anatomy of the anterior transcortical and interhemispheric transcallosal approaches, surgical principles, and illustrative pediatric cases. Acta Neurochir (Wien) 2023; 165:2421-2434. [PMID: 37418043 DOI: 10.1007/s00701-023-05697-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 06/21/2023] [Indexed: 07/08/2023]
Abstract
PURPOSE To create a high-quality, cadaver-based, operatively oriented resource documenting the anterior transcortical and interhemispheric transcallosal approaches as corridors to the third ventricle targeted towards neurosurgical trainees at all levels. METHODS Two formalin-fixed, latex-injected specimens were dissected under microscopic magnification and endoscopic-assisted visualization. Dissections of the transcortical and transcallosal craniotomies with transforaminal, transchoroidal, and interforniceal transventricular approaches were performed. The dissections were documented in a stepwise fashion using three-dimensional photographic image acquisition techniques and supplemented with representative cases to highlight pertinent surgical principles. RESULTS The anterior transcortical and interhemispheric corridors afford excellent access to the anterior two-thirds of the third ventricle with varying risks associated with frontal lobe versus corpus callosum disruption, respectively. The transcortical approach offers a more direct, oblique view of the ipsilateral lateral ventricle, whereas the transcallosal approach readily establishes biventricular access through a paramedian corridor. Once inside the lateral ventricle, intraventricular angled endoscopy further enhances access to the extreme poles of the third ventricle from either open transcranial approach. Subsequent selection of either the transforaminal, transchoroidal, or interforniceal routes can be performed through either craniotomy and is ultimately dependent on individual deep venous anatomy, the epicenter of ventricular pathology, and the concomitant presence of hydrocephalus or embryologic cava. Key steps described include positioning and skin incision; scalp dissection; craniotomy flap elevation; durotomy; transcortical versus interhemispheric dissection with callosotomy; the aforementioned transventricular routes; and their relevant intraventricular landmarks. CONCLUSIONS Approaches to the ventricular system for maximal safe resection of pediatric brain tumors are challenging to master yet represent foundational cranial surgical techniques. We present a comprehensive operatively oriented guide for neurosurgery residents that combines stepwise open and endoscopic cadaveric dissections with representative case studies to optimize familiarity with third ventricle approaches, mastery of relevant microsurgical anatomy, and preparation for operating room participation.
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Affiliation(s)
- Danielle D Dang
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
- Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, 200 1S St SW, Rochester, MN, 55902, USA
| | - Julian S Rechberger
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
- Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, 200 1S St SW, Rochester, MN, 55902, USA
| | - Luciano C P C Leonel
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
- Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, 200 1S St SW, Rochester, MN, 55902, USA
| | - Rima S Rindler
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
- Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, 200 1S St SW, Rochester, MN, 55902, USA
| | - Cody L Nesvick
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Stephen Graepel
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Michael J Link
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
- Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, 200 1S St SW, Rochester, MN, 55902, USA
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA
| | - David J Daniels
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Maria Peris Celda
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA.
- Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, 200 1S St SW, Rochester, MN, 55902, USA.
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA.
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12
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Rezende NC, Leonel LCPC, Kosugi EM, Pinheiro-Neto CD, Peris-Celda M. The Arterial Pattern of the Upper Nasal Septum (S-Point) and Potential Role in Severe Epistaxis. Laryngoscope 2023; 133:2075-2080. [PMID: 36382868 DOI: 10.1002/lary.30487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 10/18/2022] [Accepted: 10/26/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The previously described S-point, corresponds to the medial projection of the middle turbinate axilla in the superior nasal septum and has been identified as a common source of severe epistaxis. The objective is to define the anatomical patterns of vascularization of the S-point area that could explain its clinical relevance. METHODS Thirty-three nasal septums of latex-injected formalin-embalmed and fresh human cadaveric heads were dissected to analyze the arterial arrangement of the S-point area. Measurements and patterns of vascularization were described. RESULTS The S-point area, was consistently surrounded by a single or multiple arterial anastomotic arches consistently formed superiorly by the anterior ethmoidal and posterior ethmoidal artery branches, and inferiorly by the posterior septal artery. The caliber of the arterial arches was typically larger than the caliber of the arterial branches supplying them. A single arch was present in 36.3% of septums, and multiple arches in 63.6%. The mean distance from the S-point to the anterior limit of the arch was 9 mm, to the posterior arch when the present was 3 mm, to the superior limit 6 mm, to the inferior limit 6 mm, and to the nasal roof was 10 mm. CONCLUSION This study demonstrates the dense arterial configuration of the S point area, which is characterized by a single or multiple vascular arches of greater caliber than the branches of origin. This finding could explain why the S-point area is a frequent source of epistaxis, and guide its surgical cauterization when an obvious vascular ectasia is not visualized. LEVEL OF EVIDENCE N/A Laryngoscope, 133:2075-2080, 2023.
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Affiliation(s)
- Natália Cerqueira Rezende
- Division of Rhinology and Skull Base Surgery, Department of Otolaryngology - Head & Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
- Department of Otorhinolaryngology and Head and Neck Surgery, Federal University of Sao Paulo (UNIFESP-EPM), Sao Paulo, Brazil
- Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, Minnesota, USA
| | - Luciano C P C Leonel
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
- Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, Minnesota, USA
| | - Eduardo Macoto Kosugi
- Department of Otorhinolaryngology and Head and Neck Surgery, Federal University of Sao Paulo (UNIFESP-EPM), Sao Paulo, Brazil
| | - Carlos Diógenes Pinheiro-Neto
- Division of Rhinology and Skull Base Surgery, Department of Otolaryngology - Head & Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
- Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, Minnesota, USA
| | - Maria Peris-Celda
- Division of Rhinology and Skull Base Surgery, Department of Otolaryngology - Head & Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
- Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, Minnesota, USA
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13
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Plou P, Serioli S, Leonel LCPC, Alexander AY, Agosti E, Vilany L, Graepel S, Choby G, Pinheiro-Neto CD, Peris-Celda M. Surgical Anatomy and Approaches of the Anterior Cranial Fossa from a Transcranial and Endonasal Perspective. Cancers (Basel) 2023; 15:cancers15092587. [PMID: 37174053 PMCID: PMC10177555 DOI: 10.3390/cancers15092587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 04/25/2023] [Accepted: 04/28/2023] [Indexed: 05/15/2023] Open
Abstract
The anterior cranial fossa (ACF) is a complex anatomical region that can be affected by a broad spectrum of pathology. For the surgical treatment of these lesions, many approaches have been described, each of them with different scope and potential surgical complications, often associated with significant morbidity. Traditionally, tumors involving the ACF have been operated by transcranial approaches; however, in the last two decades, endoscopic endonasal approaches (EEAs) have been gaining popularity. In this work, the authors review and describe the anatomical aspects of the ACF and the technical nuances of transcranial and endoscopic approaches for tumors located in this region. Four approaches were performed in embalmed cadaveric specimens and the key steps were documented. Four illustrative cases of ACF tumors were selected to demonstrate the clinical application of anatomical and technical knowledge, which are essential in the preoperative decision-making process.
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Affiliation(s)
- Pedro Plou
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, USA
- Mayo Clinic Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Rochesrer, MN 55905, USA
- Department of Neurosurgery, Hospital Italiano de Buenos Aires, Buenos Aires C1181ACH, Argentina
| | - Simona Serioli
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, USA
- Mayo Clinic Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Rochesrer, MN 55905, USA
- Division of Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, 25121 Brescia, Italy
| | - Luciano C P C Leonel
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, USA
- Mayo Clinic Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Rochesrer, MN 55905, USA
| | - A Yohan Alexander
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, USA
- Mayo Clinic Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Rochesrer, MN 55905, USA
| | - Edoardo Agosti
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, USA
- Mayo Clinic Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Rochesrer, MN 55905, USA
- Division of Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, 25121 Brescia, Italy
| | - Larissa Vilany
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, USA
- Mayo Clinic Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Rochesrer, MN 55905, USA
| | - Stephen Graepel
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | - Garret Choby
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, USA
- Mayo Clinic Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Rochesrer, MN 55905, USA
- Department of Otorhinolaryngology Head and Neck Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | - Carlos D Pinheiro-Neto
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, USA
- Mayo Clinic Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Rochesrer, MN 55905, USA
- Department of Otorhinolaryngology Head and Neck Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | - Maria Peris-Celda
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, USA
- Mayo Clinic Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Rochesrer, MN 55905, USA
- Department of Otorhinolaryngology Head and Neck Surgery, Mayo Clinic, Rochester, MN 55905, USA
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14
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Alexander AY, Agosti E, Leonel LCPC, Lanzino G, Peris-Celda M. Comparison Between the Supracerebellar Infratentorial and Precuneal Interhemispheric, Transtentorial Approaches to the Cerebellomesencephalic Fissure: An Anatomoradiological Study and Illustrative Cases. Oper Neurosurg (Hagerstown) 2023:01787389-990000000-00658. [PMID: 36972426 DOI: 10.1227/ons.0000000000000684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 01/17/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND The dorsal brainstem and cerebellomesencephalic fissure are challenging surgical targets. To afford a preferentially craniocaudal trajectory to this region, the precuneal interhemispheric transtentorial approach (PCIT) has been proposed. OBJECTIVE To didactically describe and compare exposures and anatomic indications of the supracerebellar infratentorial approach (SCIT) and PCIT to the cerebellomesencephalic fissure. METHODS Nine formalin-fixed, latex-injected cadaveric head specimens were used to perform a midline SCIT and bilateral PCITs and measure the distance of each approach. Twenty-four formalin-fixed specimens were used to measure the distance from the most posterior cortical bridging vein entering the superior sagittal sinus to the calcarine sulcus and the torcula. Fifty-one magnetic resonance images were reviewed to calculate the angle of each approach. Three illustrative surgical cases were described. RESULTS Mean distances from the brain or cerebellar surface to the operative target of the PCIT and SCIT were 7.1 cm (range: 5-7.7 cm) and 5.5 cm (range: 3.8-6.2 cm), respectively. The SCIT provided direct access to structures of the quadrigeminal cistern bilaterally. The PCIT provided access from the ipsilateral inferior colliculus to the ipsilateral infratrochlear zone. The PCIT's benefit was the direct access it provided to the cerebellomesencephalic fissure because of its superior to inferior trajectory. CONCLUSION The PCIT is indicated for unilateral lesions of the cerebellomesencephalic fissure and dorsal brainstem that harbor a craniocaudal long axis and do not have a superior extension beyond the superior colliculi. The SCIT is beneficial for lesions that extend bilaterally, have an anteroposterior long axis, or involve the Galenic complex.
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Affiliation(s)
- A Yohan Alexander
- Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
- Medical School, University of Minnesota, Minneapolis, Minnesota, USA
| | - Edoardo Agosti
- Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
- Division of Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Luciano C P C Leonel
- Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Giuseppe Lanzino
- Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Maria Peris-Celda
- Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, USA
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15
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Alexander AY, Agosti E, Leonel LCPC, Kerezoudis P, Peris-Celda M, Lanzino G. Precuneal Interhemispheric, Transtentorial Approach to a Dorsal Pontine Cavernous Malformation: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2022; 23:e173. [PMID: 35972100 DOI: 10.1227/ons.0000000000000301] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 04/03/2022] [Indexed: 02/04/2023] Open
Affiliation(s)
- A Yohan Alexander
- Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, Minnesota, USA.,Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Edoardo Agosti
- Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, Minnesota, USA.,Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA.,Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Luciano C P C Leonel
- Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, Minnesota, USA.,Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Maria Peris-Celda
- Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, Minnesota, USA.,Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Giuseppe Lanzino
- Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, Minnesota, USA.,Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA
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Alexander AY, Leonel LCPC, Agosti E, Celda MP, Lanzino G. The precuneal interhemispheric, trans-tentorial corridor to the pineal region and brainstem, surgical anatomy, and case illustration. Acta Neurochir (Wien) 2022; 164:1095-1103. [PMID: 35266050 DOI: 10.1007/s00701-022-05167-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 02/19/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND The pineal region and dorsal midbrain are among the most challenging surgical targets. To approach lesions in this region that harbor a superior to inferior long axis, we describe the basic steps of the precuneal, interhemispheric, trans-tentorial approach and illustrate anatomical landmarks of this established, but not so popular, surgical trajectory. METHOD To study the anatomical landmarks and safety of this approach, the neurovascular anatomy was studied on 22 sides of 11 formalin-fixed latex-injected anatomical specimens. A step-by-step dissection of the precuneal interhemispheric trans-tentorial approach and study of the key anatomical landmarks was performed. An illustrative clinical case of a pontomesencephalic cavernous malformation (CM) resected through this approach is also detailed. RESULTS The mean distance from the transverse sinus to the most posterior cortical vein draining into the superior sagittal sinus was 6.4 cm. The mean distance from the calcarine sulcus to the most posterior cortical vein was 5.3 cm. Key steps of the dissection are as follows: craniotomy exposing the posterior aspect of the superior sagittal sinus (SSS), durotomy and gentle retraction of the SSS edge, dissection of the interhemispheric fissure, linear incision of the tentorium that extends anteriorly to the incisura and lateral reflection of the tentorium, and arachnoidal dissection and exposure of the cerebellomesencephalic fissure. CONCLUSION The precuneal, interhemispheric, trans-tentorial approach affords excellent access to the falcotentorial junction, splenium, pineal region, quadrigeminal cistern, and dorsal pons once the cerebellomesencephalic fissure has been dissected.
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Affiliation(s)
- A Yohan Alexander
- Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, MN, USA
- Department of Neurological Surgery, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA
| | - Luciano C P C Leonel
- Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, MN, USA
- Department of Neurological Surgery, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA
| | - Edoardo Agosti
- Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, MN, USA
- Department of Neurological Surgery, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA
- Division of Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Maria Peris Celda
- Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, MN, USA
- Department of Neurological Surgery, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA
| | - Giuseppe Lanzino
- Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, MN, USA.
- Department of Neurological Surgery, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA.
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Rezende NC, Pinheiro‐Neto CD, Leonel LCPC, Van Gompel JJ, Peris‐Celda M, Choby G. Three‐hundred and sixty degrees of surgical approaches to the maxillary sinus. World J Otorhinolaryngol Head Neck Surg 2022; 8:42-53. [PMID: 35619930 PMCID: PMC9126161 DOI: 10.1002/wjo2.12] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 08/29/2021] [Indexed: 12/13/2022] Open
Abstract
Objectives To demonstrate three‐hundred and sixty degrees of maxillary sinus (MS) surgical approaches using cadaveric dissections, highlighting the step‐by‐step anatomy of each procedure. Methods Two latex‐injected cadaveric specimens were utilized to perform surgical dissections to demonstrate different approaches to the MS. The procedures were documented with macroscopic images and endoscopic pictures. Results Dissections were performed to approach the MS medially (endoscopic maxillary antrostomy and ethmoidectomy), anteriorly (Caldwell–Luc), superiorly (transconjunctival/transorbital approach), inferiorly (transpalatal approach), and posterolaterally (preauricular hemicoronal approach). Conclusion A number of approaches have been described to address pathology in the MS. Surgeons should be familiar with indications, limitations, and surgical anatomy from different perspectives to approach the MS. This paper illustrates anatomic approaches to the MS with detailed step‐by‐step cadaveric dissections and case examples. This paper provides a comprehensive review of surgical approaches to the MS, allowing for three‐hundred and sixty degrees of access, along with detailed step‐by‐step cadaveric dissections.
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Affiliation(s)
- Natália C. Rezende
- Division of Rhinology and Skull Base Surgery, Department of Otolaryngology‐Head & Neck Surgery Mayo Clinic Rochester Minnesota USA
- Department of Neurologic Surgery Mayo Clinic Rochester Minnesota USA
| | - Carlos D. Pinheiro‐Neto
- Division of Rhinology and Skull Base Surgery, Department of Otolaryngology‐Head & Neck Surgery Mayo Clinic Rochester Minnesota USA
- Department of Neurologic Surgery Mayo Clinic Rochester Minnesota USA
| | | | - Jamie J. Van Gompel
- Division of Rhinology and Skull Base Surgery, Department of Otolaryngology‐Head & Neck Surgery Mayo Clinic Rochester Minnesota USA
- Department of Neurologic Surgery Mayo Clinic Rochester Minnesota USA
| | - Maria Peris‐Celda
- Division of Rhinology and Skull Base Surgery, Department of Otolaryngology‐Head & Neck Surgery Mayo Clinic Rochester Minnesota USA
- Department of Neurologic Surgery Mayo Clinic Rochester Minnesota USA
| | - Garret Choby
- Division of Rhinology and Skull Base Surgery, Department of Otolaryngology‐Head & Neck Surgery Mayo Clinic Rochester Minnesota USA
- Department of Neurologic Surgery Mayo Clinic Rochester Minnesota USA
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Salgado-Lopez L, Leonel LCPC, O'brien M, Adepoju A, Graffeo CS, Carlstrom LP, Link MJ, Pinheiro-Neto CD, Peris-Celda M. Anatomical Step-by-Step Dissection of Complex Skull Base Approaches for Trainees: Endoscopic Endonasal Approach to the Orbit. J Neurol Surg B Skull Base 2022; 84:79-88. [PMID: 36743715 PMCID: PMC9897906 DOI: 10.1055/a-1723-1675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 12/13/2021] [Indexed: 02/07/2023] Open
Abstract
Introduction Although endonasal endoscopic approaches (EEA) to the orbit have been previously reported, a didactic resource for educating neurosurgery and otolaryngology trainees regarding the pertinent anatomy, techniques, and decision-making pearls is lacking. Methods Six sides of three formalin-fixed, color latex-injected cadaveric specimens were dissected using 4-mm 0- and 30-degree rigid endoscopes, as well as standard endoscopic equipment, and a high-speed surgical drill. The anatomical dissection was documented in stepwise three-dimensional (3D) endoscopic images. Following dissection, representative case applications were reviewed. Results EEA to the orbit provides excellent access to the medial and inferior orbital regions. Key steps include positioning and preoperative considerations, middle turbinate medialization, uncinate process and ethmoid bulla removal, complete ethmoidectomy, sphenoidotomy, maxillary antrostomy, lamina papyracea resection, orbital apex and optic canal decompression, orbital floor resection, periorbita opening, dissection of the extraconal fat, and final exposure of the orbit contents via the medial-inferior recti corridor. Conclusion EEA to the orbit is challenging, in particular for trainees unfamiliar with nasal and paranasal sinus anatomy. Operatively oriented neuroanatomy dissections are crucial didactic resources in preparation for practical endonasal applications in the operating room (OR). This approach provides optimal exposure to the inferior and medial orbit to treat a wide variety of pathologies. We describe a comprehensive step-by-step curriculum directed to any audience willing to master this endoscopic skull base approach.
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Affiliation(s)
- Laura Salgado-Lopez
- Department of Neurosurgery, Albany Medical Center, Albany, New York, United States,Department of Neuroscience and Experimental Therapeutics, Northeast Skull Base Dissection Laboratory, Albany Medical Center, Albany, New York, United States
| | - Luciano C. P. C. Leonel
- Department of Neurosurgery, Albany Medical Center, Albany, New York, United States,Department of Neuroscience and Experimental Therapeutics, Northeast Skull Base Dissection Laboratory, Albany Medical Center, Albany, New York, United States,Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, United States,Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, Minnesota, United States
| | - Michael O'brien
- Department of Neurosurgery, Albany Medical Center, Albany, New York, United States,Department of Neuroscience and Experimental Therapeutics, Northeast Skull Base Dissection Laboratory, Albany Medical Center, Albany, New York, United States
| | - Adedamola Adepoju
- Department of Neurosurgery, Albany Medical Center, Albany, New York, United States
| | | | - Lucas P. Carlstrom
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, United States
| | - Michael J. Link
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, United States,Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, Minnesota, United States,Department of Otolaryngology, Mayo Clinic, Rochester, Minnesota, United States
| | - Carlos D. Pinheiro-Neto
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, United States,Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, Minnesota, United States,Department of Otolaryngology, Mayo Clinic, Rochester, Minnesota, United States
| | - Maria Peris-Celda
- Department of Neurosurgery, Albany Medical Center, Albany, New York, United States,Department of Neuroscience and Experimental Therapeutics, Northeast Skull Base Dissection Laboratory, Albany Medical Center, Albany, New York, United States,Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, United States,Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, Minnesota, United States,Department of Otolaryngology, Mayo Clinic, Rochester, Minnesota, United States,Address for correspondence María Peris-Celda, MD, PhD Department of Neurosurgery, Mayo ClinicRochester, Minnesota 55905United States
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Carvalho CMF, Leonel LCPC, Cañada RR, Barreto RSN, Maria DA, Del Sol M, Miglino MA, Lobo SE. Comparison between placental and skeletal muscle ECM: in vivo implantation. Connect Tissue Res 2021; 62:629-642. [PMID: 33106052 DOI: 10.1080/03008207.2020.1834540] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE OF THE STUDY Several tissues have been decellularized and their extracellular matrices used as allogeneic or xenogeneic scaffolds, either in orthotopic or heterotopic implantations, for tissue engineering purposes. Placentas have abundant matrix, extensive microvascular structure, immunomodulatory properties, growth factors and are discarded after birth, representing an interesting source of extracellular matrix. This study aimed at comparing decellularized canine placentas and murine skeletal muscles to regenerate skeletal muscles in a rat model. MATERIALS AND METHODS Muscle pockets were created at the posterior limbs of male Wistar rats, where the muscle- and placenta-derived extracellular matrices were implanted. Macroscopic, histological, and immunohistochemical analyses were performed after 3, 15, and 45 days of surgeries. RESULTS On the third day, intense inflammatory reaction, with macrophages (CD163+) and proliferative cells (PCNA+) being observed in control group and adjacent to the decellularized matrices. The percentage of proliferative cells was higher in placenta than in muscle matrices. Macrophages CD163+ high were higher in muscles than in placentas, whereas CD163+ low were higher in placentas than in muscle ECM, at days 3 and 15. Placental matrices were not completely degraded at day 15, as opposed to the muscular ones. After 45 days, both matrices were resorbed and morphologically normal myofibers, with reduction of cell infiltration, were observed. CONCLUSIONS These results demonstrated that xenogeneic placental ECM, implanted heterotopically (representing a biologically critical and challenging microenvironment), induced local inflammatory reactions similar to the allogeneic muscle ECM, implanted orthotopically. Thus, placenta-derived extracellular matrix must be further explored in regenerative medicine.
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Affiliation(s)
- Carla Maria F Carvalho
- Department of Surgery, Sector of Anatomy, School of Veterinary Medicine and Animal Science, University of São Paulo, São Paulo, Brazil
| | - Luciano C P C Leonel
- Department of Surgery, Sector of Anatomy, School of Veterinary Medicine and Animal Science, University of São Paulo, São Paulo, Brazil
| | - Rafael R Cañada
- Biological Science, University São Judas Tadeu, São Paulo, Brazil
| | - Rodrigo S N Barreto
- Department of Surgery, Sector of Anatomy, School of Veterinary Medicine and Animal Science, University of São Paulo, São Paulo, Brazil
| | - Durvanei A Maria
- Molecular BIology Laboratory, Butantan Institute, São Paulo, Brazil
| | | | - Maria Angélica Miglino
- Department of Surgery, Sector of Anatomy, School of Veterinary Medicine and Animal Science, University of São Paulo, São Paulo, Brazil
| | - Sonja E Lobo
- Department of Surgery, Sector of Anatomy, School of Veterinary Medicine and Animal Science, University of São Paulo, São Paulo, Brazil
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Miranda CMFC, Leonel LCPC, Cañada RR, Maria DA, Miglino MA, Del Sol M, Lobo SE. Effects of chemical and physical methods on decellularization of murine skeletal muscles. AN ACAD BRAS CIENC 2021; 93:e20190942. [PMID: 34190843 DOI: 10.1590/0001-3765202120190942] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 10/07/2019] [Indexed: 11/22/2022] Open
Abstract
Volumetric muscle loss causes functional weakness and is often treated with muscle grafts or implant of biomaterials. Extracellular matrices, obtained through tissue decellularization, have been widely used as biological biomaterials in tissue engineering. Optimal decellularization method varies among tissues and have significant impact on the quality of the matrix. This study aimed at comparing the efficacy of four protocols, that varied according to the temperature of tissue storage and the sequence of chemical reagents, to decellularize murine skeletal muscles. Tibialis anterior muscles were harvested from rats and were frozen at -20°C or stored at room temperature, followed by decellularization in solutions containing EDTA + Tris, SDS and Triton X-100, applied in different sequences. Samples were analyzed for macroscopic aspects, cell removal, decrease of DNA content, preservation of proteins and three-dimensional structure of the matrices. Processing protocols that started with incubation in SDS solution optimized removal of cells and DNA content and preserved the matrix ultrastructure and composition, compared to those that were initiated with EDTA + Tris. Freezing the samples before decellularization favored cell removal, regardless of the sequence of chemical reagents. Thus, to freeze skeletal muscles and to start decellularization with 1% SDS solution showed the best results.
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Affiliation(s)
- Carla M F C Miranda
- Programa de Pós-Graduação em Anatomia dos Animais Domésticos e Silvestres, Universidade de São Paulo, Faculdade de Medicina Veterinária e Zootecnia, Departamento de Cirurgia, Disciplina de Anatomia, Av. Prof. Dr. Orlando Marques de Paiva, 87, Cidade Universitária, 05508-270 São Paulo, SP, Brazil
| | - Luciano C P C Leonel
- Programa de Pós-Graduação em Anatomia dos Animais Domésticos e Silvestres, Universidade de São Paulo, Faculdade de Medicina Veterinária e Zootecnia, Departamento de Cirurgia, Disciplina de Anatomia, Av. Prof. Dr. Orlando Marques de Paiva, 87, Cidade Universitária, 05508-270 São Paulo, SP, Brazil
| | - Rafael R Cañada
- Graduação em Ciências Biológicas, Universidade São Judas Tadeu, Av. Pereira Barreto, 1479, Baeta Neves, 09751-000 São Bernardo do Campo, SP, Brazil
| | - Durvanei A Maria
- Instituto Butantan, Laboratório de Biologia Molecular, Av. Vital Brasil, 1500, 05503-900 São Paulo, SP, Brazil
| | - Maria Angélica Miglino
- Programa de Pós-Graduação em Anatomia dos Animais Domésticos e Silvestres, Universidade de São Paulo, Faculdade de Medicina Veterinária e Zootecnia, Departamento de Cirurgia, Disciplina de Anatomia, Av. Prof. Dr. Orlando Marques de Paiva, 87, Cidade Universitária, 05508-270 São Paulo, SP, Brazil
| | - Mariano Del Sol
- Universidad de La Frontera, Departamento de Ciências Básicas, Francisco Salazar, 1145, 4811230 Temuco, Chile
| | - Sonja E Lobo
- Programa de Pós-Graduação em Anatomia dos Animais Domésticos e Silvestres, Universidade de São Paulo, Faculdade de Medicina Veterinária e Zootecnia, Departamento de Cirurgia, Disciplina de Anatomia, Av. Prof. Dr. Orlando Marques de Paiva, 87, Cidade Universitária, 05508-270 São Paulo, SP, Brazil
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Carvalho CMFDE, Leonel LCPC, SimÕes LS, Sasahara THC, Martins DS, Favaron PO, Miglino MA. Stereological analysis of the New Zealand rabbits (Oryctolagus cuniculus) placenta. AN ACAD BRAS CIENC 2021; 93:e20190286. [PMID: 33656048 DOI: 10.1590/0001-3765202120190286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 06/17/2019] [Indexed: 11/21/2022] Open
Abstract
The onset of gestation is characterized by growth, morphological and functional changes of the placenta. We aim to evaluate the placental compartments in New Zealand rabbits by means of stereological methods. The fetal and maternal portion of placenta (12, 14, 18 and 20 gestational days) was randomly sampled for the stereological analysis. Histological sections were scanned to estimate fetal (labyrinth and junctional) and maternal (decidua) compartment volumes. The total volume of the placenta for the ages of 12, 14, 18 and 20 days was, respectively, 320 mm3, 340 mm3, 940 mm3 and 1300 mm3. The volume of the labyrinth was 56 mm3, 119 mm3, 231 mm3 and 481 mm3, respectively. The volume of junctional zone was 75 mm3, 76 cm3, 238 mm3 and 314 mm3, respectively. The volume of decidua was 174 mm3, 143 mm3, 469 mm3 and 504 mm3, respectively. We concluded that the rabbit´s placenta compartments varied according to the gestational period, increasing continuously over the 20 gestational days. However, on the onset of the development of the placenta the decidua presented faster growth, whereas after the 20 days of development, the labyrinth developed more quickly. This study represents an aid to the understanding of placentation in humans.
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Affiliation(s)
- Carla M F DE Carvalho
- Universidade de São Paulo/ USP, Departamento de Cirurgia, Faculdade de Medicina Veterinária e Zootecnia, Av. Prof. Dr. Orlando de Marques Paiva, 87, Vila Universitária, 05508-270 São Paulo, SP, Brazil
| | - Luciano C P C Leonel
- Universidade de São Paulo/ USP, Departamento de Cirurgia, Faculdade de Medicina Veterinária e Zootecnia, Av. Prof. Dr. Orlando de Marques Paiva, 87, Vila Universitária, 05508-270 São Paulo, SP, Brazil
| | - Luciana S SimÕes
- Universidade de São Paulo/ USP, Departamento de Cirurgia, Faculdade de Medicina Veterinária e Zootecnia, Av. Prof. Dr. Orlando de Marques Paiva, 87, Vila Universitária, 05508-270 São Paulo, SP, Brazil
| | - Tais H C Sasahara
- Universidade de São Paulo/ USP, Departamento de Cirurgia, Faculdade de Medicina Veterinária e Zootecnia, Av. Prof. Dr. Orlando de Marques Paiva, 87, Vila Universitária, 05508-270 São Paulo, SP, Brazil
| | - Daniele S Martins
- Faculdade de Zootecnia e Engenharia de Alimentos, Universidade de São Paulo/USP, São Paulo Av. Duque de Caxias Norte, 225, Zona Rural, 13635-900 Pirassununga, SP, Brazil
| | - Phelipe O Favaron
- Universidade de São Paulo/ USP, Departamento de Cirurgia, Faculdade de Medicina Veterinária e Zootecnia, Av. Prof. Dr. Orlando de Marques Paiva, 87, Vila Universitária, 05508-270 São Paulo, SP, Brazil
| | - Maria A Miglino
- Universidade de São Paulo/ USP, Departamento de Cirurgia, Faculdade de Medicina Veterinária e Zootecnia, Av. Prof. Dr. Orlando de Marques Paiva, 87, Vila Universitária, 05508-270 São Paulo, SP, Brazil
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22
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Leonel LCPC, Miranda CMFC, Coelho TM, Ferreira GAS, Caãada RR, Miglino MA, Lobo SE. Decellularization of placentas: establishing a protocol. ACTA ACUST UNITED AC 2017; 51:e6382. [PMID: 29185592 PMCID: PMC5685058 DOI: 10.1590/1414-431x20176382] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Accepted: 08/15/2017] [Indexed: 12/14/2022]
Abstract
Biological biomaterials for tissue engineering purposes can be produced through tissue and/or organ decellularization. The remaining extracellular matrix (ECM) must be acellular and preserve its proteins and physical features. Placentas are organs of great interest because they are discarded after birth and present large amounts of ECM. Protocols for decellularization are tissue-specific and have not been established for canine placentas yet. This study aimed at analyzing a favorable method for decellularization of maternal and fetal portions of canine placentas. Canine placentas were subjected to ten preliminary tests to analyze the efficacy of parameters such as the type of detergents, freezing temperatures and perfusion. Two protocols were chosen for further analyses using histology, scanning electron microscopy, immunofluorescence and DNA quantification. Sodium dodecyl sulfate (SDS) was the most effective detergent for cell removal. Freezing placentas before decellularization required longer periods of incubation in different detergents. Both perfusion and immersion methods were capable of removing cells. Placentas decellularized using Protocol I (1% SDS, 5 mM EDTA, 50 mM TRIS, and 0.5% antibiotic) preserved the ECM structure better, but Protocol I was less efficient to remove cells and DNA content from the ECM than Protocol II (1% SDS, 5 mM EDTA, 0.05% trypsin, and 0.5% antibiotic).
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Affiliation(s)
- L C P C Leonel
- Setor de Anatomia, Departamento de Cirurgia, Faculdade de Medicina Veterinária e Zootecnia, Universidade de São Paulo, São Paulo, SP, Brasil
| | - C M F C Miranda
- Setor de Anatomia, Departamento de Cirurgia, Faculdade de Medicina Veterinária e Zootecnia, Universidade de São Paulo, São Paulo, SP, Brasil
| | - T M Coelho
- Universidade Metodista de São Paulo, São Paulo, SP, Brasil
| | | | - R R Caãada
- Universidade São Judas Tadeu, São Paulo, SP, Brasil
| | - M A Miglino
- Setor de Anatomia, Departamento de Cirurgia, Faculdade de Medicina Veterinária e Zootecnia, Universidade de São Paulo, São Paulo, SP, Brasil
| | - S E Lobo
- Setor de Anatomia, Departamento de Cirurgia, Faculdade de Medicina Veterinária e Zootecnia, Universidade de São Paulo, São Paulo, SP, Brasil
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