title: Combined transoral robotic surgery and endoscopic endonasal approach for the resection of extensive malignancies of the skull base.
abstract: BACKGROUND
  Oncologic resection of the clivus, nasopharynx, craniovertebral junction, and infratemporal fossa is a challenging endeavor because of their complex and protected anatomy. Our goals were to design a cadaveric model and identify advantages and limitations of combining the transoral robotic surgery (TORS) and endoscopic endonasal approach (EEA) techniques.
  
  
  METHODS
  Cadaveric specimens were dissected using a da Vinci surgical robot and endoscopic endonasal instruments in a fashion that mimicked our operating room environment. We then applied these techniques clinically.
  
  
  RESULTS
  EEA was performed to provide a detailed dissection of the infratemporal fossa, nasopharynx, posterior skull base (clivus), and craniovertebral junction. Using TORS, we dissected the parapharyngeal space, infratemporal fossa, and nasopharynx below the eustachian tube, which represented a transition zone that delineated the most effective resection field of each approach.
  
  
  CONCLUSIONS
  TORS and EEA seem to be complementary techniques; thus, their combined use seems advantageous for selected advanced tumors in these complex areas.
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, The Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Comprehensive Cancer Center, The Ohio State University Medical Center, Columbus, Ohio.
authors.forename: Ricardo L
authors.initials: RL
authors.lastname: Carrau
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Prevedello
authors.forename: Danielle
authors.initials: D
authors.lastname: de Lara
authors.forename: Kasim
authors.initials: K
authors.lastname: Durmus
authors.forename: Enver
authors.initials: E
authors.lastname: Ozer
mesh_terms: D000328:Adult; D002102:Cadaver; D003528:Carcinoma, Adenoid Cystic / Q000473:pathology / Q000601:surgery; D002817:Chordoma / Q000473:pathology / Q000601:surgery; D003131:Combined Modality Therapy; D004210:Dissection; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009055:Mouth / Q000601:surgery; D009296:Nasal Cavity / Q000601:surgery; D057605:Natural Orifice Endoscopic Surgery / Q000295:instrumentation / Q000379:methods*; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D018570:Risk Assessment; D012371:Robotics / Q000379:methods*; D019291:Skull Base / Q000033:anatomy & histology / Q000601:surgery; D019292:Skull Base Neoplasms / Q000473:pathology* / Q000601:surgery*; D016896:Treatment Outcome
keywords: adenoid cystic carcinoma; chordoma; endoscopic surgery; skull base surgery; transoral robotic surgery