title: Endoscopic endonasal translacerum approach to the inferior petrous apex.
abstract: OBJECTIVE
  The surgical approach to lesions involving the inferior petrous apex (IPA) is still challenging. The purpose of this study is to demonstrate the anatomical features of the IPA and to assess the applicability of an endoscopic endonasal approach through the foramen lacerum (translacerum approach) to the IPA.
  
  
  METHODS
  The surgical simulation of the endoscopic endonasal translacerum approach was conducted in 3 cadaver heads. The same technique was applied in 4 patients harboring tumors involving the IPA (3 chordomas and 1 chondro-sarcoma).
  
  
  RESULTS
  By removing the fibrocartilaginous component of the foramen lacerum, a triangular space was created between the anterior genu of the petrous portion of the carotid artery and the eustachian tube, through which the IPA could be approached. The range of the surgical maneuver reached laterally up to the internal auditory canal, jugular foramen, and posterior vertical segment of the petrous portion of the carotid artery. In clinical application, the translacerum approach provided sufficient space to handle tumors at the IPA. Gross-total and partial removal was achieved in 3 and 1 cases, respectively, without permanent surgery-related morbidity and mortality.
  
  
  CONCLUSIONS
  The endoscopic endonasal translacerum approach provides reliable access to the IPA. It is indicated alone for lesions confined to the IPA and in combination with other approaches for more extensive lesions.
authors.affiliation: Department of Neurosurgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan.
authors.forename: Masaaki
authors.initials: M
authors.lastname: Taniguchi
authors.affiliation: Department of Neurosurgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan.
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Akutsu
authors.affiliation: Department of Neurosurgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan.
authors.forename: Katsu
authors.initials: K
authors.lastname: Mizukawa
authors.affiliation: Department of Neurosurgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan.
authors.forename: Masaaki
authors.initials: M
authors.lastname: Kohta
authors.affiliation: Department of Neurosurgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan.
authors.forename: Hidehito
authors.initials: H
authors.lastname: Kimura
authors.affiliation: Department of Neurosurgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan.
authors.forename: Eiji
authors.initials: E
authors.lastname: Kohmura
mesh_terms: D000328:Adult; D000368:Aged; D002102:Cadaver; D002339:Carotid Arteries / Q000033:anatomy & histology / Q000601:surgery; D002813:Chondrosarcoma / Q000473:pathology / Q000601:surgery; D002817:Chordoma / Q000473:pathology / Q000601:surgery; D004724:Endoscopy / Q000379:methods*; D005064:Eustachian Tube / Q000033:anatomy & histology / Q000601:surgery; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009296:Nasal Cavity / Q000033:anatomy & histology / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000379:methods*; D010579:Petrous Bone / Q000033:anatomy & histology / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology; D019292:Skull Base Neoplasms / Q000473:pathology / Q000601:surgery
keywords: ET = eustachian tube; FL = foramen lacerum; IPA = inferior petrous apex; endoscopic endonasal approach; eustachian tube; foramen lacerum; inferior petrous apex; petrous portion of the carotid artery; skull base tumor; surgical technique