{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T00:18:34Z","timestamp":1790381914313,"version":"4.1.0"},"reference-count":68,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,4]]},"abstract":"\n OBJECTIVE<\/jats:title>\n Minimally invasive endoscopic endonasal multiport approaches create additional visualization angles to treat skull base pathologies. The sublabial contralateral transmaxillary (CTM) approach and superior eyelid lateral transorbital approach, frequently used nowadays, have been referred to as the \"third port\" when used alongside the endoscopic endonasal approach (EEA). The endoscopic precaruncular contralateral medial transorbital (cMTO) corridor, on the other hand, is an underrecognized but unique port that has been used to repair CSF rhinorrhea originating from the lateral sphenoid sinus recess. However, no anatomical feasibility studies or clinical experience exists to assess its benefits and demonstrate its potential role in multiport endoscopic access to the other contralateral skull base areas. In this study, the authors explored the application and potential utility of multiport EEA combined with the endoscopic cMTO approach (EEA\/cMTO) to three target areas of the contralateral skull base: lateral recess of sphenoid sinus (LRSS), petrous apex (PA) and petroclival region, and retrocarotid clinoidocavernous space (CCS).<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n Ten cadaveric specimens (20 sides) were dissected bilaterally under stereotactic navigation guidance to access contralateral LRSS via EEA\/cMTO. The PA and petroclival region and retrocarotid CCS were exposed via EEA alone, EEA\/cMTO, and EEA combined with the sublabial CTM approach (EEA\/CTM). Qualitative and quantitative assessments, including working distance and visualization angle to the PA, were recorded. Clinical application of EEA\/cMTO is demonstrated in a lateral sphenoid sinus CSF leak repair.<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n During the qualitative assessment, multiport EEA\/cMTO provides superior visualization from a high vantage point and better instrument maneuverability than multiport EEA\/CTM for the PA and retrocarotid CCS, while maintaining a similar lateral trajectory. The cMTO approach has significantly shorter working distances to all three target areas compared with the CTM approach and EEA. The mean distances to the LRSS, PA, and retrocarotid CCS were 50.69 \u00b1 4.28 mm (p < 0.05), 67.11 \u00b1 5.05 mm (p < 0.001), and 50.32 \u00b1 3.6 mm (p < 0.001), respectively. The mean visualization angles to the PA obtained by multiport EEA\/cMTO and EEA\/CTM were 28.4\u00b0 \u00b1 3.27\u00b0 and 24.42\u00b0 \u00b1 5.02\u00b0 (p < 0.005), respectively.<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n Multiport EEA\/cMTO to the contralateral LRSS offers the advantage of preserving the pterygopalatine fossa contents and the vidian nerve, which are frequently sacrificed during a transpterygoid approach. This approach also offers superior visualization and better instrument maneuverability compared with EEA\/CTM for targeting the petroclival region and retrocarotid CCS.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2024.1.focus23863","type":"journal-article","created":{"date-parts":[[2024,4,1]],"date-time":"2024-04-01T02:17:53Z","timestamp":1711937873000},"page":"E10","source":"Crossref","is-referenced-by-count":12,"title":["Endoscopic precaruncular medial transorbital and endonasal multiport approaches to the contralateral skull base: a clinicoanatomical study"],"prefix":"10.3171","volume":"56","author":[{"given":"Govind S.","family":"Bhuskute","sequence":"first","affiliation":[{"name":"Department of ENT, All India Institute of Medical Sciences, Patna, Bihar, India;"},{"name":"Otolaryngology\u2013Head and Neck Surgery, The James Cancer Hospital at the Wexner Medical Center of The Ohio State University College of Medicine, Columbus, Ohio;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaskaran Singh","family":"Gosal","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery and"},{"name":"Department of Neurosurgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad Bilal","family":"Alsavaf","sequence":"additional","affiliation":[{"name":"Otolaryngology\u2013Head and Neck Surgery, The James Cancer Hospital at the Wexner Medical Center of The Ohio State University College of Medicine, Columbus, Ohio;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sunil","family":"Manjila","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyle C.","family":"Wu","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammed","family":"Alwabili","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery, Prince Sultan Military Medical City, Riyadh, Saudi Arabia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moataz D.","family":"Abouammo","sequence":"additional","affiliation":[{"name":"Otolaryngology\u2013Head and Neck Surgery, The James Cancer Hospital at the Wexner Medical Center of The Ohio State University College of Medicine, Columbus, Ohio;"},{"name":"Department of Otolaryngology\u2013Head and Neck Surgery, Tanta University, Tanta, Egypt;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ravi Sankar","family":"Manogaran","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Neuro-Otology Unit, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Darlene E.","family":"Lubbe","sequence":"additional","affiliation":[{"name":"Division of Otolaryngology, University of Cape Town Faculty of Health Sciences, Cape Town, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ricardo L.","family":"Carrau","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery and"},{"name":"Otolaryngology\u2013Head and Neck Surgery, The James Cancer Hospital at the Wexner Medical Center of The Ohio State University College of Medicine, Columbus, Ohio;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel M.","family":"Prevedello","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery and"},{"name":"Otolaryngology\u2013Head and Neck Surgery, The James Cancer Hospital at the Wexner Medical Center of The Ohio State University College of Medicine, Columbus, Ohio;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"3","key":"b1","series-title":"J Neurosurg Sci","first-page":"332","article-title":"Limits of endoscopic endonasal transpterygoid approach to cavernous sinus and Meckel\u2019s cave","volume":"62","author":"Hardesty DA","year":"2018","unstructured":"Hardesty DA, Montaser AS, Carrau RL, Prevedello DM. Limits of endoscopic endonasal transpterygoid approach to cavernous sinus and Meckel\u2019s cave. J Neurosurg Sci. 2018;62(3):332\u2013338."},{"issue":"3 suppl","key":"b2","series-title":"Neurosurgery","first-page":"ons71","article-title":"The front door to Meckel\u2019s cave: an anteromedial corridor via expanded endoscopic endonasal approach\u2014technical considerations and clinical series","volume":"64","author":"Kassam AB","year":"2009","unstructured":"Kassam AB, Prevedello DM, Carrau RL, The front door to Meckel\u2019s cave: an anteromedial corridor via expanded endoscopic endonasal approach\u2014technical considerations and clinical series. 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J Neurosurg. 2024;140(3):677\u2013687."},{"key":"b8","series-title":"World Neurosurg","first-page":"e1047","article-title":"Exposure of the cavernous sinus via the endoscopic transorbital and endoscopic endonasal approaches: a comparative study","volume":"181","author":"Wang Q","year":"2024","unstructured":"Wang Q, Xu X, Ouyang S, Exposure of the cavernous sinus via the endoscopic transorbital and endoscopic endonasal approaches: a comparative study. World Neurosurg. 2024;181:e1047\u2013e1058."},{"issue":"9","key":"b9","series-title":"Acta Neurochir (Wien)","first-page":"2097","article-title":"Endoscopic endonasal and transorbital routes to the petrous apex: anatomic comparative study of two pathways","volume":"162","author":"Topczewski TE","year":"2020","unstructured":"Topczewski TE, Di Somma A, Pineda J, Endoscopic endonasal and transorbital routes to the petrous apex: anatomic comparative study of two pathways. 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World Neurosurg. 2017;103:713\u2013732."},{"key":"b34","series-title":"World Neurosurg","first-page":"128","article-title":"Endoscopic endonasal approach to multilobular giant pituitary adenoma with cavernous sinus invasion and petroclival extension","volume":"147","author":"Rahimli T","year":"2021","unstructured":"Rahimli T, Hidayetov T, Rajabov T. Endoscopic endonasal approach to multilobular giant pituitary adenoma with cavernous sinus invasion and petroclival extension. World Neurosurg. 2021;147:128\u2013129."},{"issue":"3","key":"b1","series-title":"J Neurosurg Sci","first-page":"332","article-title":"Limits of endoscopic endonasal transpterygoid approach to cavernous sinus and Meckel\u2019s cave","volume":"62","author":"Hardesty DA","year":"2018","unstructured":"Hardesty DA, Montaser AS, Carrau RL, Prevedello DM. Limits of endoscopic endonasal transpterygoid approach to cavernous sinus and Meckel\u2019s cave. 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J Neurosurg. 2024;140(3):677\u2013687."},{"key":"b8","series-title":"World Neurosurg","first-page":"e1047","article-title":"Exposure of the cavernous sinus via the endoscopic transorbital and endoscopic endonasal approaches: a comparative study","volume":"181","author":"Wang Q","year":"2024","unstructured":"Wang Q, Xu X, Ouyang S, Exposure of the cavernous sinus via the endoscopic transorbital and endoscopic endonasal approaches: a comparative study. World Neurosurg. 2024;181:e1047\u2013e1058."},{"issue":"9","key":"b9","series-title":"Acta Neurochir (Wien)","first-page":"2097","article-title":"Endoscopic endonasal and transorbital routes to the petrous apex: anatomic comparative study of two pathways","volume":"162","author":"Topczewski TE","year":"2020","unstructured":"Topczewski TE, Di Somma A, Pineda J, Endoscopic endonasal and transorbital routes to the petrous apex: anatomic comparative study of two pathways. 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