{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T12:20:47Z","timestamp":1779884447501,"version":"3.53.1"},"reference-count":27,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,12,1]]},"abstract":"<jats:sec>\n<jats:title>OBJECTIVE<\/jats:title>\n<jats:p>Accessing the petrous apex (PA) via an endoscopic endonasal approach (EEA) is challenging due to its posterior and lateral anatomical relationship with the paraclival carotid artery. Typically, the EEA requires the mobilization or compression of the vessel and the use of angled-lens endoscopes and instruments. A sublabial contralateral transmaxillary (CTM) corridor has been used to overcome these challenges. Still, it requires extensive osteo-meatal disruption and drilling of the medial pterygoid process, which risks the vidian nerve and increases nasal morbidity. Furthermore, the CTM corridor positions the endoscope in the same horizontal plane as the instruments passing through the nostrils, leading to fencing. The authors propose a novel minimally invasive route to the PA, the precaruncular contralateral medial transorbital (cMTO) corridor, to address these issues. This anatomical study compares the EEA+CTM and EEA+cMTO corridors in accessing the PA.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>The authors dissected 14 fresh, preinjected cadaveric specimens (28 sides) using neuronavigation to complete EEA, cMTO, and CTM on each side. In addition to qualitative analysis, they measured and compared the working distance between the entry point (nose, orbit, maxilla) and the petrosal process of the sphenoid bone (PPSB), superomedial PA, and foramen lacerum (FL); angle of attack (AoA); area of surgical freedom; endoscope-instrument fencing angle; and visual angle for each approach.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>The cMTO corridor provided the shortest working distance to the petroclival region (PA = 67.4 \u00b1 4.47 mm, PPSB = 67.57 \u00b1 4.33 mm, and FL = 66.30 \u00b1 4.77 mm) compared to the CTM (PA = 75.85 \u00b1 3.63 mm, PPSB = 76 \u00b1 3.96 mm, and FL = 74.52 \u00b1 4.26 mm) and to the EEA (PA = 85.16 \u00b1 3.16 mm, PPSB = 84.55 \u00b1 3.02 mm, and FL = 83.42 \u00b1 3.21 mm, p &lt; 0.001). Both CTM and cMTO corridors had a similar visual angle to the PA (20.72\u00b0 \u00b1 2.16\u00b0 and 21.63\u00b0 \u00b1 1.84\u00b0, respectively), offering a similar but significantly better visualization than EEA alone (44.71\u00b0 \u00b1 3.24\u00b0, p &lt; 0.001). The cMTO corridor provided better instrument maneuverability than the CTM, as evidenced by a significantly greater fencing angle (30.9\u00b0 \u00b1 4.9\u00b0) than with the CTM (21.7\u00b0 \u00b1 4.02\u00b0, p &lt; 0.001). The vertical AoAs for the EEA, cMTO, and CTM corridors were 9.79\u00b0 \u00b1 1.75\u00b0, 10.65\u00b0 \u00b1 0.82\u00b0, and 9.82\u00b0 \u00b1 1.43\u00b0, respectively (p = 0.009), whereas in the horizontal plane, these were 9.29\u00b0 \u00b1 1.51\u00b0, 9.10\u00b0 \u00b1 0.73\u00b0, and 10.49\u00b0 \u00b1 1.43\u00b0 (p &lt; 0.001), respectively. Both the CTM and cMTO corridors offered similar areas of surgical freedom (678.06 \u00b1 99.5 mm<jats:sup>2<\/jats:sup> and 673.59 \u00b1 104.8 mm<jats:sup>2<\/jats:sup>, p = 0.986), but they were more significant than that provided by the EEA 487.29 \u00b1 112.9 mm<jats:sup>2<\/jats:sup> (p &lt; 0.001).<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>The EEA+cMTO multiport technique may be a better alternative than the EEA+CTM multiport approach for targeting the petroclival region. However, clinical validation is required to confirm these laboratory findings.<\/jats:p>\n<\/jats:sec>","DOI":"10.3171\/2024.4.jns24730","type":"journal-article","created":{"date-parts":[[2024,7,24]],"date-time":"2024-07-24T03:06:42Z","timestamp":1721790402000},"page":"1494-1504","source":"Crossref","is-referenced-by-count":10,"title":["Comparison of endoscopic multiport approaches to the petrous apex: contralateral transmaxillary versus contralateral medial transorbital corridor"],"prefix":"10.3171","volume":"141","author":[{"given":"Jaskaran S.","family":"Gosal","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India;"},{"name":"Departments of Neurological Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Govind S.","family":"Bhuskute","sequence":"additional","affiliation":[{"name":"Otolaryngology\u2013Head & Neck Surgery, The James Cancer Hospital at the Wexner Medical Center of The Ohio State University College of Medicine, Columbus, Ohio;"},{"name":"Department of ENT, All India Institute of Medical Sciences (AIIMS), Patna, Bihar, India;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad Bilal","family":"Alsavaf","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery and"},{"name":"Otolaryngology\u2013Head & 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":"Moataz D.","family":"Abouammo","sequence":"additional","affiliation":[{"name":"Otolaryngology\u2013Head & 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; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sunil","family":"Manjila","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":"Kyle C.","family":"Wu","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deepak K.","family":"Jha","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ricardo L.","family":"Carrau","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery and"},{"name":"Otolaryngology\u2013Head & 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 & 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":[{"key":"b1","series-title":"Adv Tech Stand Neurosurg","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1007\/978-3-211-47423-5_5","article-title":"Surgical anatomy of the petrous apex and petroclival region","volume":"32","author":"Fournier HD","year":"2007","unstructured":"Fournier HD, Mercier P, Roche PH. 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