Case 181 - Transbuccal, Paramaxillary Approach for a Carotid Space Mass using the Styloid Process a Fixed Point

Not all cases need videos. Some can be explained with just images.

Current Case:

A 63-years old lady had left ear tinnitus - known to have a cavernous sinus lesion and a carotid space lesion for a few years, indeterminate etiology. A PET showed a lesion in the carotid space encasing the vessels.

MRI 2 weeks later shows a mass in the carotid space encasing the ICA and extending through the skull base into the dura.

The patient was referred for a CT guided biopsy.

A planning CT angio showed a clear route from the buccal region, past the maxillary sinus, through the pterygoid muscles into the lesion. The idea was to keep the styled process (arrow) as a fixed point marker such that the needle would not be more than 6.5 mm lateral to the process, to avoid the carotid artery.