Endoscopic endonasal approach to the pterygopalatine fossa: anatomic study.
OBJECTIVE
The pterygopalatine fossa is a relatively small anatomic region. Because of its rich vasculonervous contents and its connections with several intracranial and extracranial compartments, it is of particular surgical interest. Because of its deep localization and despite its small size, however, it can require extensive anatomic approaches, especially for invasive cranial base lesions. We performed a cadaveric study through a minimally invasive endoscopic endonasal approach to the pterygopalatine fossa.


METHODS
We studied 16 pterygopalatine fossae in eight adult cadaveric heads in which the arteries and veins were injected with latex. For visualization, we used rod-lens endoscopes, 4 mm in diameter and 18 cm in length, with 0-, 30-, 45-, and 70-degree lenses. An endonasal middle meatal transpalatine approach, an endonasal middle meatal transantral approach, and an endonasal inferior turbinectomy transantral approach were used.


RESULTS
The middle meatal transpalatine approach allows for medial exposure of the pterygopalatine fossa contents, the middle meatal transantral approach allows a lateral view, and the inferior turbinectomy transantral approach allows the widest view and room for surgical maneuvering in the medial and lateral compartments of the pterygopalatine fossa and the infratemporal fossa.


CONCLUSIONS
Our anatomic study shows that this approach can be considered a valid minimally invasive option to approach pterygopalatine fossa lesions.
Alfieri
Alessandra
A
Department of Neurological Surgery, Centre Hospitalier Régional et Universitaire Dupuytren, Limoges, France. alessandralfieri@yahoo.it
Jho
Hae-Dong
HD
Schettino
Raffaele
R
Tschabitscher
Manfred
M
D000328:Adult; D035301:Cranial Fossa, Middle / Q000033:anatomy & histology / Q000601:surgery; D003399:Craniotomy; D004724:Endoscopy; D006801:Humans; D008443:Maxillary Sinus / Q000033:anatomy & histology / Q000601:surgery; D008866:Microsurgery; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D010159:Palate / Q000033:anatomy & histology / Q000601:surgery*; D019291:Skull Base / Q000033:anatomy & histology / Q000601:surgery*; D014420:Turbinates / Q000033:anatomy & histology / Q000601:surgery