Extended endoscopic endonasal approach to the pterygopalatine fossa: anatomical study and clinical considerations.
OBJECTIVE
The pterygopalatine fossa is an area located deep in the skull base. The microsurgical transmaxillary-transantral route is usually chosen to remove lesions in this region. The increasing use of the endoscope in sinonasal functional surgery has more recently led to the advent of the endoscope for the treatment of tumors located in the pterygopalatine fossa as well.


METHODS
An anatomical dissection of three fresh cadaveric heads (six pterygopalatine fossas) and three dried skull base specimens was performed to evaluate the feasibility of the approach and to illustrate the surgical landmarks that are useful for operations in this complex region. The endoscopic endonasal approach allows a wide exposure of the pterygopalatine fossa. Furthermore, with the same access (that is, through the nostril) it is possible to expose regions contiguous with the pterygopalatine fossa, either to visualize more surgical landmarks or to accomplish a better lesion removal.


CONCLUSIONS
In this anatomical study the endoscopic endonasal approach to the pterygopalatine fossa has been found to be a safe approach for the removal of lesions in this region. The approach could be proposed as an alternative to the standard microsurgical transmaxillary-transantral route.
Cavallo
Luigi M
LM
Division of Neurosurgery, Department of Neurological Sciences, Universita degli Studi di Napoli Federico II, Naples, Italy.
Messina
Andrea
A
Gardner
Paul
P
Esposito
Felice
F
Kassam
Amin B
AB
Cappabianca
Paolo
P
de Divitiis
Enrico
E
Tschabitscher
Manfred
M
D035262:Cranial Fossa, Anterior / Q000601:surgery*; D003399:Craniotomy / Q000379:methods; D004724:Endoscopy / Q000379:methods*; D006801:Humans; D008866:Microsurgery / Q000379:methods*; D009296:Nasal Cavity / Q000601:surgery*; D019291:Skull Base / Q000601:surgery*