title: Extended endoscopic endonasal approach to the pterygopalatine fossa: anatomical study and clinical considerations.
abstract: 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.
authors.affiliation: Division of Neurosurgery, Department of Neurological Sciences, Universita degli Studi di Napoli Federico II, Naples, Italy.
authors.forename: Luigi M
authors.initials: LM
authors.lastname: Cavallo
authors.forename: Andrea
authors.initials: A
authors.lastname: Messina
authors.forename: Paul
authors.initials: P
authors.lastname: Gardner
authors.forename: Felice
authors.initials: F
authors.lastname: Esposito
authors.forename: Amin B
authors.initials: AB
authors.lastname: Kassam
authors.forename: Paolo
authors.initials: P
authors.lastname: Cappabianca
authors.forename: Enrico
authors.initials: E
authors.lastname: de Divitiis
authors.forename: Manfred
authors.initials: M
authors.lastname: Tschabitscher
mesh_terms: 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*