title: [Transpterygoid expanded endonasal approach in fibrous dysplasia of the skull base: case report and technical note].
abstract: BACKGROUND
  Expanded endonasal approaches (EEA) are becoming a first-level technique for the treatment of skull base pathologies. In some cases, the endoscopic procedures make it possible to dissect structures manipulated with greater difficulty in the classic approaches. We report a full endoscopic transpterygoid EEA for the treatment of a fibrous dysplasia (FD) of the skull base. In addition, we reviewed the English literature available on FD and transpterygoid EEA, establishing an exact surgical technique and showing our intraoperative experience.
  
  
  METHODS
  A 42-year-old male with right sixth cranial nerve palsy. Cranial MRI and CT showed a central skull base lesion with diagnostic suspicion of FD. Patient underwent a full endoscopic transpterygoid EEA, achieving a wide skull base neurovascular decompression. Neuronavigation and the vidian canal landmark resulted mandatory during intraoperative procedure.
  
  
  CONCLUSIONS
  The transpterygoid EEA is a safe technique consistently supported in the literature. It may reduce the morbidity associated to the classic transcranial approaches, since it permits maximum resection with minimum craniofacial distortion. The vidian hole and canal are the landmarks used to locate and avoid injury to the lacerum segment of the carotid injury. The surgical treatment indication in FD cases must be established in symptomatic patients.
  
  
  CONCLUSIONS
  Transpterygoid EEA for treatment of FD of the skull base is a safe and effective procedure, thanks to the guide that the vidian canal provides in finding the lacerum segment of the carotid artery.
authors.affiliation: Servicio de Neurocirugía, Hospital Universitario La Fe, Valencia, España.
authors.forename: Juan Antonio
authors.initials: JA
authors.lastname: Simal-Julian
authors.forename: Eugenio
authors.initials: E
authors.lastname: Cárdenas-Ruiz-Valdepeñas
authors.forename: Pablo
authors.initials: P
authors.lastname: Miranda-Lloret
authors.forename: José
authors.initials: J
authors.lastname: Pamíes-Guilabert
authors.forename: Fernando
authors.initials: F
authors.lastname: Mas-Estelles
authors.forename: Estela
authors.initials: E
authors.lastname: Plaza-Ramírez
authors.forename: Andrés
authors.initials: A
authors.lastname: Beltrán-Giner
authors.forename: Carlos
authors.initials: C
authors.lastname: Botella-Asunción
mesh_terms: D004724:Endoscopy; D006801:Humans; D019635:Neurosurgical Procedures; D009666:Nose; D019291:Skull Base / Q000601:surgery; D019292:Skull Base Neoplasms