Endoscopic Endonasal Approach to the Pterygopalatine Fossa: Anatomic Study

Neurosurgery ◽  
2003 ◽  
Vol 52 (2) ◽  
pp. 374-380 ◽  
Author(s):  
Alessandra Alfieri ◽  
Hae-Dong Jho ◽  
Raffaele Schettino ◽  
Manfred Tschabitscher
Keyword(s):  
Minimally Invasive ◽  
Infratemporal Fossa ◽  
Lateral View ◽  
Pterygopalatine Fossa ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Anatomic Study ◽  
Endoscopic Endonasal ◽  
Arteries And Veins ◽  
Anatomic Region

Abstract 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. CONCLUSION Our anatomic study shows that this approach can be considered a valid minimally invasive option to approach pterygopalatine fossa lesions.

The Endoscopic Endonasal Approach to the Lateral Recess of the Sphenoid Sinus Via the Pterygopalatine Fossa: Comparison Of Endoscopic and Radiological Landmarks

2006 ◽  
Vol 59 (suppl_4) ◽  
pp. ONS-237-ONS-243 ◽  
Author(s):  
Francesco Magro ◽  
Domenico Solari ◽  
Luigi M. Cavallo ◽  
Amir Samii ◽  
Paolo Cappabianca ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Sphenoid Sinus ◽  
Pterygopalatine Fossa ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Anatomic Landmarks ◽  
Endoscopic Endonasal ◽  
Invasive Approach ◽  
Lateral Recess ◽  
Radiological Images

Abstract OBJECTIVE: The endoscopic endonasal approach offers the opportunity to reach the ptery-gopalatine fossa, the lateral recess of the sphenoid sinus, and other areas of the cranial base through a minimally invasive approach. This study compares the anatomy of these areas when observed through an endoscopic endonasal view with the anatomy of the same regions as they appear in computed tomographic scans. The aim was to identify and correlate the corresponding anatomic structures, providing the surgeons with anatomic landmarks to guide them when operating in these areas through an endoscopic endonasal approach. METHODS: An anatomic dissection of six fixed cadaver heads was performed by an endoscopic endonasal approach. A step-by-step comparison of endoscopic and radiological images was made to identify the landmarks of the surgical field. RESULTS: The step-by-step comparison of endoscopic and radiological images acquired during the endoscopic endonasal approach to the lateral recess of the sphenoid sinus via the pterygopalatine fossa allowed the identification of all the relevant anatomic landmarks of the procedure. CONCLUSION: The endoscopic endonasal approach via the pterygopalatine fossa offers direct, minimally invasive access to the lateral recess of the sphenoid sinus, which can be monitored in each phase through consistent radiological imagery.

Endoscopic Endonasal Approach to the Infratemporal Fossa

Skull Base ◽  
2007 ◽  
Vol 17 (S 2) ◽  
Author(s):  
Lee Zimmer ◽  
Aaron Brescia ◽  
Bharat Guthikonda ◽  
Jeffrey Keller ◽  
Philip Theodosopoulos
Keyword(s):  
Infratemporal Fossa ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Endoscopic Endonasal

Endoscopic Endonasal Approach for the Treatment of Benign Schwannoma of the Sinonasal Tract and Pterygopalatine Fossa

2002 ◽  
Vol 16 (2) ◽  
pp. 113-118 ◽  
Author(s):  
Ernesto Pasquini ◽  
Vittorio Sciarretta ◽  
Giovanni Farneti ◽  
Antonio Ippolito ◽  
Diego Mazzatenta ◽  
...  
Keyword(s):  
Pterygopalatine Fossa ◽  
Sinonasal Tract ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Endoscopic Endonasal ◽  
Benign Schwannoma

Comparison of Endoscopic Endonasal Approach and Lateral Microsurgical Infratemporal Fossa Approach to the Jugular Foramen: An Anatomical Study

2021 ◽  
Author(s):  
Jianfeng Liu ◽  
Carlos D. Pinheiro-Neto ◽  
Dazhang Yang ◽  
Eric Wang ◽  
Paul A. Gardner ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Infratemporal Fossa ◽  
Deep Understanding ◽  
Type A ◽  
Jugular Foramen ◽  
Anatomical Landmarks ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Endoscopic Endonasal ◽  
Complex Anatomy

Abstract Objective The jugular foramen is one of the most challenging surgical regions in skull base surgery. With the development of endoscopic techniques, the endoscopic endonasal approach (EEA) has been undertaken to treat some lesions in this area independently or combined with open approaches. The purpose of the current study is to describe the anatomical steps and landmarks for the EEA to the jugular foramen and to compare it with the degree of exposure obtained with the lateral infratemporal fossa approach. Materials and Methods A total of 15 osseous structures related to the jugular foramen were measured in 33 adult dry skulls. Three silicone-injected adult cadaveric heads (six sides) were dissected for EEA and three heads (six sides) were used for a lateral infratemporal fossa approach (Fisch type A). The jugular foramen was exposed, relevant landmarks were demonstrated, and the distances between relevant landmarks and the jugular foramen were obtained. High-quality pictures were obtained. Results The jugular foramen was accessed in all dissections by using either approach. Important anatomical landmarks for EEA include internal carotid artery (ICA), petroclival fissure, inferior petrosal sinus, jugular tubercle, and hypoglossal canal. The EEA exposed the anterior and medial parts of the jugular foramen, while the lateral infratemporal fossa approach (Fisch type A) exposed the lateral and posterior parts of the jugular foramen. With EEA, dissection and transposition of the facial nerve was avoided, but the upper parapharyngeal and paraclival ICA may need to be mobilized to adequately expose the jugular foramen. Conclusion The EEA to the jugular foramen is anatomically feasible but requires mobilization of the ICA to provide access to the anterior and medial aspects of the jugular foramen. The lateral infratemporal approach requires facial nerve transposition to provide access to the lateral and posterior parts of the jugular foramen. A deep understanding of the complex anatomy of this region is paramount for safe and effective surgery of the jugular foramen. Both techniques may be complementary considering the different regions of the jugular foramen accessed with each approach.

Extended endoscopic endonasal approach to the pterygopalatine fossa: anatomical study and clinical considerations

2005 ◽  
Vol 19 (1) ◽  
pp. 1-7 ◽  
Author(s):  
Luigi M. Cavallo ◽  
Andrea Messina ◽  
Paul Gardner ◽  
Felice Esposito ◽  
Amin B. Kassam ◽  
...  
Keyword(s):  
Skull Base ◽  
Anatomical Study ◽  
Pterygopalatine Fossa ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Endoscopic Endonasal ◽  
Anatomical Dissection ◽  
Clinical Considerations ◽  
Functional Surgery ◽  
Safe Approach

Object 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.

Extended endoscopic endonasal approach to the suprasellar parachiasmatic cisterns: anatomic study

2010 ◽  
Vol 26 (9) ◽  
pp. 1161-1170 ◽  
Author(s):  
Bashar Abuzayed ◽  
Necmettin Tanriover ◽  
Ziya Akar ◽  
Berna Senel Eraslan ◽  
Nurperi Gazioglu
Keyword(s):  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Anatomic Study ◽  
Endoscopic Endonasal

Modified endoscopic endonasal approach with a minimally invasive transoral approach-an adjunct to infrapetrous approaches

2018 ◽  
Vol 129 (2) ◽  
pp. 339-343 ◽  
Author(s):  
Guillermo Maza ◽  
Ali M. Moustafa Omar ◽  
Somasundram Subramaniam ◽  
Bradley A. Otto ◽  
Daniel M. Prevedello ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Transoral Approach ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Endoscopic Endonasal

Endoscopic endonasal approach for the treatment of schwannomas of the pterygopalatine fossa: Case report and review of the literature

2014 ◽  
Vol 60 (4) ◽  
pp. 174-179 ◽  
Author(s):  
D. Bresson ◽  
N. McLaughlin ◽  
L.F.S. Ditzel Filho ◽  
C.F. Griffiths ◽  
R.L. Carrau ◽  
...  
Keyword(s):  
Case Report ◽  
Pterygopalatine Fossa ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Review Of The Literature ◽  
Endoscopic Endonasal

Anatomical study of the pterygopalatine fossa using an endoscopic endonasal approach: spatial relations and distances between surgical landmarks

2007 ◽  
Vol 106 (1) ◽  
pp. 157-163 ◽  
Author(s):  
Domenico Solari ◽  
Francesco Magro ◽  
Paolo Cappabianca ◽  
Luigi M. Cavallo ◽  
Amir Samii ◽  
...  
Keyword(s):  
Skull Base ◽  
Anatomical Study ◽  
Spatial Relations ◽  
Pterygopalatine Fossa ◽  
Direct Access ◽  
Anatomical Landmarks ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Endoscopic Endonasal ◽  
Invasive Approach

Object The pterygopalatine fossa is an area that lies deep within the skull base. The recent extensive use of the endoscopic endonasal approach has provided neurosurgeons with a method to reach various areas of the skull base through a less invasive approach than traditional transcranial or transfacial approaches. This study aims to provide neurosurgeons with new data concerning direct endoscopic measurements and precise anatomical topography features of the pterygopalatine fossa. Methods An anatomical dissection of six fixed cadaver heads (12 pterygopalatine fossae) was performed to analyze spatial relationships and distances between the most important neurovascular structures in this region, and to estimate the size of the endoscopic surgical field for operations in this area. The endoscopic endonasal approach offers direct access to the pterygopalatine fossa through its anteromedial walls. Conclusions Using an endoscopic endonasal approach makes it possible to identify all of the anatomical landmarks of the pterygopalatine fossa and almost all of the contiguous skull base areas.

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