Nasal cavity-maxillary sinus-pterygopalatine fossa-Meckel’s cave: a preliminary anatomic study of an endoscopy-based operative approach

Abstract

Objective To provide a new approach for the treatment of tumor in Meckel's cave, by dissecting adjacent structures of the nasal cavity-maxillary sinus-pterygopalatine fossa-Meckel's cave approach. Methods Fifteen adult cadaver heads (30 sides) were dissected and the correlated anatomic landmarks were observed, measured and analyzed in an operative route. Results The approach was divided into 3 steps: entering the maxillary sinus, the later pterygopalatine fossa and the final Meckel's cave. Safe access to Meckel's cave could be achieved by tracing the vidian neurovascular bundles and dissecting the quadrangular space (QS). The distances from the nasal columella to the apertura maxillaries, the sphenopalatine foramen, and the anterior foramen of the pterygoid canal were (44.08±2.61) mm, (64.83±2.42) mm, and (70.43±2.94) mm, respectively.The angles between the horizontal plate of the palatine bone and the link from nasal columella to apertura maxillaries, between the horizontal plate of the palatine bone and the link from nasal columella to sphenopalatine foramen were (38.10±2.46)° and (26.15±2.26)°, respectively. Conclusion The endoscopic approach of transnasal maxillary sinus-pterygopalatine fossaMeckel's cave (ENMPA) is a safe and direct way to access Meckel's cave, and could be employed for the treatment of tumor in Meckel's cave.

Preliminary clinical applications of image-guided endoscopic endonasal transmaxillary transpterygoid approach to meckel’s cave

“…There are scattered reports about endoscopic endonasal transmaxillary transpterygoid approach to MC in the literature (1,6). We also confirmed by the anatomical study and clinical use that endoscopic endonasal transmaxillary transpterygoid approach can be chosen for the tumors involving the MC.…”

“…Because of anatomical drawbacks, it is not always possible to fully expose inner side of MC and trigeminal nerve. It may be easy to leave residual tumor and it is difficult to achieve Simpson grade I resection in meningiomas (1,14,15).…”

“…In recent years, endoscopic techniques and instruments have continued to progress. Today, there are only a limited number of patients having been operated in a few specialized centers by endoscopic endonasal transmaxillary transpterygoid approach to MC (1,6,11). The indications, safety, and limits of this approach are still under investigation.…”

What is the Best Route to the Meckel Cave? Anatomical Comparison between the Endoscopic Endonasal Approach and a Lateral Approach

“…5 The most common approach for accessing the Meckel cave is anterolateral using a pterional craniotomy. [6][7][8] With advancements in optical technology, new avenues of visualization have been made available to the surgeon. 9,10 The development of the endoscope enabled the ability to peer deep into the corpus.…”

“…Accessing this region using an open approach would require significant brain manipulation. 5,8,10,15 The purpose of this article is to draw a comparison between the two approaches in an anatomical cadaveric model.…”