Abstract
Objective Tumors involving Meckel cave (MC) always present challenges to neurosurgeons. We
performed an investigation of the anatomical characteristics of the endoscopic endonasal
transmaxillary transpterygoid approach to MC as an alternative to routine transcranial
approaches and further confirmed its efficacy in the clinical setting.
Methods Five adult fresh head specimens (10 sides) were studied to identify crucial anatomical
landmarks and quantify the anatomical structures involved in the endoscopic endonasal
transmaxillary transpterygoid approach. Two patients with a tumor involving the left
MC were treated using the endoscopic endonasal transmaxillary transpterygoid approach.
Results The distance from the columella nasi to the choana, the sphenoid ostium, the anterior
aperture of the palatosphenoidal canal (PSC), the sphenopalatine foramen, and the
anterior aperture of the vidian canal (VC) was 66.5 ± 3.3 mm, 61.2 ± 1.6 mm, 64.6 ± 1.4 mm,
62.8 ± 2.3 mm, and 75.4 ± 3.3 mm, respectively. The distance from the anterior aperture
of the VC to the anterior aperture of the PSC and the foramen rotundum (FR) was 2.1 ± 0.7 mm
and 7.5 ± 0.7 mm, respectively; the length of the PSC and the VC was 6.4 ± 0.5 mm
and 13.3 ± 1.2 mm, respectively. The landmarks of this route included the PSC, the
VC, and the paraclival carotid prominence (CP). Subtotal resection and gross total
resection were achieved in the first and second patients, respectively.
Conclusion The anatomical landmarks of the endoscopic endonasal transmaxillary transpterygoid
route are useful for clinical application. The endoscopic endonasal transmaxillary
transpterygoid approach is an effective and minimally invasive route for certain tumors
involving MC. Identifying the anatomical landmarks including the PSC, the VC, the
FR, and the CP is crucial for safe manipulation.
Keywords
endoscopy - endonasal transmaxillary transpterygoid approach - anatomy - Meckel cave
- tumor
