REVIEW  THE LIMITS OF ENDOSCOPIC ENDONASAL APPROACHES 

Journal of Neurosurgical Sciences 2018 June;62(3):332-8

DOI: 10.23736/S0390-5616.18.04330-8

Copyright © 2018 EDIZIONI MINERVA MEDICA

lingua: Inglese

Limits of endoscopic endonasal transpterygoid approach to cavernous sinus and Meckel’s cave

Douglas A. HARDESTY ^{1, 2}, Alaa S. MONTASER ^{1, 3}, Ricardo L. CARRAU ^{1, 4}, Daniel M. PREVEDELLO ^{1, 4} ✉

¹ Department of Neurological Surgery, Wexner Medical Center, The Ohio State University College of Medicine, Columbus, OH, USA; ² Department of Neurosurgery, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, AZ, USA; ³ Department of Neurosurgery, Ain Shams University, Cairo, Egypt; ⁴ Department of Otolaryngology, Head and Neck Surgery, Wexner Medical Center, The Ohio State University College of Medicine, Columbus, OH, USA

The endoscopic endonasal approach (EEA) to the ventral skull base has greatly increased in popularity over the last two decades. So-called expanded EEA have opened corridors to pathology off-midline, including lesions within the cavernous sinus and Meckel’s cave. A standard EEA exposure into the sphenoid sinus allows visualization of the medial cavernous sinus; a transpterygoid approach allows for surgical manipulation of the lateral cavernous sinus and Meckel’s cave contents. Pituitary adenomas, meningiomas, and schwannomas are the most common pathologies in this region. This approach to the “front door” of the cavernous sinus and Meckel’s cave should be considered complementary to traditional craniotomy techniques as each have benefits and limitations. Herein we review the published literature regarding endoscopic endonasal transpterygoid surgery for pathology in the lateral cavernous sinus and Meckel’s cave, and the anatomical and functional limitations of these approaches.

KEY WORDS: Skull base - Surgery - Neurosurgical procedures - Endoscopy - Methods