| Objective:This study aimed to investigate the anatomic characteristics of endoscopic endonasal transmaxillary transpterygoid approach to Meckel’s cave, which included searching respective important anatomic landmarks and obtaining respective anatomic measurements. To establish an anatomic basis for clinical applications of endoscopic endonasal transmaxillary transpterygoid approach to Meckel’s cave.Methods:11cases (22sides) of dry skulls are investigated to identify important anatomic landmarks and measure distances of bone anatomical structures; Five adult fresh head specimens (10sides) are investigated to identify important anatomic landmarks and measure distances of anatomical structures in endoscopic endonasal transmaxillary transpterygoid approach to Meckel’s cave.Results:(1) Data of dry skull specimens:the distance between columella nasi and the anterior aperture of palatosphenoidal canal is60.0±3.8mm, columella nasi and the aperture of palatosphenoidal canal is62.6±4.2mm, columella nasi and sphenopalatine foramen is62.0±4.6mm, sphenopalatine foramen and the anterior aperture of palatosphenoidal canal is3.4±0.5mm, sphenopalatine foramen and the posterior aperture of palatosphenoidal canal is7.4±1.3mm, columella nasi and the anterior aperture of vidian is64.8±3.2mm, columella nasi and the posterior aperture of vidian is73.9±2.7mm; the length of vidian cave is13.8±1.1mm.(2) Data of head specimens:the distance between columella nasi and aperture of sphenoid sinus is61.2±1.6mm, upper choana and aperture of sphenoid sinus is22.3±2.8mm, columella nasi and sphenopalatine foramen is62.8±2.3mm, columella nasi and the anterior aperture of vidian canal is75.4±3.3mm, columella nasi and the anterior aperture of palatosphenoidal canal is64.6±2.4mm, columella nasi and the upper edge of choana is66.5±3.3mm, anterior aperture of vidian canal and palatosphenoidal canal is2.14±0.7mm, anterior aperture of vidian canal and foramen rotundum is7.57±0.7mm; the length of palatosphenoidal canal is6.43±0.5mm; the length of vidian nerve is13.3±1.2mm.(3) All specimens were treated with endoscopic endonasal transmaxillary transpterygoid approach to Meckel’s cave. From the experiment, the anterior aperture of VC, PSC and FR all locate in the posterior wall of PPF. PSC lies medial and FR lies lateral and upper. The anterior aperture of VC can be identified by PSC; VC leads to the anterior genu of petrous ICA; paraclival ICA can be identified by paraclival CP. Imaging navigation system(IGS) can help to identify anatomical landmarks and guid anatomic manipulating.Conclusions:(1) Meckel’s cave can be fully exposed in endoscopic endonasal transmaxillary transpterygoid approach.(2) From anterior of Meckel’s cave, the approach can enter a quadrangular space. The quadrangular space is limited medially and inferiorly by ICA, laterally by V2, and superiorly by the Vlth cranial nerve. Among them, ICA and V2are the most important anatomical landmarks. It could take advantage of PSC, VC, CP to identify paraclival ICA.(3) The data from the experiment is useful to locate the important anatomical landmarks.(4) The IGS can help to identify anatomical landmarks precisely and guid anatomic manipulating. Objective:To investigate the feasibility and efficacy of image-guided endoscopic endonasal transmaxillary transpterygoid,approach to resect tumors in Meckel’s cave. And summarise the preliminary experience of this approach.Methods:Two patients with tumors located at the left Meckel’s cave were enrolled. A50-year-old male who presented with masticatory atonia and facial numbness for four months, admission MRI revealed a3*2.5*2cm solid tumor in left Meckel’s cave. And another40-year-old female suffered from facial pain for2years, preoperative MRI also revealed a4.2*3.7*3.3cm solid tumor in left Meckel’s cave. Both of them were treated with image-guided endoscopic endonasal transmaxillary transpterygoid approach.Results:Subtotal resection was achieved in first patient and totle resection in second one. The pathology of first patients was low differentiated squamous cell carcinoma and anathor was schwannoma. These two patients had a transient III and VI cranial nerve palsy, respectively. There were no other endoscopic related complications. The preoperative symptoms were partly disappeared. But the deficits were improved during the2-6months follow-up.Conclusion:The image-guided endoscopic endonasal transmaxillary transpterygoid approach is a novel, safe, effective and minimally invasive approach for selected tumors involving in Meckel’s cave. The anatomic landmarks including PSC、VC、FR、CP and IGS, micro-doppler can provide correct anatomic directions and safe operational range. |
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