Endoscopic Anatomy And Clinical Application Of Endoscopic Prelacrimal Recess Approach To Pterygopalatine Fossa

Part Ⅰ Anatomical study of the endoscopic prelacrimal recess approach to pterygopalatine fossaObjective: To study the anatomy of pterygopalatine fossa with the endoscopic prelacrimal recess approach on cadaveric head specimens,and measure the related anatomical landmarks with the endoscopy.To explore the effective exposure range and advantages of the endoscopic prelacrimal recess approach to pterygopalatine fossa.To provide anatomical data and technical support for clinical treatment of pterygopalatine fossa using the endoscopic prelacrimal recess approach.Methods: 4 cadaveric head specimens(8 sides)were fixed by formalin and perfused with blood vessels,and the skull base structure was not abnormal.The anatomical structure of PPF were observed and measured by the endoscopic prelacrimal recess approach,and the related data were recorded.To further study the effective exposure range and the advantages of endoscopic prelacrimal recess approach to PPF.Results:(1)Anatomical study of pterygopalatine fossa via endoscopic prelacrimal recess approach was performed successfully in 4 cases(8 sides)of cadaveric head specimens.The anatomical structures were observed and the related data of the anatomy were measured and recorded.The distance from the root of the nasal columella to the inferior orifice of nasolacrimal duct,maxillary sinus orifice,sphenopalatine foramen,pterygoid canal,foramen rotundum were 36.89±2.87 mm,45.84±3.07 mm,67.44±3.18 mm,72.04±3.17 mm,77.03 ±4.35 mm.The internal maxillary artery,descending palatal artery and sphenopalatine artery showed a "M" in 1 side,"T" in 2 sides,"Y" in 2 sides and intermediate type in 3 sides.(2)The endoscopic prelacrimal recess approach can expose the entire pterygopalatine fossa and most part of medial infratemporal fossa while preserving the nasal cavity structure.Thetemporalis can be exposed laterally via this approach,also the Meckel’s cave and lateral inferior wall of the sphenoid sinus can be reached.Conclusion: The endoscopic prelacrimal recess approach is a safe,effective and minimally invasive surgical treatment for pterygopalatine fossa lesion.It can avoid the shortcomings of traditional open surgical approach such as facial incision,maxillary incision and so on.At the same time,it can protect the integrity of nasal cavity structure as much as possible,but the difficulty of endoscopic manipulation could be a great challenge to clinicians.Part Ⅱ Clinical application of endoscopic transnasal approach for resection of pterygopalatine fossa tumorObjective: To explore the feasibility and effectives of navigation-assisted endoscopic transnasal approach for resection of pterygopalatine fossa tumor,and summarize the early clinical experience of this surgical approach.Methods: The clinical data of 2 patients with pterygopalatine fossa tumor treated by navigation-assisted endoscopic transnasal approach in November 2016 and June 2018 at the Neurosurgery Department of the First Affiliated Hospital of Shenzhen University were retrospectively analyzed.The clinical data includes clinical history,surgical treatment and resection rate,and postoperative complications.Results: The two cases were successfully treated with navigation-assisted endoscopic transnasal approach for resecting the tumor involving pterygopalatine fossa.About Case 1,as a result of huge malignant tumor and abundant blood supply,only partial resection was caused during the operation.Pathological report showed acinar soft tissue sarcoma.Follow-up examination of MRI showed that the tumor continued to increase and the prognosis was very poor.About Case 2,no complications occurred after total resection of cystic mass in the operation.The pathological report showed epidermoid cyst.MRI did not show the recurrent in follow-up examination after operation,and the prognosis was good.Conclusion: Navigation-assisted endoscopic transnasal approach is a safe,effective and minimally invasive surgical treatment for resection of tumor invading pterygopalatine fossa.Using navigation can improve the accuracy of operation and the resection rate of tumors,and also can improve the prognosis of patients.It is worthy being popularized and applied.