Endoscopic Transmaxillary Trans-Alisphenoid Approach to the Meckel's Cave: An Anatomical Study

Background: Multiple approaches have been designed to reach the medial middle fossa, for Meckel’s cave lesions particularly, but the anterior approach through the greater wing of sphenoid (transalisphenoid) has not been explored.

Objectives: To assess the feasibility of the endoscopic endonasal transantral transalisphenoid approach to the Meckel’s cave and lateral cavernous wall.

Methods: Endoscopic dissection was performed on three vascular-injected cadaver heads bilaterally to develop the approach and define surgical landmarks.

Results: The endoscopic transmaxillary transalisphenoid approach was divided into 4 stages: entry into the maxillary sinus, exposure of the greater wing of sphenoid, exposure of medial middle fossa, exposure of Meckel’s cave and lateral wall of cavernous sinus. The approach provided excellent surgical access to the anterior and lateral portion of Meckel’s cave with possibility of expansion into the infratemporal fossa and laterally to middle fossa.

Conclusion: We found that the endoscopic transalisphenoid approach to the Meckel’s cave is technically feasible with certain advantages in specific clinical situations. The approach may complement the current repertoire of surgical treatment for Meckel’s cave lesions, and could be ideal for lesions that extend from the maxillary sinus, infratemporal fossa, or pterygopalatine fossa into the middle cranial fossa, Meckel’s cave, and cavernous sinus such as schwannomas, meningiomas and sinonasal tumors.