Enoloscopic anatomy of the endonasal transmaxillary transpterygoid approach to Meckel’s cave

doi:10.3969/j.issn.0529-1356.2014.01.017

Abstract

Abstract:

Objective To investigate anatomic characteristics of an endoscopic endonasal transmaxillary transpterygoid approach to Meckel’s cave, which included searching significant anatomic landmarks and obtaining relevant anatomic measurements. To establish an anatomic basis for clinical applications of endoscopic endonasal transmaxillary transpterygoid approach to Meckel’s cave. Methods Five adult fresh head specimens (10 sides) were investigated to identify important anatomic landmarks. The distances between the landmarks in the endoscopic endonasal transmaxillary transpterygoid approach to Meckel’s cave were measured during the anatomic procedure. Imaging navigation system (IGS) was employed. Results The distances from columella nasi (NC) to choana, sphenoid ostium (SO), anterior aperture of palatosphenoidal canal (PSC), sphenopalatine foramen (SPF), and the anterior aperture of vidian canal (VC) were(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 distances from anterior aperture of VC to anterior aperture of PSC and foramen rotundum (FR) were (2.1±0.7) mm and (7.5±0.7) mm. The lengths of PSC and VC were (6.4±0.5) mm and (13.3±1.2) mm. The anterior aperture of VC was identified via finding PSC. VC was considered a landmark to the anterior genu of petrous internal carotid (ICA). Paraclival ICA was be identified by paraclival carotid prominence (CP). Imaging navigation system (IGS) helped identifying anatomical landmarks and guiding anatomic manipulating. Conclusion Fully exposure of Meckel’s cave via the endoscopic endonasal transmaxillary transpterygoid approach is feasible. The approach enters into anterior Meckel’s cave through a quadrangular space, which is bordered medially and inferiorly by ICA, laterally by maxillary nerve, and superiorly by the abducens cranial nerve. The data from the experiment and IGS is useful to locate crucial anatomical landmarks.

Key words: Endoscopy, Meckel’s cave, Vidian canal, Palatosphenoidal canal, Foramen rotundum, Anatomy, Adult

GU Ye ZHANG Xiao-biao*WANG Xue-jianYU Yong HU FanXU Wen-long XIE Tao SUN Chong-jing. Enoloscopic anatomy of the endonasal transmaxillary transpterygoid approach to Meckel’s cave[J]. AAS, 2014, 45(1): 89-93.

References

［1］Sabanc PA, Batay F, Civelek E, et al. Meckel’s cave ［J］. World Neurosurg, 2011, 76(3-4):335-341.
［2］Kawase T, van Loveren H, Keller JT, et al. Meningeal architecture of the cavernous sinus: clinical and surgical implications［J］. Neurosurgery, 1996, 39(3):527-534.
［3］Kapila A, Chakeres DW, Blanco E. The Meckel’s cave: computed tomographic study. Part I: Normal anatomy; Part II: Pathology［J］. Radiology, 1984, 152(2):425-433.
［4］Rubinstein D, Stears RL, Stears JC. Trigeminal nerve and ganglion in the Meckel’s cave: appearance at CT and MR imaging ［J］. Radiology, 1994, 193(1):155-159.
［5］Zhang XB. Present state and perspectives of endoscopic endonasal skull base surgery［J］. Chinese Journal of Neurosurgical Disease Research, 2011, 10(5):385-387.(in Chinese)
张晓彪.内镜经鼻颅底外科的现状和展望［J］.中华神经外科疾病研究杂志,2011,10(5):385-387. 
［6］Gu Y, Zhang XB, LI WSh, et al. Anatomy of extended endoscopic endonasal transsphenoidal approach to the suprasellar region and the third ventricle［J］. Acta Anatomica Sinica, 2012, 42(3):415-420. (in Chinese)
顾晔,张晓彪,李文生,等. 神经内镜下扩大经鼻蝶入路至鞍上区和第三脑室的解剖［J］. 解剖学报，2012,42(3):415-420. 
［7］Hu F, Gu Y, Xie T, et al. Image-guided extended endoscopic endonasal transsphenoidal approach for removal of craniopharyngiomas in the suprasellar region and third ventricle［J］. Chinese Journal of Neurosurgery, 2011, 27(3):247-252. (in Chinese)
胡凡,顾晔,谢涛,等. 导航引导下内镜扩大经鼻蝶窦人路切除鞍上区和第三脑室内颅咽管瘤［J］. 中华神经外科杂,2011,27(3):247-252.
［8］Zhang XB, Hu F, Gu Y, et al. Extended endoscopic endonasal transsphenoidal approach for resection of craniopharyngiomas in the suprasellar region and third ventricle［J］. Chinese Journal of Clinical Medicine, 2010, 17(4):474-476. (in Chinese)
张晓彪,胡凡,顾晔,等. 内镜下扩大经鼻蝶入路切除鞍上三脑室内颅咽管瘤［J］. 中国临床医学, 2010, 17(4):474-476. 
［9］Xie T, Hu F, Yu Y, et al. Endoscopic endonasal resection of symptomatic Rathke cleft cysts［J］. J Clin Neurosci, 2011, 18(6):760-762.
［10］Kassam AB, Prevedello DM, Carrau RL, et al. The front door to Meckel’s cave: an anteromedial corridor via expanded endoscopic endonasal approach-technical considerations and clinical series［J］. Neurosurgery, 2009, 64(3 Suppl):71-82.
［11］Bai ZQ, Cai EY, Wang SQ, et al. Nasal cavity-maxillary sinus-pterygopalatine fossa-Meckel’s cave: a preliminary anatomic study of an endoscopy-based operative approach ［J］. Neurosci Bull, 2009, 25(6):376-382.
［12］Samii M, Tatagiba M, Carvalho GA. Retrosigmoid intradural suprameatal approach to Meckel’s cave and the middle fossa: surgical technique and outcome［J］. J Neurosurg, 2000, 92(2):235-241.
［13］Samii M, Carvalho GA, Tatagiba M, et al. Surgical management of meningiomas originating in Meckel’s cave［J］. Neurosurgery, 1997, 41(4):767-774.
［14］Muto J, Kawase T, Yoshida K. Meckel’s cave tumors: relation to the meninges and minimally invasive approaches for surgery: anatomic and clinical studies［J］. Neurosurgery, 2010, 67(3 Suppl Operative):ons291-298.
［15］Pinheiro-Neto CD, Fernandez-Miranda JC, Rivera-Serrano CM, et al. Endoscopic anatomy of the palatosphenoidal canal (palatosphenoidal canal): a landmark for dissection of the vidian nerve during endonasal transpterygoid approaches ［J］. Laryngoscope, 2012, 122(1):6-12.
［16］Vescan AD, Snyderman CH, Carrau RL, et al. Vidian canal: analysis and relationship to the internal carotid artery［J］. Laryngoscope, 2007, 117(8):1338-1342.
［17］Osawa S, Rhoton AL Jr, Seker A, et al. Microsurgical and endoscopic anatomy of the vidian canal［J］. Neurosurgery, 2009, 64(5 Suppl 2):385-411.
［18］Patel MR, Stadler ME, Snyderman CH, et al. How to choose? Endoscopic skull base reconstructiveoptions and limitations［J］. Skull Base, 2010, 20(6):397-404.
［19］Leng LZ, Brown S, Anand VK, et al. Gasket-seal" watertight closure in minimal-access endoscopic cranial base surgery［J］. Neurosurgery, 2008, 62(5 Suppl 2): ons342-343.［20］Nakamura M, Krauss JK. Image-guided resection of small lesions in the cavernous sinus and Meckel’s cave［J］. Eur J Surg Oncol, 2010, 36(2):208-213.

[1]	YIN Shi-qin YANG Si-yi WANG Rui-han YOU Gui-xuan YANG Ying-qiu ZHANG Lei. Distal tibiofibular syndesmosis fibular notch typing and its clinical significance based on CT [J]. Acta Anatomica Sinica, 2024, 55(1): 82-87.
[2]	YANG Yang SHI Jun LI Kun MA Yuan ZHANG Shao-jie HOU Er-fei WANG Chao-qun CHEN Jie WANG Xing LI Zhi-jun. Finite element analysis of cervical intervertebral discs after removing different ranges of uncinate processes [J]. Acta Anatomica Sinica, 2024, 55(1): 88-97.
[3]	YUAN Shuo ZHAO An-quan HUANG Qi-ri-mai-la-tu WU Hai-he XU Yong-sheng QI Yan-song BAO Hu-ri-cha. Association between posterior tibial slope and tibial torsion angle and recurrent patellar dislocation based on the full-length CT of the lower limbs [J]. Acta Anatomica Sinica, 2023, 54(6): 703-709.
[4]	WANG Zi-shan ZHANG Xing-hua XU Fei YU Ke-li ZHENG Lian-bin CHENG Yu. Nutritional physical indexes，obesity status and their warning effect on hypertension among Blang, Deang and Va ethnic groups in Yunnan [J]. Acta Anatomica Sinica, 2023, 54(6): 730-737.
[5]	ZHOU Chun-hui XIE Sheng-qiang WANG Jiang-ting LAN Xiao-juan ZHANG Jian-ning ZHAO Hu-lin . Application of multimodal electromagnetic navigation in endoscopic endonasal skull base anatomical measurement of fresh cadavers [J]. Acta Anatomica Sinica, 2023, 54(5): 560-566.
[6]	BAI Peng LI Wei ZHONG Hua WANG Zhan-fei. Measurement of the magnetic resonance imaging of the area supratentorial and infratentorial mid-sagittal plane of the normal Tibetan adults [J]. Acta Anatomica Sinica, 2023, 54(5): 567-574.
[7]	LIU Jian ZHU Guang-qiong LIU Kun-xiang . Muscle architecture and intramuscular nerve distribution pattern of adult elbow muscle [J]. Acta Anatomica Sinica, 2023, 54(5): 582-585.
[8]	ZHU Qiu-liang YU Xiang-ping MA Jun CHEN Yun-yun LIN Fang RUAN Wen-bin . Adjustment of X-ray angle intraoperation based on the anatomic shape of femoral neck section [J]. Acta Anatomica Sinica, 2023, 54(5): 586-592.
[9]	NIU Shi-bo YANG Meng-yi XU Yu DANG Jie MA Zhan-bing HUO Zheng-hao LU Hong . Digit ratio in men with schizophrenia [J]. Acta Anatomica Sinica, 2023, 54(4): 473-476.
[10]	XU Guo-chang CHEN Zhi-guo WEN You-feng JIANG Dong GUO Ke-lei . Six body indexes and typing characteristics of Xibe adults [J]. Acta Anatomica Sinica, 2023, 54(4): 477-483.
[11]	LIU Hai-lan MEI Yi-xuan ZHANG Yi LIU Cheng LIU Shu-wei. Classification and clinical significance of the branching patterns of the right pulmonary arteries based on the intravital CT data [J]. Acta Anatomica Sinica, 2023, 54(4): 453-459.
[12]	LUO Yan-ping LIU Chao GU Xi-xi CHEN Jian-ming LAN Yan WEI Ye-sheng. Distribution characteristics of polymorphisms of microRNA-30 gene in Guangxi Zhuang population and their association with serum lipid levels [J]. Acta Anatomica Sinica, 2023, 54(4): 400-404.
[13]	YANG Chen WANG Lu-fei QIAO Hui ZHU Hai-ge WEN Shao-qing ZHANG Hang TAN Jing-ze. Dental non-metric traits of Han and Zhuang people [J]. Acta Anatomica Sinica, 2023, 54(3): 357-367.
[14]	CHENG Zhi-han RAN Zhi-yu LING Liang-you HE Jia-ning. Sex differences in the morphology of the distal humerus in Ming and Qing Dynasties population in North China [J]. Acta Anatomica Sinica, 2023, 54(3): 328-334.
[15]	LI Yun-qing. Trends in neuroanatomical research [J]. Acta Anatomica Sinica, 2023, 54(3): 368-373.