Endoscopic Transpterygoid Nasopharyngectomy: Correlation of Surgical Anatomy with Multiplanar CT

Background: The complex and protected anatomy of the nasopharynx presents a challenge for oncologic resections in the area. Our purpose was to design a surgical model that illustrates the anatomical landmarks from the endoscopic standpoint and serves as a training model.

Material and Methods: Cadaveric specimens were injected with red and blue silicone dyes into the great vessels of the neck. Digital data acquired from a high resolution CT scan was imported to a surgical image guidance system. An endoscopic endonasal dissection of the nasopharynx was completed under conditions that mimicked our operating suite.

Results: Preparation of the sinonasal corridor, harvesting the nasoseptal flap, and dissections of the pterygopalatine and infratemporal fossae were performed prior to the dissection of the nasopharynx. A detailed anatomical dissection of the nasopharynx was correlated to the image guidance (navigation) system. This provided a surgical map highlighting critical neurovascular structures and illustrating the potential endoscopic surgical corridors.

Conclusions: A thorough understanding of the modular skull base approaches required prior to the nasopharyngectomy as well as knowledge of the regional anatomy viewed from the endoscopic perspective facilitates safe surgical planning.