Introduction: A common approach to Meckel’s cave involves a pterional craniotomy. Recent advances
in expanded endonasal endoscopy have facilitated the surgical access to portions of
the lateral skull base such as Meckel’s cave. A transantral approach, however, could
provide a more direct pathway to this region, obviating the need for extensive endonasal
transsphenoidal resection. Potentially, this could reduce the overall sinonasal morbidity.
Our study goal was to assess the feasibility of using an endoscopic transantral approach
to Meckel’s cave and to compare it to an endoscopic endonasal approach, in a cadaveric
model.
Methods: We prepared 14 cadaveric specimens with intravascular injections of colored latex.
Eight cadavers underwent endoscopic endonasal transpterygoid approaches to Meckel’s
cave. The six additional specimens underwent an endoscopic transantral approach to
the same region. Photographic evidence was obtained for review.
Results: Both endoscopic approaches, endonasal and transantral, provided a direct access to
the anterior and inferior portions of Meckel’s cave. However, the endoscopic transantral
approach required shorter instrumentation, and the dissection was swifter, as the
initial endonasal corridor is not needed.
Conclusion: An endoscopic transantral approach to Meckel’s cave is anatomically feasible in select
cases. Some of the morbidity associated with extensive endonasal resection could possibly
be avoided. Better understanding of the complex skull base anatomy from different
perspectives helps to improve current endoscopic skull base surgery and to develop
new alternatives, which consequently lead to improvements in safety and efficacy.
