An Endoscopic Transantral Compared with an Endonasal Approach to Meckel’s Cave: An Anatomical Study

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.