Abstract
Background Traditionally, a pterional approach is utilized to access the Meckel cave. Depending
on the tumor location, extradural dissection of the Gasserian ganglion can be performed.
An endoscopic endonasal access could potentially avoid a craniotomy in these cases.
Methods We performed an endoscopic endonasal approach as well as a lateral approach to the
Meckel cave on six anatomic specimens. To access the Meckel cave endoscopically, a
complete sphenoethmoidectomy and maxillary antrostomy followed by a transpterygoid
approach was performed. For lateral access, a pterional craniotomy with extradural
dissection was performed.
Results The endoscopic endonasal approach allowed adequate access to the Gasserian ganglion.
All the relevant anatomy was identified without difficulty. Both approaches allowed
for a similar exposure, but the endonasal approach avoided brain retraction and improved
anteromedial exposure of the Gasserian ganglion. The lateral approach provided improved
access posterolaterally and to the superior portion.
Conclusion The endoscopic endonasal approach to the Meckel cave is anatomically feasible. The
morbidity associated with brain retraction from the open approaches can be avoided.
Further understanding of the endoscopic anatomy within this region can facilitate
continued advancement in endoscopic endonasal surgery and improvement in the safety
and efficacy of these procedures.
Keywords
endonasal endoscopic - Gasserian ganglion - lateral approach - maxillary antrostomy
- Meckel cave - pterional craniotomy - sphenoethmoidectomy
