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J Neurol Surg B Skull Base 2021; 82(03): 357-364
DOI: 10.1055/s-0039-3399553
Original Article

Endoscopic-Assisted Lateral Corridor to the Infratemporal Fossa: Proposal and Quantitative Comparison to the Endoscopic Transpterygoid Approach

Abraam Yacoub 
1   Department of Otorhinolaryngology-Head and Neck Surgery, Inselspital, University Hospital and University of Bern, Switzerland
2   Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt
,
Daniel Schneider
3   Image-Guided Therapy, ARTORG Center for Biomedical Research, University of Bern, Switzerland
,
Ahmed Ali
4   Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, South Valley University, Qena, Egypt
,
Wilhelm Wimmer
5   Hearing Research Laboratory, ARTORG Center for Biomedical Engineering Research, University of Bern, Switzerland
,
Marco Caversaccio
1   Department of Otorhinolaryngology-Head and Neck Surgery, Inselspital, University Hospital and University of Bern, Switzerland
,
Lukas Anschuetz
1   Department of Otorhinolaryngology-Head and Neck Surgery, Inselspital, University Hospital and University of Bern, Switzerland
› Author Affiliations
Funding None.
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Abstract

Objective This study was aimed to propose an expanded endoscopic-assisted lateral approach to the infratemporal fossa (ITF) and compare its area of exposure and surgical freedom with the endoscopic endonasal transptergyoid approach (EETA).

Methods Anatomical dissections were performed in five cadaver heads (10 sides). The ITF was first examined through the endoscopically assisted lateral corridor, herein referred to as the endoscopic-assisted transtemporal fossa approach (TTFA). After that, the EETA was performed and coupled with two sequential maxillary procedures (medial maxillectomy [MM], and endoscopic-assisted Denker's approach [DA]). Using the stereotactic neuronavigation, measurements of the area of exposure and surgical freedom at the foramen ovale were determined for the previously mentioned approaches.

Results Bimanual exploration of the ITF through the endoscopic-assisted lateral approach was achieved in all specimens. The DA (729 ± 49 mm2) provided a larger area of exposure than MM (568 ± 46 mm2; p < 0.0001). However, areas of exposure were similar between the DA and the TTFA (677 ± 35 mm2; p = 0.09). The surgical freedom offered by the TTFA (109.3 ± 19 cm2) was much greater than the DA (24.7 ± 4.8 cm2; p < 0.0001), and the MM (15.2 ± 3.2 cm2, p < 0.0001).

Conclusion The study demonstrates the feasibility of the proposed approach to provide direct access to the extreme extensions of the ITF. The lateral corridor offers an ideal working area in the posterior compartment of the ITF without crossing over important neurovascular structures. The new technique may be used alone in selected primary ITF lesions or in combination with endonasal approaches in pathologies spreading laterally from the nose or nasopharynx.

Keywords

Infratemporal fossa - endoscopic transpterygoid approach - endoscopic-assisted Denker's approach - medial maxillectomy - cranial base surgery


Publication History

Received: 31 May 2019

Accepted: 28 September 2019

Article published online:
06 November 2019

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