Introduction: The endoscopic transpterygoid approach classically involves sacrificing the vidian
nerve to drill the base of the pterygoid bone. If it is necessary to remove pterygoid
plates to access the infratemporal fossa, the greater palatine nerve and the descending
palatine artery are usually transected.
Aim: The aim of this report is to describe an endoscopic transpterygoid approach in which
the pterygoid base and medial and lateral plates are removed with preservation of
all neurovascular structures within the pterygopalatine fossa. The technique described
is based on the en bloc transposition of the neurovascular structures of the pterygopalatine
fossa.
Methods: Three fresh cadaveric specimens were dissected bilaterally. One surgical case was
done. Dissection technique was based on preservation and lateral mobilization of the
periosteum of the pterygopalatine fossa. The pterygoid base and plates were exposed
and drilled with isolation and preservation of neurovascular structures passing through
the bone.
Results: In all six sides dissected and also during the surgical case, it was possible to
remove all pterygoid bone while preserving the neurovascular structures of the pterygopalatine
fossa.
Conclusion: The neurovascular structures of the pterygopalatine fossa structures can be preserved
during endoscopic endonasal approaches to the skull base. The transposition requires
comprehensive knowledge of regional anatomy. The anatomical preservation of the neurovascular
structures may preserve neural function and enhance postoperative quality of life
of patients. Clinical studies are necessary to confirm the benefits of this technique.
