Transposition of the Pterygopalatine Fossa during Endonasal Endoscopic Transpterygoid Approaches

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.