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Acta Neurochirurgica

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01.06.2015 | Clinical Article - Neurosurgical Techniques

Combined endonasal and sublabial endoscopic transmaxillary approach to the pterygopalatine fossa and orbital apex

verfasst von: Maysam Alimohamadi, Mohamadreza Hajiabadi, Venelin Gerganov, Rudolf Fahlbusch, Madjid Samii

Erschienen in: Acta Neurochirurgica | Ausgabe 6/2015

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Abstract

Background

The pterygopalatine fossa (PPF) and inferomedial orbital apex are difficult regions for open neurosurgical access. The traditional extensive anterior approach (transfacial or transmandibular) and lateral/posterolateral (transcranial) approach were used to access the PPF. The combined endonasal and sublabial transmaxillary approach is a less invasive access route for these lesions. In this study, we present the technical and clinical details of our experience with the combined endoscopic endonasal and transmaxillary approach.

Methods

A retrospective analysis of our patients operated on using a combined endoscopic endonasal and transmaxillary approach was done. The preoperative, intraoperative and postoperative images and all the clinical data were evaluated. The accessibility to the area and extent of surgical resection were reviewed. The surgery-related complications and postoperative morbidities were analyzed. The main items of interest were the exposure of the target area and possibility for safe removal.

Results

Five patients with pathologies located in the area of the PPF and orbital apex were operated on using the combined endoscopic sublabial and endonasal transmaxillary approach. The technique provided sufficient exposure of the area and allowed for safe removal of the preoperatively determined target in all of the patients. One patient developed dry eye and a neurotrophic corneal ulcer, and another patient developed temporary postoperative facial numbness. In the follow-up, only one patient with skull base chordoma had an asymptomatic tumor regrowth. The other patients had no recurrence or regrowth.

Conclusions

The combined endoscopic sublabial and endonasal transmaxillary approach is a safe and effective method for resection of lesions in the PPF and inferomedial orbital apex.

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Titel: Combined endonasal and sublabial endoscopic transmaxillary approach to the pterygopalatine fossa and orbital apex
verfasst von: Maysam Alimohamadi
Mohamadreza Hajiabadi
Venelin Gerganov
Rudolf Fahlbusch
Madjid Samii
Publikationsdatum: 01.06.2015
Verlag: Springer Vienna
Erschienen in: Acta Neurochirurgica / Ausgabe 6/2015
Print ISSN: 0001-6268
Elektronische ISSN: 0942-0940
DOI: https://doi.org/10.1007/s00701-015-2402-z

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