Surgical anatomy and nuances of the expanded transpterygoid approach to the pterygopalatine fossa and upper parapharynge
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HOW I DO IT - NEUROSURGICAL ANATOMY
Surgical anatomy and nuances of the expanded transpterygoid approach to the pterygopalatine fossa and upper parapharyngeal space: a stepwise cadaveric dissection Giuliano Silveira-Bertazzo 1,2 & Rafael Martinez-Perez 1 & Ricardo L. Carrau 1,3 & Daniel M. Prevedello 1,3 Received: 20 May 2020 / Accepted: 24 August 2020 # Springer-Verlag GmbH Austria, part of Springer Nature 2020
Abstract Background Superb knowledge of anatomy and techniques to remove the natural barriers preventing full access to the most lateral aspect of the skull base determines the ease of using the transpterygoid approach (ETPA) as the main gateway for all the coronal planes during endonasal surgeries. Methods Throughout stepwise image-guided cadaveric dissections, we describe the surgical anatomy and nuances of the ETPA to the pterygopalatine fossa (PPF) and upper parapharyngeal space (UPPS). Conclusion The ETPA represents a lateral extension of the midline corridor and provides a valuable route to access the PPF/ UPPS. Major landmarks for this EEA are the infraorbital canal, sphenopalatine foramen, and vidian nerve. It comprises the removal of the palatine bone, posterior wall of the maxillary sinus, and PPF transposition to drill the pterygoid process. Keywords Skull base surgery . EEA . Transpterygoid . Infratemporal fossa . Pterygopalatine fossa, expanded endonasal . Upper parapharyngeal space . Parasagittal, muscles of mastication, pterygoid muscle, Eustachian tube, postyloid compartment
Abbreviations EEA Expanded endoscopic endonasal approach ETPA Expanded transpterygoid approach e-ICG Indocyanine-green video angiography ITF Infratemporal fossa IMA Internal maxillary artery
JNA PPF SPA PWMS UPPS VN
Juvenile angiofibroma Pterygopalatine fossa Sphenopalatine artery The posterior wall of the maxillary sinus Upper parapharyngeal space Vidian nerve
This article is part of the Topical Collection on Neurosurgical Anatomy Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00701-020-04551-y) contains supplementary material, which is available to authorized users. * Giuliano Silveira-Bertazzo [email protected] * Daniel M. Prevedello [email protected] 1
Department of Neurological Surgery, The Ohio State University Medical Center, N-1049 Doan Hall, 410 West 10th. Avenue, Columbus, OH 43210, USA
2
Department of Neurosurgery, University of Joinville Region, and Neurological and Neurosurgical Clinic of Joinville, Joinville, SC, Brazil
3
Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Medical Center, Columbus, OH, USA
Introduction and relevant surgical anatomy The expanded transpterygoid approach (ETPA) provides an avenue in the-off midline coronal plane and a valuable route to access the pterygopalatine fossa (PPF) and upper parapharyngeal space (UPPS) [2, 8]. It comprises the removal of the posterior wall of the maxillary sinus (PWMS), the perpendicular process of the palatine bone, and the pterygopalatine fossa transposit
