An Alternative Endoscopic Anterolateral Route to Meckel's Cave: An Anatomic Feasibility Study Using a Sublabial Transmaxillary Approach

Abstract

Objective: To describe an endoscopic anterolateral surgical route to the lateral portion of Meckel's cave.

Methods: A sublabial transmaxillary transpterygoid approach was performed in 6 cadaveric heads (12 sides). A craniectomy was drilled between the foramen rotundum (FR) and foramen ovale (FO) with defined borders. Extradural dissection was performed up to the V2-V3 junction of the trigeminal ganglion. The working space was analyzed using anatomic measurements.

Results: The approach allowed for extradural dissection to the lateral aspect of Meckel's cave and provided excellent exposure of V2, V3, and the V2-V3 junction at the gasserian ganglion. The mean distance between the FR and FO along the pterygoid process of the sphenoid bone was 21.3 ± 2.8 mm (range, 18-24.4 mm). The mean distance of V2 and V3 segments from their foramina to the gasserian ganglion junction was 12.0 ± 2.3 mm (range, 9.2-14.6 mm) and 15.2 ± 2.7 mm (range, 12.3-18.5 mm), respectively (6 sides). A potential working area (mean area, 89 mm²) is described. Its superior edge is from the FR to the V2-V3 junction at the gasserian ganglion, its inferior edge is from the FO to the V2-V3 junction at the gasserian ganglion, and its base is from the FO to the FR. The surgical anatomy of the infratemporal fossa, pterygopalatine fossa, and lateral Meckel's cave is highlighted.

Conclusions: An endoscopic anterolateral sublabial transmaxillary transpterygoid approach between the FR and FO avoids crossing critical neurovascular structures within the cavernous sinus and pterygopalatine fossa and can provide a safe surgical corridor for laterally based lesions in Meckel's cave.

Keywords: Cavernous sinus; Endoscopic; Meckel's cave; Sublabial; Transmaxillary; Transpterygoid.