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Updated: Nov 11, 2025
Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas
Published on: January 17, 2018
Simplifying Access to the Lateral Sphenoid Recess: A Modification of the Transpterygoid Approach
Satyan B Sreenath1, Dennis M Tang2, João Paulo De Almeida3
1Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio.
Background:
Meningoencephaloceles originating in the lateral recess of the sphenoid sinus can be difficult to access. Historically, the endoscopic transpterygoid approach was advocated, which carries additional morbidity given the dissection of the pterygopalatine fossa (PPF) contents to provide a direct line approach to the defect. Given our increased facility with angled endoscopes and instrumentation, we now approach this region in a less invasive manner.
Methods:
We describe the endoscopic modified transpterygoid approach (MTPA), a quicker approach to the lateral sphenoid recess which preserves the PPF contents through a single nostril corridor.
Results:
In the MTPA, the face of the sphenoid and anterior junction of the pterygoid plates are removed, allowing for mobilization of the PPF contents with the periosteum intact. Angled instrumentation is then used to resect the meningoencephalocele and repair the skull base defect in the lateral recess. If increased exposure is needed, this can be gained by sacrificing the sphenopalatine artery and even the vidian nerve, although this is rarely required.
Conclusions:
The MTPA obviates the need for PPF dissection and simplifies access to the lateral sphenoid recess while minimizing postoperative morbidity. This approach should be considered for accessing meningoencephaloceles and other benign lesions in this challenging location.
Insights
The endoscopic modified transpterygoid approach (MTPA) offers a less invasive way to access sphenoid sinus meningoencephaloceles. This technique simplifies surgical access and reduces patient morbidity by avoiding pterygopalatine fossa dissection.
Area of Science:
- Neurosurgery
- Otolaryngology
- Skull Base Surgery
Background:
- Meningoencephaloceles in the lateral sphenoid sinus recess present surgical access challenges.
- Traditional endoscopic transpterygoid approach requires pterygopalatine fossa (PPF) dissection, increasing morbidity.
- Advancements in endoscopic technology allow for less invasive surgical techniques.
Purpose of the Study:
- To describe the endoscopic modified transpterygoid approach (MTPA) for accessing lateral sphenoid sinus lesions.
- To present MTPA as a quicker and less invasive alternative to the traditional transpterygoid approach.
- To highlight the preservation of pterygopalatine fossa contents during MTPA.
Main Methods:
- The endoscopic modified transpterygoid approach (MTPA) involves removing the anterior sphenoid face and pterygoid plate junction.
- Mobilization of pterygopalatine fossa contents is performed with the periosteum intact.
- Angled instrumentation is utilized for meningoencephalocele resection and skull base repair.
Main Results:
- The MTPA provides a simplified surgical corridor through a single nostril.
- Preservation of pterygopalatine fossa contents is achieved, minimizing associated morbidity.
- Limited sacrifice of the sphenopalatine artery or vidian nerve may be necessary for increased exposure, but is rarely required.
Conclusions:
- The MTPA obviates the need for pterygopalatine fossa dissection, simplifying access to the lateral sphenoid recess.
- This minimally invasive approach reduces postoperative morbidity for patients.
- MTPA is a viable option for treating meningoencephaloceles and other lesions in this difficult-to-access location.
