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The endoscopic endonasal transpterygoid approach (EETPA) offers extensive access to the skull base. Careful preoperative planning is essential to navigate its complex anatomy and avoid potential complications like nerve injury.

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Area of Science:

  • Neurosurgery
  • Endoscopic Skull Base Surgery
  • Anatomy

Background:

  • The endoscopic endonasal transpterygoid approach (EETPA) is a minimally invasive technique.
  • It provides unparalleled access to critical structures of the skull base.

Purpose of the Study:

  • To detail the anatomical essentials for preoperative planning of the EETPA.
  • To outline the procedural steps and potential complications of the EETPA.
  • To describe the variants and indications for their use.

Main Methods:

  • Detailed anatomical review of the pterygoid process and related foramina.
  • Stepwise description of the surgical technique, including maxillary antrostomy and pterygoid process removal.
  • Discussion of potential complications and their avoidance.

Main Results:

  • The EETPA allows direct access to the petrous apex, lateral clivus, cavernous sinus, jugular foramen, and infratemporal fossa.
  • Understanding key foramina (palatovaginal, vidian, foramen rotundum) is crucial for surgical corridor.
  • Potential complications include lacrimation deficits and facial anesthesia/neuralgia.

Conclusions:

  • The EETPA significantly expands surgical exposure in the coronal plane.
  • Thorough preoperative assessment of relevant anatomy and potential pitfalls is vital for successful outcomes.
  • Knowledge of EETPA variants aids in tailoring the approach to specific pathologies.