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Endoscopic Multiportal Approaches to Meckel's Cave: A Cadaveric Study and a Three-Dimensional Anatomical Video
Eman H Salem1,2, Ahmed Musaad Abd El-Fattah1, Hisham Atef Ebada1
1Department of Otolaryngology-Head and Neck Surgery, Mansoura University, Mansoura, Egypt.
Journal of Neurological Surgery. Part B, Skull Base
|November 1, 2024
Summary
This cadaveric study compares lateral transorbital (LTO), transantral transpterygoid (TATP), and endoscopic endonasal approaches (EEA) to Meckel's cave, revealing TATP offers superior freedom to foramen rotundum and EEA excels in medial exposure.
Area of Science:
- Neurosurgery
- Otolaryngology
- Anatomy
Background:
- Meckel's cave (MC) is a critical anatomical region for neurosurgical and otolaryngological interventions.
- Understanding the surgical freedom and exposure offered by different approaches to MC is essential for optimizing patient outcomes.
- Existing literature may not comprehensively compare the lateral transorbital (LTO), transantral transpterygoid (TATP), and endoscopic endonasal approaches (EEA) to MC.
Purpose of the Study:
- To illustrate and compare the surgical freedom, area of exposure, advantages, and limitations of LTO, TATP, and EEA to Meckel's cave.
- To refine the indications for each surgical approach based on anatomical and technical considerations.
- To evaluate the efficacy of combined surgical techniques for accessing Meckel's cave.
Main Methods:
- A cadaveric study involving bilateral dissections of five injected cadavers (10 sides).
- Quantitative assessment of surgical freedom (distance to targets) and area of exposure for EEA, TATP, and LTO approaches.
- Comparison of individual approaches and combined techniques regarding exposure and accessibility to Meckel's cave structures.
Main Results:
- The TATP approach provided superior surgical freedom to foramen rotundum (167.70 mm).
- The LTO approach offered the best surgical freedom to foramen ovale (75.01 mm).
- EEA yielded the largest medial MC exposure (587.69 mm²), while LTO and TATP offered comparable lateral MC access (468.90–650.11 mm²).
- Combined approaches significantly increased the total area of exposure (1,056.59–1,237.79 mm²).
Conclusions:
- Each approach (LTO, TATP, EEA) has distinct advantages and limitations for accessing Meckel's cave.
- Combined surgical techniques can significantly enhance the area of exposure.
- The choice of approach, whether single or combined, should be tailored to the specific pathology and extent of the disease.
