Endoscopic Multiportal Approaches to Meckel's Cave: A Cadaveric Study and a Three-Dimensional Anatomical Video

Objective  This cadaveric study aims to illustrate the lateral transorbital (LTO), transantral transpterygoid (TATP), and endoscopic endonasal approaches (EEA) to Meckel's cave (MC), defining their surgical freedom, area of exposure, and advantages and limitations; thus, refining their respective indications. Design  Cadaveric study. Setting  The Anatomical Laboratory for Visuospatial Innovations in Otolaryngology and Neurosurgery (ALT-VISION) at the Ohio State University, Wexner Medical Center. Participants  Bilateral dissections of five injected cadavers (10 sides). Main Outcome Measures  Distance to targets, surgical freedom, and area of exposure provided by the EEA, TATP, and LTO approaches. Results  The TATP approach provides superior surgical freedom to foramen rotundum (167.70 ± 29.762 mm). However, surgical freedom to foramen ovale was best when using the LTO approach (75.01 ± 15.773 mm). The EEA provides a superior exposure of the medial MC (mean area of 587.69 ± 38.59 mm ² ). The LTO and TATP approaches provide equivalent access to the lateral MC (ranging from 468.90 ± 26.98 mm ² for TATP to 650.11 ± 35.76 mm ² for the LTO approach). Combining approaches increases the area of exposure significantly (1,237.79 ± 48.41 mm ² and 1,056.59 ± 48.12 mm ² for EEA and LTO vs. EEA and TATP). Conclusion  This study thoroughly emphasizes the pros and cons of the aforementioned approaches. Each approach may be applied in selected cases as a single or as part of a combined technique. However, conventional approaches are still indicated according to extent and pathology. Level of Evidence : V.