Clinical implications of the anatomical relationships of the pterygopalatine fossa and Vidian canal: an endonasal endoscopic cadaveric study

Abstract

Objectives: The aim of our study was to describe a surgical access to pterygopalatine fossa and Vidian canal using an endonasal endoscopic approach. We also intend to reveal the anatomical relations of the neurovascular structures in the surgical corridors and to determine the relationships between previously defined reference points in order to prevent surgical complications during surgical access to these regions. Methods: Our study was carried out between October-December 2016 in Cerrahpaşa Faculty of Medicine Microneurosurgery and Neuroanatomy Laboratory. A total of 7 silicon dye-injected cadavers (4 males and 3 females) were studied. 3D images were obtained by photographing the approaches applied to the pterygopalatine fossa and Vidian canal and related anatomical structures. Results: We succeeded in exposing and examining the pterygopalatine fossa and Vidian canal endoscopically in all samples. First, the posterior wall of the maxillary sinus was opened to reach the pterygopalatine fossa. The pterygopalatine fossa was divided into 3 anatomical compartments. The first layer encountered was the periosteum covering the pterygopalatine fossa. After removing the periosteum, the fat layer was revealed. Under the fat layer, the vascular compartment and finally the neural compartment were encountered. Conclusion: Our study revealed three-dimensional anatomical data related to the surgical margins involved in approaches to the pterygopalatine fossa and Vidian canal; and specifically defined various neurovascular structures encountered in these approaches. Our study provides information to decrease potential complications that may develop during endonasal endoscopic surgery. We conclude that as the anatomy of the pterygopalatine fossa and Vidian canal is known in details, the endonasal endoscopic approach is likely to become the standard method to access lesions in these regions.