Endoscopic Transmaxillary Approach for Sclerotherapy of an Infratemporal Fossa Venous Malformation

Abstract

Disfiguring or symptomatic venous and lymphatic malformations are often treated with sclerotherapy. A 10-year-old girl with a history of epilepsy and migraines presented with progressive facial pain along the mandibular division of the trigeminal nerve. Magnetic resonance imaging identified a lobulated, enhancing lesion within the lateral pterygoid muscle, consistent with a venous malformation. It could not be safely approached transcutaneously; therefore, an endoscopic transmaxillary approach was offered. The lesion was localized with neuronavigation, and digital subtraction venography was employed to confirm entry into the lesion. Primary drainage via the pterygoid plexus toward the left retromandibular vein without any connections to the cavernous sinus or left orbit was identified. At this point, foam sclerosant was injected. Postoperatively, the facial pain resolved, and magnetic resonance imaging demonstrated an excellent response to the sclerotherapy. To our knowledge, this is the first report of an endoscopic transmaxillary approach for sclerotherapy of an infratemporal fossa venous malformation.