Minimally invasive trans-nasal approach to the anteromedial temporal fossa and lateral sphenoid using a novel landmark between periorbita and periosteum of pterygopalatine fossa: a cadaveric study

Abstract

The anteromedial temporal region and lateral wall of the sphenoid sinus, in which the second and third divisions of the trigeminal nerve (V2, V3), internal carotid artery, cavernous sinus, and temporal lobe exist can be the site of an array of pathology including trigeminal schwannoma, encephalocele, cholesterol granuloma of the petrous apex, malignancy with or without perineural spread, infection, and sellar pathology extending to the lateral cavernous sinus. Approaches to this region are technically challenging and the existing approach requires sacrifice of the all of the turbinate include nasolacrimal duct, which can cause postoperative complications. We describe a novel anatomical landmark between the periorbita and periosteum of the pterygopalatine fossa (which is located at the inferior lateral periorbital periosteal line: ILPPL). The posterior one third of the incision line lies between the foramen rotundum and superior orbital fissure, which is proximity of the maxillary strut Using a 1.5-cm incision can divide the orbital and pterygoid contents and lead us to the posterior infra-lateral orbital region, antero-medial temporal region, lateral wall of the sphenoid sinus, and lateral wall of cavernous sinus. Combined with multi- angled approach with ILPPL enable us to preserve all of the turbinates and septum, nasolacrimal duct allowing for the preservation of physiological function and pedicled flaps, such as the middle turbinate, inferior turbinate, and septum membrane flap. The ILPPL is a simple, effective, and novel landmark for the minimally invasive approach to the anteromedial temporal fossa.