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J Neurol Surg B Skull Base 2024; 85(06): 641-649
DOI: 10.1055/a-2158-6037
Original Article

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

Eman H. Salem 
1   Department of Otolaryngology—Head and Neck Surgery, Mansoura University, Mansoura, Egypt
2   Department of Otolaryngology-Head and Neck Surgery, Wexner Medical Center, Ohio State University, Columbus, Ohio, United States
,
Ahmed Musaad Abd El-Fattah
1   Department of Otolaryngology—Head and Neck Surgery, Mansoura University, Mansoura, Egypt
,
Hisham Atef Ebada
1   Department of Otolaryngology—Head and Neck Surgery, Mansoura University, Mansoura, Egypt
,
Kyle van Koevering
2   Department of Otolaryngology-Head and Neck Surgery, Wexner Medical Center, Ohio State University, Columbus, Ohio, United States
,
Douglas A. Hardesty
3   Department of Neurosurgery, Wexner Medical Center, Ohio State University, Columbus, Ohio, United States
,
Daniel M. Prevedello
2   Department of Otolaryngology-Head and Neck Surgery, Wexner Medical Center, Ohio State University, Columbus, Ohio, United States
3   Department of Neurosurgery, Wexner Medical Center, Ohio State University, Columbus, Ohio, United States
,
Mohamed Abd El-halem Al-Saddeik
1   Department of Otolaryngology—Head and Neck Surgery, Mansoura University, Mansoura, Egypt
,
Ricardo L. Carrau
2   Department of Otolaryngology-Head and Neck Surgery, Wexner Medical Center, Ohio State University, Columbus, Ohio, United States
3   Department of Neurosurgery, Wexner Medical Center, Ohio State University, Columbus, Ohio, United States
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Abstract

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 mm2). The LTO and TATP approaches provide equivalent access to the lateral MC (ranging from 468.90 ± 26.98 mm2 for TATP to 650.11 ± 35.76 mm2 for the LTO approach). Combining approaches increases the area of exposure significantly (1,237.79 ± 48.41 mm2 and 1,056.59 ± 48.12 mm2 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.

Keywords

Meckel's cave - transorbital - transpterygoid - endoscopic endonasal - multiportal

Author's Contributions

Eman H. Salem: original conception, study design, data collection and interpretation, manuscript drafting and critical review, final approval, agreement to be accountable for all aspects of the work; Hisham Atef Ebada, Ahmed Musaad Abd El-Fattah, Mohamed Abd El-halem Al-Saddeik: manuscript drafting and critical review, final approval, agreement to be accountable for all aspects of the work; Kyle van Koevering, Douglas A. Hardesty, Daniel M. Prevedello, and Ricardo L. Carrau: study design, supervision on cadaveric study, final approval, manuscript drafting and critical review, and agreement to be accountable for all aspects of the work.




Publication History

Received: 14 April 2023

Accepted: 17 August 2023

Accepted Manuscript online:
22 August 2023

Article published online:
25 September 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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