Suero Molina E, Revuelta Barbero J M, Ewelt C, Stummer W, Carrau R L, Prevedello D M
Department of Neurosurgery, University Hospital Münster, Albert-Schweitzer-Campus 1, A1, 48149, Munster, Germany.
Department of Otolaryngology-Head and Surgery, The Ohio State University, Wexner Medical Center, Columbus, OH, USA.
Neurosurg Rev. 2021 Feb;44(1):249-259. doi: 10.1007/s10143-020-01247-w. Epub 2020 Feb 10.
Accessing Meckel's cave (MC) is surgically challenging. Open approaches are complex and often correlated with high morbidity. Endoscopic approaches emerged in the last decade as feasible alternatives to open approaches, especially for sampling indeterminate lesions. This article first analyses available routes to approach Meckel's cave and presents furthermore an illustrative case. We conducted a systematic review and reported according to the guidelines for preferred reporting items for systematic reviews and meta-analyses (PRISMA). Various surgical approaches identified through the search are evaluated and discussed in detail. Additionally, we report on a case of woman with a lesion in MC, which was accessed through an endoscopic transpterygoid approach subsequently diagnosed as a diffuse large B cell lymphoma. Our search delivered 75 articles that included case reports (n = 21), cadaveric studies (n = 32), clinical articles (n = 16), review of the literatures (n = 3), as well as technical notes (n = 2) and a radiological manuscript (n = 1). Open routes included lateral approaches with many variations, mainly intra- and extradural pterional approaches and anterior petrosal, as well as a retrosigmoid intradural suprameatal and a lateral transorbital approach. Endoscopically, MC was reached via approaches that included transpterygoid, transorbital or infraorbital fissure routes. Percutaneous approaches, e.g. through the foramen ovale, were also described. Multiple surgical approaches to MC are currently available. Their different characteristics as well as individual patient factors, such as clinical history and the localization of the disease, have to be considered when choosing a surgical corridor. Studies included in this review highlight the endonasal endoscopic transpterygoidal technique as an excellent corridor for biopsies in the ventral MC.
进入梅克尔腔（MC）在手术上具有挑战性。开放手术方法复杂，且常常伴有高发病率。内镜手术方法在过去十年中出现，成为开放手术方法可行的替代方案，尤其是对于采集不确定病变样本。本文首先分析进入梅克尔腔的可用途径，并进一步展示一个病例。我们进行了系统综述，并按照系统综述和荟萃分析的首选报告项目（PRISMA）指南进行报告。对通过检索确定的各种手术方法进行了详细评估和讨论。此外，我们报告了一例患有梅克尔腔病变的女性病例，该病例通过内镜经翼突入路进入，随后被诊断为弥漫性大B细胞淋巴瘤。我们的检索得到75篇文章，包括病例报告（n = 21）、尸体研究（n = 32）、临床文章（n = 16）、文献综述（n = 3），以及技术笔记（n = 2）和一篇放射学手稿（n = 1）。开放途径包括多种变化的外侧入路，主要是硬膜内和硬膜外翼点入路以及岩前入路，还有乙状窦后硬膜内颞上入路和外侧经眶入路。在内镜下，通过包括经翼突、经眶或眶下裂途径进入梅克尔腔。还描述了经皮入路，例如通过卵圆孔。目前有多种进入梅克尔腔的手术方法。在选择手术通道时，必须考虑它们不同的特点以及个体患者因素，如临床病史和疾病的定位。本综述纳入的研究强调鼻内镜经翼突技术是腹侧梅克尔腔活检的极佳通道。
