Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio.
Department of Otolaryngology, Cedars-Sinai Medical Center, Los Angeles, California.
Am J Rhinol Allergy. 2021 Nov;35(6):798-801. doi: 10.1177/19458924211003813. Epub 2021 Mar 24.
Meningoencephaloceles originating in the lateral recess of the sphenoid sinus can be difficult to access. Historically, the endoscopic transpterygoid approach was advocated, which carries additional morbidity given the dissection of the pterygopalatine fossa (PPF) contents to provide a direct line approach to the defect. Given our increased facility with angled endoscopes and instrumentation, we now approach this region in a less invasive manner.
We describe the endoscopic modified transpterygoid approach (MTPA), a quicker approach to the lateral sphenoid recess which preserves the PPF contents through a single nostril corridor.
In the MTPA, the face of the sphenoid and anterior junction of the pterygoid plates are removed, allowing for mobilization of the PPF contents with the periosteum intact. Angled instrumentation is then used to resect the meningoencephalocele and repair the skull base defect in the lateral recess. If increased exposure is needed, this can be gained by sacrificing the sphenopalatine artery and even the vidian nerve, although this is rarely required.
The MTPA obviates the need for PPF dissection and simplifies access to the lateral sphenoid recess while minimizing postoperative morbidity. This approach should be considered for accessing meningoencephaloceles and other benign lesions in this challenging location.
起源于蝶窦侧隐窝的脑膜脑膨出很难进入。历史上，提倡使用经蝶翼突入路，由于翼腭窝（PPF）内容物的解剖以提供直达缺损的直接途径，因此会带来额外的发病率。鉴于我们对角度内镜和器械的使用更加熟练，我们现在以一种侵入性更小的方式来处理这个区域。
我们描述了经内镜改良翼突入路（MTPA），这是一种更快的进入蝶窦侧隐窝的方法，通过单个鼻孔通道保留 PPF 内容物。
在 MTPA 中，去除蝶骨的前面和翼突板的前结合部，使 PPF 内容物在完整的骨膜下得以移动。然后使用角度器械切除脑膜脑膨出并修复外侧隐窝的颅底缺损。如果需要增加暴露，可以通过牺牲蝶腭动脉甚至翼管神经来获得，尽管这种情况很少需要。
MTPA 避免了 PPF 解剖的需要，简化了进入外侧蝶窦隐窝的途径，同时最大限度地减少了术后发病率。对于在这个具有挑战性的位置的脑膜脑膨出和其他良性病变，应考虑采用这种方法。
