Department of Neurosurgery, Virgen del Rocío University Hospital, Seville, Spain.
Department of Neurosurgery, La Fe University Hospital, Valencia, Spain.
World Neurosurg. 2022 Jul;163:e124-e136. doi: 10.1016/j.wneu.2022.03.077. Epub 2022 Mar 22.
An anteromedial corridor via an expanded endoscopic endonasal approach to the Meckel cave (MC) was described more than a decade ago. However, few clinical series or endoscopic endonasal technical contributions exist concerning this type of approach to this complex region.
We present a detailed description of the surgical technique for this approach reviewing the original technique and adding clarifying conceptual notions. We conducted a multicenter retrospective study selecting patients who underwent endonasal endoscopic surgery for lesions exclusively limited to the MC in the past 6 years. Intraoperative and postoperative complications were analyzed. The study of 10 cadaveric specimens provides additional information.
We performed a fully endoscopic anteromedial corridor to the MC in 18 patients. The most prevalent pathologic finding was schwannoma of the V nerve in 4 patients. Sixth cranial nerve palsy (13 patients) and trigeminal dysfunction (10 patients) were the predominant preoperative clinical signs. There were no remarkable intraoperative complications. Corneal keratopathy caused by dry eye syndrome affected 3 patients and V2 residual neuralgia appeared postoperatively in 2 patients. Six patients recovered from sixth cranial nerve palsy, and 2 showed improvement in preoperatively referred facial pain.
The front door to the MC via the endonasal anteromedial corridor could be a good option. Understanding of the anatomy and the concept of the quadrangular space is crucial to performing this technique safely, which has few complications in experienced hands. Recovery from sixth nerve palsy is possible with this approach. Corneal keratopathy in these patients is a potential complication.
通过扩大经鼻内镜颅底入路（EEA）进入 Meckel 腔（MC）的前内侧通道，十多年前就已经有过相关描述。然而，关于这种进入复杂区域的方法，仅有少数临床系列或内镜经鼻技术贡献。
我们详细介绍了这种入路的手术技术，回顾了原始技术并添加了澄清概念。我们进行了一项多中心回顾性研究，选择了过去 6 年内仅因 MC 内病变而行内镜经鼻手术的患者。分析了术中及术后并发症。10 例尸体标本的研究提供了额外的信息。
我们对 18 例患者进行了完全内镜前内侧 MC 通道手术。最常见的病理发现是 4 例 V 神经神经鞘瘤。术前主要的临床体征是第 6 颅神经麻痹（13 例）和三叉神经功能障碍（10 例）。术中无明显并发症。3 例因干燥综合征引起的角膜病变，2 例术后出现 V2 残留神经痛。6 例第 6 颅神经麻痹患者恢复，2 例术前面部疼痛改善。
通过经鼻内镜前内侧通道进入 MC 的前门是一个不错的选择。理解解剖结构和四边形空间的概念对于安全地进行这项技术至关重要，在有经验的手中，这种技术的并发症很少。通过这种方法可以恢复第 6 颅神经麻痹。这些患者的角膜病变是一个潜在的并发症。
