• World Neurosurg · Jul 2022

    Multicenter Study

    THE QUADRANGULAR SPACE, ENDONASAL ACCESS TO MECKEL'S CAVE: TECHNICAL CONSIDERATIONS AND CLINICAL SERIES.

    • Eugenio Cárdenas Ruiz-Valdepeñas, Juan A Simal Julián, Gustavo Pérez Prat, Miguel A Arraez, Jesus Ambrosiani, Martin SchraderIgnacioIDepartment of Neurosurgery, Virgen del Rocío University Hospital, Seville, Spain., Alfonso Soto Moreno, and Ariel Kaen.
    • Department of Neurosurgery, Virgen del Rocío University Hospital, Seville, Spain. Electronic address: cardenas.eugenio@gmail.com.
    • World Neurosurg. 2022 Jul 1; 163: e124-e136.

    ObjectiveAn 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.MethodsWe 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.ResultsWe 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.ConclusionsThe 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.Copyright © 2022 Elsevier Inc. All rights reserved.

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