Turkish Neurosurgery
The Endoscopic Trans-Sinusoidal Trans-Pterygopalatine Route To The Foramen Rotundum Approach In Trigeminal Neuralgia Treatment
Muhammet Arif Ozbek1, Ahmet Tulgar Basak2, Nazli Cakici3, Bayram Ufuk Sakul4, Nejat Akalan5
1Haseki Research and Training Hospital, Neurosurgery Clinic, İstanbul,
2Koc University Faculty of Medicine, Department of Neurosurgery, İstanbul,
3Medicana International Hospital, Department of Neurosurgery, İstanbul,
4Istanbul Medipol University School of Medicine, Department of Anatomy, İstanbul,
5Istanbul Medipol University, Department of Neurosurgery, İstanbul,
DOI: 10.5137/1019-5149.JTN.30283-20.3

Aim:Despite many surgical and medical treatment procedures have been used in trigeminal neuralgia to date, the cure rate remains below expectations. In our study, we aimed to describe a new, minimally invasive, and safe access to foramen rotundum via the endoscopic endonasal trans-sinusoidal route for trigeminal nerve blockage. Material and Methods:We studied 5 fresh cadavers bilaterally and 10 pterygopalatine fossae and maxillary nerves using the endoscopic endonasal trans-sinusoidal trans-pterygopalatine approach. Results:The proposed approach enabled the maxillary nerve to be visualized after revealing the foramen rotundum with the help of some craniometric measurements. Distance between sphenoid sinus lateral wall and maxillary sinus posterior wall was measured. This measurement was found to be an important triangulation point to determine the location of the entrance to the pterygopalatine fossa. The distance between the foramen rotundum and the sphenopalatine artery was found to be significant. The foramen rotundum diameter was calculated, and the maxillary nerve was found to be situated inferolateral to the foramen rotundum. Therefore, the safe entry zone was determined superomedially. No significant difference was found between male and female and the right and left nostrils. Conclusion:Various surgical procedures have been applied to treat drug-resistant trigeminal neuralgia. Nevertheless, their cure rates remain less than anticipated. Recurrences up to 30% have been reported in the literature. In this study, the endoscopic endonasal transmaxillary trans-pterygopalatine route offers a new perspective on the foramen rotundum approach and provides a panoramic and safe view in previously high-risk percutaneous interventions.

Corresponding author : Muhammet Arif Ozbek