The endoscopic trans-sinusoidal trans-pterygopalatine route to the foramen rotundum approach in trigeminal neuralgia treatment

Abstract

AIM: 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.