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Endoscopic anatomy of a double nostrils surgical approach to Meckel’s cave
BAI Zhi-qiang JIN Yong* TAO Bao-hong WU Zhong-min
Acta Anatomica Sinica ›› 2014, Vol. 45 ›› Issue (1) : 84-88.
Endoscopic anatomy of a double nostrils surgical approach to Meckel’s cave
Objective To study the structures relevant to the endoscopic approach to the Meckel’s cave via the amphirhinal in order to provide the anatomy and morphology information for the Meckel’s cave surgery. Methods By simulating the operative approach to the Meckel’s cave via the amphirhinal under the endoscope, the operative approach-relevant anatomic landmarks in 10 cadaveric heads (20 sides) were observed, analyzed, photographied and measured. The cadavers were arterially and venously perfused with colored latex. Results The approach to the Meckel’s cave via the amphirhinal was divided into 4 steps: finding ostium of the maxillary sinus，entering the maxillary sinus，entering pterygopalatine fossa（PPF）and entering the Meckel’s cave. The distance from the nasal columella to the ostium of the maxillary sinus was (45.07±2.01) mm；the distance from the nasal columella to the sphenopalatine foramen was(64.84±3.00) mm；the distance from the nasal columella to the anterior foramen of the pterygoid canal was (71.34±2.99) mm. The angle between the lines from nasal columella to posterior nasal spine and from nasal columella to apertura maxillaries was (38.81±1.72)°. The angle between the lines from nasal columella to posterior nasal spine and from nasal columella to sphenopalatine foramen was(25.92±2.05) °. The diameter of sphenopalatine artery was (2.21±0.24)mm, and the diameter of vidian artery was (1.07±0.27)mm. The PPF region was structurally complicated due to the inside maxillary artery and its terminal branch-sphenopalatine artery, and great variation of the descending palatine artery. Tracing the sphenopalatine artery made it easier to localize the maxillary artery and its branches. When the constitutions such as pterygopalatine ganglions, veins were carefully departed, the vidian nerve and vessel bundles were tracked. The vidian ending was characterized to face with the ruptured fractions of the internal carotid artery. Meckel’s cave was straightly accessed by anatomically departing the quadrangular space (QS). Conclusion The selection of the operative approach to Meckel’s cave should be individualized. The location and the size of the lesion in Meckel’s cave are the major factors in deciding approaches for surgical treatment. The endoscopic approach of double nostrils-Meckel’s cave provides direct exposure to the anteromedial compartment of Meckel’s cave and PPF. Notable anatomical landmarks for the endoscopic surgeon are the sphenopalatine foramen, the vidian nerve and its canal and maxillarynerve (V2). A dissection superficial to the vascular structures preserves the neural elements. The nerves, such as the vidian nerve and V2, and their bony foramina are critical anatomical landmarks to identify and control the ICA( internal carotid artery) at the skull base.
Double nostrils / Meckel’s cave / Applied anatomy / Endoscope / Human
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