Endoscopic transpterygoid approach to the lateral sphenoid recess: Surgical approach and clinical experience

OBJECTIVE: Pathology within a lateral recess of a widely pneumatized sphenoid sinus is difficult to access with the use of traditional open and current endoscopic surgical approaches. A new surgical procedure, the endoscopic transpterygoid approach, directly accesses this region. A clinical experience over several year with this approach is reported as well as a refined and updated description of the technique. SETTING: Tertiary care center. METHODS: Retrospective review of medical records of patients treated with the endoscopic transpterygoid approach to the lateral sphenoid recess. RESULTS: An endoscopic transpterygoid approach was performed in 9 patients, 6 to resect a middle fossa meningoencephalocele and repair the CSF leak and associated skull base defect, 2 for possible invasive fungal sinusitis, and 1 to marsupialize a symptomatic epidermoid cyst. Patients tolerated the approach well and no significant complications occurred. CONCLUSIONS AND SIGNIFICANCE: In selected cases, the endoscopic transpterygoid approach enables the otolaryngologist to meet modem demands to treat conditions in the lateral sphenoid using minimally invasive techniques that are well-tolerated by patients. The surgical approach and the initial experience described herein is presented in the hopes that it can aid fellow otolaryngologists to help patients with challenging conditions in this region of the body. (c) 2005 American Academy of Otolaryngology-Head and Neck Surgery Foundation, Inc. All rights reserved.