What is the best route to the Meckel cave? Anatomical comparison between the endoscopic endonasal approach and a lateral approach

Jason Van Rompaey, Carrie Bush, Eyad Khabbaz, John Vender, Ben Panizza, C. Arturo Solares

Research output: Contribution to journalArticlepeer-review

12 Scopus citations


Background: Traditionally, a pterional approach is utilized to access the Meckel cave. Depending on the tumor location, extradural dissection of the Gasserian ganglion can be performed. An endoscopic endonasal access could potentially avoid a craniotomy in these cases. Methods: We performed an endoscopic endonasal approach as well as a lateral approach to the Meckel cave on six anatomic specimens. To access the Meckel cave endoscopically, a complete sphenoethmoidectomy and maxillary antrostomy followed by a transpterygoid approach was performed. For lateral access, a pterional craniotomy with extradural dissection was performed. Results: The endoscopic endonasal approach allowed adequate access to the Gasserian ganglion. All the relevant anatomy was identified without difficulty. Both approaches allowed for a similar exposure, but the endonasal approach avoided brain retraction and improved anteromedial exposure of the Gasserian ganglion. The lateral approach provided improved access posterolaterally and to the superior portion. Conclusion: The endoscopic endonasal approach to the Meckel cave is anatomically feasible. The morbidity associated with brain retraction from the open approaches can be avoided. Further understanding of the endoscopic anatomy within this region can facilitate continued advancement in endoscopic endonasal surgery and improvement in the safety and efficacy of these procedures.

Original languageEnglish (US)
Pages (from-to)331-336
Number of pages6
JournalJournal of Neurological Surgery, Part B: Skull Base
Issue number6
StatePublished - 2013


  • Gasserian ganglion
  • Meckel cave
  • endonasal endoscopic
  • lateral approach
  • maxillary antrostomy
  • pterional craniotomy
  • sphenoethmoidectomy

ASJC Scopus subject areas

  • Clinical Neurology


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