{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T12:29:33Z","timestamp":1772108973992,"version":"3.50.1"},"reference-count":34,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2018,1]]},"abstract":"<jats:sec><jats:title>OBJECTIVE<\/jats:title><jats:p>Multiple approaches have been designed to reach the medial middle fossa (for lesions in Meckel\u2019s cave, in particular), but an anterior approach through the greater wing of the sphenoid (transalisphenoid) has not been explored. In this study, the authors sought to assess the feasibility of and define the anatomical landmarks for an endoscopic anterior transmaxillary transalisphenoid (EATT) approach to Meckel\u2019s cave and the middle cranial fossa.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p>Endoscopic dissection was performed on 5 cadaver heads injected intravascularly with colored silicone bilaterally to develop the approach and define surgical landmarks. The authors then used this approach in 2 patients with tumors that involved Meckel\u2019s cave and provide their illustrative clinical case reports.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>The EATT approach is divided into the following 4 stages: 1) entry into the maxillary sinus, 2) exposure of the greater wing of the sphenoid, 3) exposure of the medial middle fossa, and 4) exposure of Meckel\u2019s cave and lateral wall of the cavernous sinus. The approach provided excellent surgical access to the anterior and lateral portions of Meckel\u2019s cave and offered the possibility of expanding into the infratemporal fossa and lateral middle fossa and, in combination with an endonasal transpterygoid approach, accessing the anteromedial aspect of Meckel\u2019s cave.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS<\/jats:title><jats:p>The EATT approach to Meckel\u2019s cave and the middle cranial fossa is technically feasible and confers certain advantages in specific clinical situations. The approach might complement current surgical approaches for lesions of Meckel\u2019s cave and could be ideal for lesions that are lateral to the trigeminal ganglion in Meckel\u2019s cave or extend from the maxillary sinus, infratemporal fossa, or pterygopalatine fossa into the middle cranial fossa, Meckel\u2019s cave, and cavernous sinus, such as schwannomas, meningiomas, and sinonasal tumors and perineural spread of cutaneous malignancy.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2017.8.jns171308","type":"journal-article","created":{"date-parts":[[2018,2,2]],"date-time":"2018-02-02T15:00:09Z","timestamp":1517583609000},"page":"227-237","source":"Crossref","is-referenced-by-count":34,"title":["Endoscopic anterior transmaxillary \u201ctransalisphenoid\u201d approach to Meckel\u2019s cave and the middle cranial fossa: an anatomical study and clinical application"],"prefix":"10.3171","volume":"130","author":[{"given":"Huy Q.","family":"Truong","sequence":"first","affiliation":[{"name":"Departments of Neurological Surgery and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xicai","family":"Sun","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery and"},{"name":"Department of Otolaryngology, Eye, Ear, Nose, and Throat Hospital, Shanghai Medical College of Fudan University, Shanghai, People\u2019s Republic of China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emrah","family":"Celtikci","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hamid","family":"Borghei-Razavi","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eric W.","family":"Wang","sequence":"additional","affiliation":[{"name":"Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carl H.","family":"Snyderman","sequence":"additional","affiliation":[{"name":"Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paul A.","family":"Gardner","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Juan C.","family":"Fernandez-Miranda","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery and"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"key":"b1","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"453","DOI":"10.3171\/jns.2002.96.3.0453","article-title":"Trigeminal schwannomas: removal of dumbbell-shaped tumors through the expanded Meckel cave and outcomes of cranial nerve function","volume":"96","author":"Al-Mefty O","year":"2002","unstructured":"Al-Mefty O, Ayoubi S, Gaber E: Trigeminal schwannomas: removal of dumbbell-shaped tumors through the expanded Meckel cave and outcomes of cranial nerve function. 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