Minimally Invasive Lateral Endoscopic Multiport Approach to the Infratemporal Fossa: A Cadaveric Study

OBJECTIVE Expanded endoscopic endonasal approaches to the infratemporal fossa (ITF) are increasingly performed due to the improved visualization and the less morbidity in comparison to the classic open approaches. However, only a few studies in the literature investigated the lateral endoscopic access to the ITF. The purpose of our study is to examine the ITF with the minimal invasive endoscopically assisted Gillies approach with the trial of its expansion through a double port technique. MATERIALS AND METHODS The ITF was examined in 10 sides of five cadaver heads using a lateral endoscopic assisted approach. Moreover, a double portal technique was developed to allow bimanual dissection. Specific long angled skull base instruments were used for the dissection under stereotactic guidance. RESULTS The endoscopic assisted Gillies approach permitted a minimally invasive access to the complete anteroposterior extension of the ITF with sufficient mobility of the surgical instruments. A new anatomical classification for the ITF from a lateral endoscopic perspective was introduced. The addition of the second port gave the opportunity for bimanual dissection. CONCLUSIONS This cadaveric study shows the feasibility of an endoscopically assisted lateral approach to the ITF. Furthermore, the addition of a posterior port expands the approach through increasing the working area and enable a bimanual dissection technique. Either performed alone or in combination with an anterior endoscopic transnasal approach, the hereby proposed technique can offer a minimally invasive access to the ITF. The development of specifically designed instruments would further improve the impact and ease of this promising approach.