Endoscopic transnasal approach to the pterygopalatine fossa.

OBJECTIVE To describe an endoscopic transnasal approach to the pterygopalatine fossa (PPF). DESIGN Case series of 3 patients. SETTING An academic medical center. Patients One patient presented with an asymptomatic PPF schwannoma. The second patient presented after a sudden onset of complete unilateral vision loss with a complete ipsilateral sphenoid sinus opacification and radiographic signal abnormality in the PPF and inferior orbital fissure. The third patient had a history of adenoid cystic carcinoma of the lacrimal gland, and was found to have new-onset facial numbness. Intervention One patient had a complete excision of a schwannoma by means of an endoscopic transnasal approach. The other 2 patients had wide exposure and biopsies of the PPF. One patient had a revision procedure through the same approach with further lateral exposure to the area of the inferior orbital fissure. RESULTS All patients had successful endoscopic approaches for tumor removal (case 1) and biopsy (cases 2 and 3) of the PPF. The second patient had a repeat endoscopic biopsy 1 week later to obtain more tissue for diagnostic purposes. None of the patients had any major vascular complications. At follow-up, 2 of 3 patients had persistent sensory deficits. CONCLUSIONS The endoscopic transnasal approach to the PPF is a safe and effective method for biopsy and removal of PPF masses. The endoscopic approach improves access and visualization, and has the potential to reduce complications compared with open approaches. Image guidance is helpful in these cases.