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Abstract：
Introduction The endoscopic endonasal transpterygoid approach (EETPA) with or without the addition of the endoscopic-assisted sublabial anterior transmaxillary approach (ESTA) has become increasingly utilized for lesions posterior to the pterygopalatine fossa (PPF), including infratemporal fossa (ITF), lateral recess of the sphenoid sinus, Meckel\'s cave, petrous apex, and parapharyngeal space. The main goal of this study is to develop an educational resource to learn the steps of the EETPA for trainees. Methods EETPA and ESTA were performed in 12 specimens by neurosurgery trainees, under supervision from the senior authors. One EETPA and one ESTA were performed on each specimen on opposite sides. Dissections were supplemented with representative cases. Results After a wide unilateral sphenoidotomy, ethmoidectomy, and partial medial maxillectomy, the anteromedial bone limits of the PPF were identified and drilled out. The pterygoid progress was modularly removed. By enlarging the opening of the posterior and lateral walls of the maxillary sinus through EETPA and ESTA, respectively, the neurovascular and muscular compartments of the PPF and ITF were better identified. The EETPA opens direct corridors to the PPF, medial ITF, middle cranial fossa, cavernous sinus, Meckel\'s cave, petrous apex, and internal carotid artery. If a more lateral exposure of the ITF is needed, the ESTA is an appropriate addition. Conclusion Despite the steep learning curve of the EETPA, granular knowledge of its surgical anatomy and basic surgical steps are vital for those advancing their learning in complex endoscopic approaches to the ventral skull base when expanding the approach laterally in the coronal plane.
摘要：
简介内镜经鼻腔入路（EETPA）加上或不加上内镜辅助的唇下前经上颌入路（ESTA）已越来越多地用于翼腭窝（PPF）后方的病变。包括颞下窝(ITF)，蝶窦外侧隐窝，梅克尔的洞穴,岩尖，和咽旁空间。这项研究的主要目标是开发一种教育资源，以学习学员的EETPA步骤。方法对12例神经外科学员进行EETPA和ESTA检查，在高级作者的监督下。在每个样品的相对侧上进行一个EETPA和一个ESTA。解剖补充了代表性的病例。结果单侧蝶窦广泛切开术后，筛窦切除术,和上颌内侧部分切除术,确定并钻出了PPF的前内侧骨界限.翼状体进展被模块化删除。通过EETPA和ESTA扩大上颌窦后壁和侧壁的开口，分别,更好地识别了PPF和ITF的神经血管和肌肉区室.EETPA打开了通往PPF的直接走廊，中间ITF,中颅窝,海绵窦,梅克尔的洞穴,岩尖，和颈内动脉.如果需要更横向地暴露ITF，ESTA是一个适当的补充。结论尽管EETPA的学习曲线陡峭，在冠状平面横向扩展方法时，对其手术解剖结构和基本手术步骤的粒状知识对于那些在腹侧颅底的复杂内窥镜方法中进行学习的人至关重要。
