An anteromedial corridor via an expanded endoscopic endonasal approach to Meckel’s Cave (MC) was described over a decade ago. However, few clinical series or endoscopic endonasal technical contributions concerning this type of approach to this complex region exist.
We present a detailed description of the surgical technique for this approach reviewing the original technique and adding clarifying conceptual notions. At the same time, we conducted a multicenter retrospective study selecting patients who underwent endonasal endoscopic surgery for lesions exclusively limited to MC in the past 6 years. Intraoperative and postoperative complications were analyzed. The study of 10 cadaveric specimens provides additional information.
We performed a fully endoscopic anteromedial corridor to MC in 18 patients. The most prevalent pathological finding was schwannoma of the V nerve in four patients. Sixth cranial nerve palsy (13 patients) and trigeminal dysfunction (10 patients) were the predominant preoperative clinical signs. There were no remarkable intraoperative complications. Corneal keratopathy due to dry eye syndrome affected three patients and V2 residual neuralgia appeared postoperatively in two patients. Six patients recovered from sixth cranial nerve palsy, and two showed improvement in preoperatively referred facial pain.
The front door to MC via the endonasal anteromedial corridor could be a good option. Understanding of the anatomy and the concept of the quadrangular space is crucial to performing this technique safely, and has few complications in experienced hands. Recovery from sixth nerve palsy is possible with this approach. Corneal keratopathy in these patients is a potential complication.

Copyright © 2022. Published by Elsevier Inc.