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Indications Corridor and Limits of Exposure: The endoscopic endonasal transpterygoid approach (EETPA) provides direct access to the petrous apex, lateral clivus, inferior cavernous sinus compartment, jugular foramen, and infratemporal fossa. 1,2 In the coronal plane, it provides exposure far beyond a traditional sphenoidotomy., Anatomic Essentials Need for Preoperative Planning and Assessment: The pterygoid process of the sphenoid bone forms the junction between the body and greater sphenoid wing before bifurcating because it descends into medial and lateral plates. The key to this exposure lies in the region's bony foramina: the palatovaginal canal, vidian canal, and foramen rotundum. 3., Essentials Steps of the Procedure: After performing a maxillary antrostomy, stepwise exposure of these foramina leads to the pterygopalatine fossa. The sphenopalatine artery is cauterized as it becomes the posterior septal artery at the sphenopalatine foramen, and the maxillary sinus' posterior wall is opened to expose the pterygopalatine fossa. After mobilizing and retracting the contents of the pterygopalatine fossa, the pterygoid process is removed, improving access in the coronal plane. 4., Pitfalls/avoidance of Complications: Vidian neurectomy causes decreased or absent lacrimation. Injury to the maxillary nerve or its branches results in facial, palatal, or odontogenic anesthesia or neuralgia. In addition, the EEPTA precludes the ability to raise an ipsilateral nasal septal flap, making it crucial to plan reconstruction preoperatively. 4,5., Variants and Indications for Their Use: There are 5 variants of the EEPTA: extended pterygopalatine fossa, lateral recess of the sphenoid sinus, petrous apex, infratemporal fossa and petrous carotid artery, and middle and posterior skull base. 5The patient consented to the procedure.Images in the video used with permission as follows: images at 0:33 and 1:15 reused from Bozkurt et al, 3 © Georg Thieme Verlag KG; image at 0:39 from Prosser et al, 5 © John Wiley and Sons; images at 0:54, 9:03, and 9:38 from Kasemsiri et al, 1 © John Wiley and Sons; images at 1:07 and 9:44 from Falcon et al, 2 © John Wiley and Sons; image at 1:15 from Sandu et al, 4 © Springer Nature., (Copyright © Congress of Neurological Surgeons 2023. All rights reserved.)

Background: Many lesions in the anterior skull base may compress the optic nerve (ON), leading to vision loss, and even irreversible blindness. Although decompression of the optic nerve has traditionally been achieved transcranially, the endoscopic endonasal approach (EEA) is gaining traction as a minimally invasive approach recently. Method: We describe the key steps of an EEA ON decompression. The relevant surgical anatomy with illustration is described. Additionally, a video detailing our technique and instruments on an illustrative case is provided. Conclusion: Endoscopic endonasal approach ON decompression with a straight feather blade is a feasible, minimally invasive procedure to decompress the ON in the setting of anterior skull base mass lesions. [ABSTRACT FROM AUTHOR]

This article, published in the Journal of Neurological Surgery, discusses two cases of frontoethmoidal osteoma, a rare type of benign bone tumor. The patients presented with neurological deficits and cerebral spinal fluid (CSF) leaks. Both cases were successfully treated with different surgical approaches, resulting in complete tumor resection and no complications or signs of CSF leak. The authors emphasize the need for more cases to better understand the epidemiology, clinical presentation, treatment strategies, and outcomes of this condition. The article also includes a literature review of eight previously reported cases. [Extracted from the article]