Fully endoscopic transnasal approach to the jugular foramen: anatomic study and clinical considerations

BACKGROUND AND IMPORTANCE: To describe a transnasal endoscopic route to the
jugular foramen and the endoscopic anatomy of the infratemporal fossa.
CLINICAL PRESENTATION: Endoscopic transnasal dissection of the infratemporal
fossa was performed in 3 injected fresh heads (1 head only in arteries and 2
heads in arteries and veins). Two other double-injected specimens were dissected
externally (2 of them side laterally and 1 anteriorly) to compare the different
views and better understand the 3-dimensionality of the region.Detailed
endoscopic anatomy of the infratemporal fossa was clearly observed. The
realization of a septal and posterior maxillary window allows surgeons to gain
space to the jugular foramen. The ability to manage the vessels, especially the
veins, and identify the muscles is mandatory. The fundamental role of the vidian
canal in targeting the anterior genu of the internal carotid artery is confirmed.
The role of the maxillary and mandibular branches of the trigeminal nerve and the
eustachian tube in this kind of approach is critical.
CONCLUSION: A fully transnasal endoscopic route to the jugular foramen is
feasible. The most important landmark for this kind of approach is the eustachian
tube.