Transmaxillary Endoscopic Approach To Contralateral Parasellar Lesions

Despite the improvement of endonasal endoscopic approach techniques, tumors extending to the cavernous sinus or to the petrous apex still represent a surgical challenge. As the cavernous sinus has an anterior-to-posterior orientation, almost parallel to the midline, approaching from the nasal corridor offers a very short angle of visualization. Besides that, dissecting in the most lateral aspect of the sphenoid sinus can be limited by nasal structures or pterygopalatine fossa.The transmaxillary endoscopic approach to contralateral parasellar lesions offers an alternative route to the cavernous sinus. It provides a much wider angle of approach, favoring visualization and dissection. Besides that, it offers a third and wide working channel for maneuvering surgical instruments and scopes. In this chapter, the authors describe the surgical technique, relevant anatomical details and present an illustrative case.