# Lessons learned in 20 years of endoscopic endonasal surgery for pterygopalatine and infratemporal fossae lesions: analysis of a patient series and systematic review of literature

## TL;DR

This study examines the effectiveness of endoscopic endonasal surgery for tumors in the pterygopalatine and infratemporal fossae over 20 years, finding it to be safe and effective with certain limitations based on tumor location.

## Contribution

The study provides a 20-year analysis of EEA outcomes and identifies specific tumor locations that negatively affect resection rates.

## Key findings

- Gross total resection was achieved in 88% of patients.
- Tumor location in the temporo-masseteric and tubo-pharyngeal zones was negatively associated with complete resection.
- EEA showed a favorable complication rate and quick patient recovery.

## Abstract

Recently, the endoscopic endonasal approach (EEA) has been proposed as a possible surgical option for benign and malignant tumors, located in the infratemporal (ITF) and pterygopalatine fossae (PPF). The aim of this study is to analyze the surgical outcome of the EEA for these lesions, identifying the preoperative factors affecting tumor resection.

All consecutive cases of PPF and ITF tumors operated through an EEA have been retrospectively collected. Preoperative clinical and radiological features, surgical outcome, complications and patient follow-up have been analyzed. A systematic review of literature has been performed.

The series includes 100 patients (66 males, 66.0%, mean age: 43.7 ± 22.1). The most common histotypes were juvenile angiofibromas (36 cases, 36.0%), malignancies (26, 26.0%), and chordomas (14, 14.0%). Gross total resection of the PPF/ITF portion of the tumor was achieved in 88 (88.0%) patients. The most common complication was represented by 10 cases (10.0%) of V2 hypoesthesia (3 transient). At logistic regression, tumor location in the temporo-masseteric and tubo-pharyngeal zones proved negatively associated with the GTR rate (p:0.05, p<0.01).

EEA is an effective and safe approach for both benign and malignant tumors involving the PPF and ITF. It is characterized by a favorable complications rate and a quick patients recovery. We observed that the tumor extensions in the temporo-masseteric area and in the tubo-pharyngeal space were the most relevant factors negatively associated with complete tumor removal.