Minimally invasive transnasal and transmaxillary approaches to the pterygopalatine fossa

The pterygopalatine fossa is a well-protected region of the skull base, and surgical access for resection of tumors growing in this region can be challenging. Historically, the approach to this anatomical space has been an open transmaxillary technique. This results in disruption of the anterior and posterior walls of the maxillary sinus and numerous postoperative morbidities. More recently, improvements in endoscopic sinus surgery instrumentation and techniques have led to the advent of minimally invasive surgical approaches to the skull base. The use of endoscopes allows for improved visualization and surgical manipulation, as well as reduced postoperative comorbidities. We discuss a graduated, minimally invasive approach to the pterygopalatine fossa.