Middle cranial fossa endoscopy using a rigid endoscope.

Trigeminal neuralgia (TN), also known as tic douloureaux, is a craniofacial pain disorder which is typically associated with acute-onset severe pain on one side of the face usually. The condition is characterized by intermittent unilateral pain affecting the lower face and jaw. Although many potential causes have been implicated, in many patients the etiology remains obscure. Initially, patients with trigeminal neuralgia should be offered conservative medical management. If surgery is necessary, the simplest and least hazardous procedure should be chosen. The goals of modern surgical therapy are: Long-term pain control, minimal to no morbidity, and as low a mortality risk as possible. In this study, we attempted to perform middle cranial fossa endoscopic exploration in four adult phenol-formalin embalmed cadavers, using a rigid endoscope with 3.8 mm external diameter and two working channels of 1 mm in diameter each (Karl Storz, Tuttlingen, Germany), inserted through a burr-hole centered at the base of the middle cranial fossa, 1 cm in front and 1 cm upwards of the tragus. Our objective was to determine if this approach provides adequate access to the trigeminal ganglion for possible dissection of V2 and V3 trigeminal roots, the two typically radiating sites of TN. In all four cadavers, middle cranial fossa exploration was possible without difficulties. We offer this approach as a minimally invasive surgical procedure to access the trigeminal ganglion, for potential use as another alternative for the surgical management of medically refractory trigeminal neuralgia.