• Jung Joo Lee, Gwanghui Ryu, Hyo Yeol Kim, Hun-Jong Dhong, Seung-Kyu Chung, and Sang Duk Hong.
• Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
• World Neurosurg. 2019 Apr 1; 124: 566156-61.

BackgroundThe endoscopic endonasal approach to the infratemporal fossa (ITF) has gained popularity. However, the inferior turbinate and/or lacrimal duct are often removed when performing endoscopic medial maxillectomy for ITF approach, and there is potential risk for empty nose syndrome or epiphora. Although the endoscopic prelacrimal recess approach was introduced to avoid these complications, there were some limitations associated with surgical freedom. We report a 2-port endoscopic technique using both prelacrimal recess and antral window as a means to preserve the inferior turbinate and lacrimal duct, while facilitating instrument availability during ITF tumor resection.MethodsWe retrospectively reviewed 3 patients between September 2016 and May 2018 who were treated with a modified 2-port technique for ITF tumors.ResultsThere was 1 case of trigeminal schwannoma originating in the mandibular nerve, 1 recurrent meningioma, and 1 paraganglioma. The 2-port technique was not initially planned in these 3 cases, but it was decided to use the technique during surgery because tumors were extensively attached to surrounding muscles and had profuse bleeding. After tumor resection, sinonasal anatomy including inferior turbinate and lacrimal duct was well preserved.ConclusionsWe propose a hybrid endoscopic surgical procedure for ITF tumors using both endoscopic prelacrimal recess approach and transantral window. This technique provides surgeons an adequate working space via a bimanual technique through 2 different ports, while preserving normal sinonasal structures.Copyright © 2019 Elsevier Inc. All rights reserved.

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