Vidian Nerve Transposition for Endoscopic Endonasal Middle Fossa Approaches

BACKGROUND: The vidian nerve is a landmark for safe identification of the petrous internal carotid artery during endonasal endoscopic approaches (EEAs) to the skull base. The surgical technique classically described involves sacrifice of the nerve. OBJECTIVE: To demonstrate the feasibility of vidian nerve transposition during EEA. METHODS: After exposure of the vidian canal aperture, the bone is removed along its inferior and medial aspect. Once the depth is understood, determining the position of the internal carotid artery, the bone superior to the vidian nerve is drilled. The vidian nerve can then be transposed from its canal and retracted superiorly, allowing the drill to come inferiorly and to remove the bone lateral to the nerve, finalizing freedom around the vidian nerve. RESULTS: Four patients underwent EEA with vidian transposition. Case illustration: a 20-year-old woman presented with partial numbness on the left side of the face and some tingling in the face, particularly inside her mouth. Magnetic resonance imaging scans demonstrated a Meckel cave tumor compatible with a left-side trigeminal schwannoma. EEA to the Meckel cave was performed and the vidian nerve was transposed. The tumor was totally resected and the vidian nerve preserved. The patient was discharged home in 2 days, stating improvement in facial sensation without new neurological deficits and denying dry eye. The patient was asymptomatic at the 9-month follow-up. None of the 4 patients who underwent this procedure complained of dry eye during the postoperative period. CONCLUSION: The vidian nerve transposition for EEAs to the skull base is an alternative technique that is feasible and conservative. It seems to be a good option that could prove beneficial to the quality of life of patients after surgery.