Endoscopic vidian neurectomy: update on techniques and evidence.

PURPOSE OF REVIEW: The aim of this work, based on a recent review of the literature, is to update the surgical techniques for endoscopic vidian neurectomy (EVN).

RECENT FINDINGS: Traditionally, vidian neurectomy was performed on the orifice of the vidian canal on the posterior surface of the pterygopalatine fossa (PPF) through an open approach. A major advance in vidian neurectomy is to transect the vidian nerve endoscopically. In the past 2 decades, EVN has been developed and has replaced the traditional open approach because of improved visualization of the vidian nerve and the less invasive procedure. In addition, computed tomographic (CT) scanning has become a routine evaluation tool for EVN.

SUMMARY: In the past decade, there has been renewed interest in the procedure of vidian neurectomy because endoscopic techniques have greatly improved. The recent evolution of EVN improves the surgical visualization of the vidian nerve and minimizes surgical complications. Preoperative CT imaging is a key element in determining the surgical approach. This study reviews the literature and summarizes the preferred vidian nerve exposure, recent technical refinements, and our current surgical approach.