Surgical corridors to the infratemporal fossa: a systematic review of the anatomical and clinical evidence

Abstract Purpose The infratemporal fossa (ITF) is a deep, neurovascularly dense compartment reached through a growing array of open and endoscopic corridors that have been studied too heterogeneously to compare easily. We systematically reviewed the anatomical and clinical evidence on ITF corridors to compare, corridor by corridor, their exposure, the targets they reach and their attendant morbidity. Methods Following PRISMA 2020, cadaveric-anatomical, radio-anatomical and clinical studies were identified in PubMed/MEDLINE, Scopus, Embase and Web of Science from inception to 20 January 2026, with reference-list screening; only English-language reports were eligible. Two reviewers screened and extracted data independently. Cadaveric studies were appraised with the QUACS scale and clinical studies with the Joanna Briggs Institute checklists. Given the heterogeneity of reported metrics, a structured narrative and tabular synthesis was performed without meta-analytic pooling. Results Twenty-nine studies were included. Endoscopic endonasal corridors gave direct, incision-free access to the medial ITF and pterygopalatine fossa but limited control of the parapharyngeal internal carotid artery and lateral ITF; incremental maxillectomy and multiportal combinations enlarged exposure. Lateral and transcranial routes maximised surgical freedom and vascular control at the cost of higher cranial-nerve and cosmetic morbidity. Reported gross- or near-total resection ranged from approximately 57% to 88% but was strongly corridor- and pathology-dependent and, given the clinical heterogeneity, is not comparable across corridors; trigeminal dysfunction was the most frequently reported morbidity. Conclusion Corridor selection is target-driven: medial and paramedian pathology favours endonasal routes, whereas lateral, posterior or vascular-encasing disease favours lateral or combined approaches. The evidence is dominated by cadaveric feasibility work; anatomical feasibility should not be read as clinical efficacy.