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Karımzada G, Evleksiz Karımzada D, Erol G, Celtikci E, Temiz NÇ, Kutlay AM, İzci Y, Jean WC, Güngör A. Expanding horizons: the feasibility and challenges of tubular retraction in endoscopic transorbital skull base approaches. Surg Radiol Anat 2025; 47:96. [PMID: 40067392 DOI: 10.1007/s00276-025-03592-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2024] [Accepted: 02/07/2025] [Indexed: 05/13/2025]
Abstract
PURPOSE Endoscopic transorbital skull base approaches are always challenging and require good anatomical knowledge.The aim of this study was to describe the anatomical pathways of endoscopic transorbital approaches and to determine the limitations of these procedures. To evaluate the feasibility of the tubular retractor and the difference with manual retractor. METHODS The targets of endoscopic transorbital approach were the anterior and middle cranial fossa, mesial temporal region, meckel's cave, petroclival area, opticocarotid region, anterior and lateral walls of the cavernous sinus, etc. Step-by-step anatomical dissections were performed in cadaveric heads using manual and tubular retractors. RESULTS Anterior and middle cranial fossa was reached. The branches of the trigeminal nerve, the lateral wall of the cavernous sinus, meckel's cave and gasserian ganglion were exposed by manual and tubular retraction using an endoscopic transorbital approach. Access to the temporal horn of the lateral ventricle and the mesial temporal region was more accessible with a tubular retractor. Also, following the anterior clinoidectomy, the cavernous segment of the internal carotid artery, as well as, the arteries of the anterior circulation were exposed to gain access the vascular skull base lesions. CONCLUSION The endoscopic transorbital approach is suitable for the surgical treatment of many pathologies located in the anterior and middle skull base. It provides direct access to vascular and tumoral lesions. We observed that mesial temporal region interventions are possible with this approach. The transtubular technique may have some limitations, but in selected cases it can provide clear vision without brain retraction.
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Affiliation(s)
- Gardashkhan Karımzada
- Department of Neurosurgery, Central Military Hospital of the Armed Forces, Baku, Azerbaijan
- Department of Neurosurgery, Hitit University, Erol Olçok Training and Research Hospital, Çorum, Turkey
| | - Demet Evleksiz Karımzada
- Department of Neurosurgery, Hitit University, Erol Olçok Training and Research Hospital, Çorum, Turkey
| | - Gökberk Erol
- Department of Neurosurgery, Adıyaman University, Training and Research Hospital, Adıyaman, Turkey
| | - Emrah Celtikci
- Department of Neurosurgery, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Nail Çağlar Temiz
- Department of Neurosurgery, University of Health Sciences, Gülhane Training and Research Hospital, Ankara, Turkey
| | - Ahmet Murat Kutlay
- Department of Neurosurgery, University of Health Sciences, Gülhane Training and Research Hospital, Ankara, Turkey
| | - Yusuf İzci
- Department of Neurosurgery, University of Health Sciences, Gülhane Training and Research Hospital, Ankara, Turkey
| | - Walter C Jean
- Division of Neurosurgery, Lehigh Valley Fleming Neuroscience Institute, Allentown, PA, USA
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Plata-Bello J, Mosteiro-Cadaval A, Manfrellotti R, Torné R, Perelló MA, Prats-Galino A, Di Somma A, Enseñat J. The Endoscopic Transorbital Approach for Vascular Surgery: An Anterior Circulation Anatomic Study, 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2025; 28:232-239. [PMID: 38967432 DOI: 10.1227/ons.0000000000001254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 05/08/2024] [Indexed: 07/06/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Minimally invasive endoscopic approaches in cranial base surgery have been developing in the past decades. The transorbital (TO) route is one promising alternative, yet its adequacy for intracranial vascular lesions remains unclear. The present anatomic work aimed to test the feasibility and to provide a qualitative description of the endoscopic TO approach for the anterior circulation, namely the internal carotid artery and the middle cerebral artery. METHODS Seven embalmed adult cadaveric specimens (12 sides) were used in the study. Each side was approached in 3 successive steps: (1) Superior-eyelid TO approach, with great and lesser sphenoid wing removal. (2) Removal of anterior clinoid process (ACP). (3) Removal of the lateral orbital rim. All the procedures were performed under endoscopic view. RESULTS The TO approach without removing the ACP allowed to dissect the sphenoidal and lateral segments of the Sylvian fissure with an adequate identification of the middle cerebral artery bifurcation in all specimens. The removal of the ACP allowed further dissection toward the opticocarotid cistern, with the identification of the ophthalmic, posterior communicating, and the anterior choroidal arteries. The internal carotid artery bifurcation and A1 segment were also readily identified. Finally, removal of the lateral orbital rim provided a wider and more comfortable access to the above-mentioned vascular structures. CONCLUSION According to our anatomic data, the TO approach can be used to reach the main vascular components of the anterior circulation. This opens the field for exploring its application in the treatment of vascular pathology, particularly aneurysms.
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Affiliation(s)
- Julio Plata-Bello
- Department of Neurosurgery, Hospital Universitario de Canarias, Tenerife , Spain
| | | | - Roberto Manfrellotti
- Laboratory of Surgical Neuroanatomy (LSNA), Faculty of Medicine and Health Sciences, Universitat de Barcelona, Barcelona , Spain
| | - Ramón Torné
- Department of Neurosurgery, Hospital Clínic de Barcelona, Barcelona , Spain
| | | | - Alberto Prats-Galino
- Laboratory of Surgical Neuroanatomy (LSNA), Faculty of Medicine and Health Sciences, Universitat de Barcelona, Barcelona , Spain
- Clinical Neurophysiology Research Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona , Spain
| | - Alberto Di Somma
- Department of Neurosurgery, Hospital Clínic de Barcelona, Barcelona , Spain
| | - Joaquim Enseñat
- Department of Neurosurgery, Hospital Clínic de Barcelona, Barcelona , Spain
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Tariciotti L, Rodas A, Patel B, Zohdy YM, De Andrade EJ, Revuelta Barbero M, Porto E, Vuncannon J, Maldonado J, Vergara SM, Lohana S, Solares CA, DiMeco F, Garzon-Muvdi T, Pradilla G. Biportal Endoscopic TransOrbital and transMaxillary Approach to the Cranio-Orbital Region and Middle Cranial Fossa: A Preliminary Analysis of Maneuverability. Oper Neurosurg (Hagerstown) 2025; 28:240-254. [PMID: 39012138 DOI: 10.1227/ons.0000000000001259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 05/08/2024] [Indexed: 07/17/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Traditional and well-established transcranial approaches to the spheno-orbital region and middle cranial fossa guarantee optimal intracranial exposure, and additional orbital and zygomatic osteotomies provide further control over extracranial components to be resected; however, these techniques come at the cost of additional morbidity. The introduction of minimally invasive endoscopic approaches and the conceptualization of the so-called "multiportal" paradigm might provide an alternative route. This preliminary study investigates the feasibility of the combined Biportal Endoscopic TransOrbital and transMaxillary Approach (bETOMA) approach to the spheno-orbital and middle cranial fossa regions. METHODS Using 4 silicon-injected adult cadaver heads (8 sides; 16 approaches), we systematically dissected through superior eyelid ETOA and endoscopic TMA approaches. The analysis focused on pterygopalatine, infratemporal, anterior and middle cranial fossae, Meckel cave, and cavernous sinus access. We evaluated the feasibility of bETOMA using linear distances, angles of attack, and exposure areas. We also introduced volume of operative maneuverability, its standardized derivative (sVOM), target distance, visuo-operative angle, and working zone volume as novel metrics. RESULTS The analysis revealed comparable angles of attack between approaches. ETOA and TMA exposure areas were 918.38 ± 223.93 mm 2 and 257.07 ± 86.07 mm 2 , respectively. TMA showed a larger VOM in the greater sphenoid wing, but ETOA offered superior distal maneuverability (sVOM: 5.39 ± 1.94 vs 2.54 ± 0.79 cm 3 ) and closer intracranial space access (27.45 vs 50.83 mm). The combined approaches yielded a mean working zone volume of 13.75 ± 3.73 cm 3 in the spheno-orbital interface. CONCLUSION The bETOMA approach provides adequate neurovascular exposure and maneuverability to the spheno-orbital region, infratemporal, and anterior and middle cranial fossae, addressing significant limitations of previously investigated monoportal techniques (ie, optic nerve decompression, hyperostotic bone resection, and infratemporal exposure). This combined minimally invasive approach might help manage lesions harbored within the cranio-orbital interface region invading the extracranial space.
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Affiliation(s)
- Leonardo Tariciotti
- Department of Neurosurgery, Emory University, Atlanta , Georgia , USA
- Department of Oncology and Hemato-Oncology, University of Milan, Milan , Italy
| | - Alejandra Rodas
- Department of Otorhinolaryngology-Head and Neck Surgery, Emory University, Atlanta , Georgia , USA
| | - Biren Patel
- Department of Neurosurgery, Emory University, Atlanta , Georgia , USA
| | - Youssef M Zohdy
- Department of Neurosurgery, Emory University, Atlanta , Georgia , USA
| | | | | | - Edoardo Porto
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan , Italy
| | - Jackson Vuncannon
- Department of Otorhinolaryngology-Head and Neck Surgery, Emory University, Atlanta , Georgia , USA
| | - Justin Maldonado
- Department of Neurosurgery, Emory University, Atlanta , Georgia , USA
| | - Silvia M Vergara
- Department of Neurosurgery, Emory University, Atlanta , Georgia , USA
| | - Samir Lohana
- Department of Neurosurgery, Emory University, Atlanta , Georgia , USA
| | - C Arturo Solares
- Department of Otorhinolaryngology-Head and Neck Surgery, Emory University, Atlanta , Georgia , USA
| | - Francesco DiMeco
- Department of Oncology and Hemato-Oncology, University of Milan, Milan , Italy
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan , Italy
- Department of Neurosurgery, Johns Hopkins University, Baltimore , Maryland , USA
| | | | - Gustavo Pradilla
- Department of Neurosurgery, Emory University, Atlanta , Georgia , USA
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Piper K, Saez-Alegre M, Perillo T, Peto I, Najera E, Williams J, Breton J, Felbaum DR, Jean WC. Transorbital Approach Clipping of Middle Cerebral Artery Aneurysm: A Virtual Reality Morphometric Anatomic Study. World Neurosurg 2024:S1878-8750(24)01521-3. [PMID: 39236805 DOI: 10.1016/j.wneu.2024.08.152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2024] [Accepted: 08/28/2024] [Indexed: 09/07/2024]
Abstract
BACKGROUND The transorbital approach (TOA) has a unique advantage to the more common lateral approaches as it provides direct access to the anterior middle fossa and medial sylvian fissure (SF) without significant dissection or retraction. However, when to use the TOA for surgical treatment of middle cerebral artery (MCA) aneurysms remains unclear. This study details the feasibility of clipping unruptured MCA aneurysms via the TOA by highlighting the anatomic features that either facilitate or hinder the approach. METHODS Virtual reality (VR) models of 25 MCA aneurysms from computed tomography angiograms of actual patients were rendered with the relevant anatomic structures, including the neighboring temporal lobe and SF. TOA was performed on the models in VR and the globe was translated medially and inferiorly, replicating retraction used intraoperatively. Anatomic data, including the area of surgical freedom (AOF) at the aneurysm, were recorded. Trials of aneurysm clipping were conducted in VR and each aneurysm was classified as "possible" or "impossible" candidates for clipping via TOA. Separately, the relationship between surgical view and SF visualized was analyzed. RESULTS Sixteen aneurysms were eliminated as candidates for TOA treatment either through VR clip trial and/or because the SF was inaccessible. The remaining 9 (36%) were candidates for TOA. Comparing the details of these 2 aneurysm categories with Mann Whitney U tests, there was a statistically significant difference in the AOF of the TOA approach and the width of the aneurysm dome. A clinical case report is also provided highlighting the VR rehearsal similarity with surgery. CONCLUSIONS Given the minimally invasive, technically challenging approach, the feasibility and safety of TOA for MCA aneurysms must be evaluated before wide clinical adoption. This study identified AOF, aneurysm width, and SF accessibility as three features that may significantly impact the possibility of clipping MCA aneurysms via TOA.
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Affiliation(s)
- Keaton Piper
- Department of Neurologic Surgery and Brain Repair, University of South Florida, Tampa, Florida, USA.
| | - Miguel Saez-Alegre
- Division of Neurosurgery, Fleming Neuroscience Institute, Lehigh Valley Network, Allentown, Pennsylvania, USA; Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Ivo Peto
- Department of Neurologic Surgery and Brain Repair, University of South Florida, Tampa, Florida, USA
| | - Edinson Najera
- Division of Neurosurgery, Fleming Neuroscience Institute, Lehigh Valley Network, Allentown, Pennsylvania, USA
| | - Josef Williams
- Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, District of Columbia, USA
| | - Jeff Breton
- Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, District of Columbia, USA
| | - Daniel R Felbaum
- Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, District of Columbia, USA
| | - Walter C Jean
- Department of Neurologic Surgery and Brain Repair, University of South Florida, Tampa, Florida, USA; Division of Neurosurgery, Fleming Neuroscience Institute, Lehigh Valley Network, Allentown, Pennsylvania, USA
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Al-Shalchy A, Al-Taie RH, Algburi HA, Ismail M. Neuroanatomical perspectives on transorbital approaches: A meta-analysis. Surg Neurol Int 2024; 15:202. [PMID: 38974567 PMCID: PMC11225392 DOI: 10.25259/sni_351_2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Accepted: 05/29/2024] [Indexed: 07/09/2024] Open
Abstract
Background Transorbital approaches represent a paradigm shift in skull base surgery, focusing on minimally invasive techniques that prioritize patient outcomes and surgical precision. The scientific community, recognizing the significance of these advances, necessitates a possible review and meta-analysis to encapsulate the collective efficacy, safety, and developmental trajectory of these approaches. Methods This was a literature review targeting literature in the past 10 years to present evidence for studies on surgical approaches transorbital. The included articles were analyzed. In addition, the references list of the included papers was searched for further articles. Results Studies based on the endoscopic endonasal and transorbital approach have emphasized that it is minimally invasive; on the other hand, it offers an advantage to maximal resection success in the case of skull base tumors with advanced endoscopic skills. Transorbital neuroendoscopic surgery was criticized for being highly technical and narrow in its scope, with reduced morbidity. Superior Eyelid Approach involves a direct access with hidden incisions, potential for eyelid complications. Lateral orbitotomy entailed some inherent risks, such as muscle and nerve injury, but it gave excellent exposure to lesions that are lateral in the orbit. The transorbital endoscopic intraconal approach and the transconjunctival approach give direct advantages but are, however, limited to the type of lesion and location. Conclusion The main technique focused on in this overview is the approaches through orbits, which greatly contribute to further innovation brought into the surgical panorama of skull base interventions. All such techniques do have their characteristics and applications, keeping them moving toward less invasiveness.
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Affiliation(s)
- Ali Al-Shalchy
- Department of Surgery, Univeristy of Baghdad, College of Medicine, Baghdad, Iraq
| | - Rania H. Al-Taie
- Department of Surgery, Univeristy of Mustansiriyah, College of Medicine, Baghdad, Iraq
| | - Hagar A. Algburi
- Department of Surgery, Univeristy of Baghdad, College of Medicine, Baghdad, Iraq
| | - Mustafa Ismail
- Department of Neurosurgery, Neurosurgery Teaching Hospital, Baghdad, Iraq
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Plata-Bello J, Mosteiro-Cadaval A, Torné R, Di Somma A, Enseñat J, Prats-Galino A. Optimizing the Endoscopic Transorbital Approach: MacCarty Keyhole for Enhanced Surgical Exposure in the Opticocarotid Region. World Neurosurg 2024; 185:290-296. [PMID: 38453005 DOI: 10.1016/j.wneu.2024.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 03/01/2024] [Accepted: 03/02/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND In recent years, the endoscopic transorbital (TO) approach has gained increasing interest for the treatment of middle cranial fossa lesions. We propose a technical refinement to the conventional superior eyelid TO approach, which improves the surgical exposure and augments the working angles when targeting the opticocarotid region. METHODS Four embalmed adult cadaveric specimens (8 sides) were dissected at the Laboratory of Surgical Neuroanatomy of our institution. A TO approach was performed, with removal of the anterior clinoid process and the lateral orbital rim. Subsequently, the MacCarty keyhole was drilled in the superolateral orbital wall. Given that the lesser sphenoid wing was already drilled in the conventional TO craniectomy, the opening of the keyhole was essentially a lateral extension of the craniectomy. RESULTS The procedure was successfully conducted in all 4 orbits. Clinoidectomy was performed either before or after extending the craniectomy to the MacCarty point. Extending the craniectomy made anterior clinoidectomy easier, by increasing the surgical exposure, and allowing a more lateral entrance for the endoscope. The extension also facilitated frontal lobe retraction, and it facilitated the optic nerve and carotid artery manipulation. Postoperative computed tomography scans showed a minimal 10-mm craniectomy extension, which remained covered by the temporal muscle after reconstruction. CONCLUSIONS The modified endoscopic TO approach with the extension of the craniectomy to MacCarty point improves surgical access and visualization of the opticocarotid region. This facilitates anterior clinoidectomy and optic nerve decompression. Although it implies judicious instrument manipulation and a larger incision size, further studies can define its potential benefits.
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Affiliation(s)
- Julio Plata-Bello
- Department of Neurosurgery, Hospital Universitario de Canarias, Tenerife, Spain
| | | | - Ramón Torné
- Department of Neurosurgery, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Alberto Di Somma
- Department of Neurosurgery, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Joaquim Enseñat
- Department of Neurosurgery, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Alberto Prats-Galino
- Laboratory of Surgical Neuroanatomy (LSNA), Faculty of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
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Lin BJ, Ju DT, Hueng DY, Chen YH, Ma HI, Liu MY. Endoscopic transorbital decompression for traumatic superior orbital fissure syndrome: from cadaveric study to clinical application. Eur Arch Otorhinolaryngol 2024; 281:1933-1940. [PMID: 38197935 DOI: 10.1007/s00405-023-08440-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 12/26/2023] [Indexed: 01/11/2024]
Abstract
PURPOSE The endoscopic endonasal approach (EEA) is a minimally invasive and promising modality for treating traumatic superior orbital fissure (SOF) syndrome (tSOFS). Recently, the endoscopic transorbital approach (ETOA) has been considered an alternative method for reaching the anterolateral skull base. This study accessed the practicality of using the ETOA to treat SOF decompression using both cadaveric dissection and clinical application. METHODS Bilateral anatomic dissections were performed on four adult cadaveric heads using the ETOA and EEA to address SOF decompression. The ETOA procedure for SOF decompression is described, and the extent of SOF decompression was compared between the ETOA and EEA. The clinical feasibility of the ETOA for treating SOF decompression was performed in two patients diagnosed with tSOFS. RESULTS ETOA allowed for decompression over the lateral aspect of the SOF, from the meningo-orbital band superolaterally to the maxillary strut inferomedially. By contrast, the EEA allowed for decompression over the medial aspect of the SOF, from the lateral opticocarotid recess superiorly to the maxillary strut inferiorly. In both patients treated using the ETOA and SOF decompression, the severity of ophthalmoplegia got obvious improvement. CONCLUSIONS Based on the cadaveric findings, ETOA provided a feasible access pathway for SOF decompression with reliable outcomes, and our patients confirmed the clinical efficacy of the ETOA for managing tSOFS.
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Affiliation(s)
- Bon-Jour Lin
- Department of Neurological Surgery, Tri-Service General Hospital, National Defense Medical Center, No 325, Section 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan.
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan.
| | - Da-Tong Ju
- Department of Neurological Surgery, Tri-Service General Hospital, National Defense Medical Center, No 325, Section 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan
| | - Dueng-Yuan Hueng
- Department of Neurological Surgery, Tri-Service General Hospital, National Defense Medical Center, No 325, Section 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan
| | - Yuan-Hao Chen
- Department of Neurological Surgery, Tri-Service General Hospital, National Defense Medical Center, No 325, Section 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan
| | - Hsin-I Ma
- Department of Neurological Surgery, Tri-Service General Hospital, National Defense Medical Center, No 325, Section 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan
| | - Ming-Ying Liu
- Department of Neurological Surgery, Tri-Service General Hospital, National Defense Medical Center, No 325, Section 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan
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Corrivetti F, Guizzardi G, Bove I, Enseñat J, Prats-Galino A, Solari D, Cavallo LM, Iaconetta G, Di Somma A, de Notaris M. Transorbital Exposure of the Internal Carotid Artery: A Detailed Anatomic and Quantitative Roadmap for Safe Successful Surgery. Oper Neurosurg (Hagerstown) 2024; 26:314-322. [PMID: 37815220 DOI: 10.1227/ons.0000000000000943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 08/15/2023] [Indexed: 10/11/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The superior eyelid endoscopic transorbital approach has rapidly gained popularity among neurosurgeons for its advantages in the treatment, in a minimally invasive fashion, of a large variety of skull base pathologies. In this study, an anatomic description of the internal carotid artery (ICA) is provided to identify risky zones related to lesions that may be approached using this technique. In this framework, a practical roadmap can help the surgeon to avoid potentially life-threatening iatrogenic vascular injuries. METHODS Eight embalmed adult cadaveric specimens (16 sides) injected with a mixture of red latex and iodinate contrast underwent superior eyelid transorbital endoscopic approach, followed by interdural dissection of the cavernous sinus, extradural anterior clinoidectomy, and anterior petrosectomy, to expose the entire "transorbital" pathway of the ICA. Furthermore, the distance of each segment of the ICA explored by means of the superior eyelid endoscopic transorbital approach was quantitatively analyzed using a neuronavigation system. RESULTS We exposed 4 distinct ICA segments and named the anatomic window in which they are displayed in accordance with the cavernous sinus triangles distribution of the middle cranial fossa: (1) clinoidal (Dolenc), (2) infratrochlear (Parkinson), (3) anteromedial (Mullan), and (4) petrous (Kawase). Critical anatomy and key surgical landmarks were defined to further identify the main danger zones during the different steps of the approach. CONCLUSION A detailed knowledge of the reliable surgical landmarks of the course of the ICA as seen through an endoscopic transorbital route and its relationship with the cranial nerves are essential to perform a safe and successful surgery.
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Affiliation(s)
- Francesco Corrivetti
- Laboratory of Neuroanatomy, EBRIS Foundation, European Biomedical Research Institute of Salerno, Salerno , Italy
| | - Giulia Guizzardi
- Department of Neurosurgery, Hospital Clinic de Barcelona, Barcelona , Spain
- Laboratory of Surgical Neuroanatomy, Faculty of Medicine, Universitat de Barcelona, Barcelona , Spain
| | - Ilaria Bove
- Division of Neurosurgery, Università degli Studi di Napoli Federico II, Naples , Italy
| | - Joaquim Enseñat
- Department of Neurosurgery, Hospital Clinic de Barcelona, Barcelona , Spain
| | - Alberto Prats-Galino
- Laboratory of Surgical Neuroanatomy, Faculty of Medicine, Universitat de Barcelona, Barcelona , Spain
| | - Domenico Solari
- Division of Neurosurgery, Università degli Studi di Napoli Federico II, Naples , Italy
| | - Luigi Maria Cavallo
- Division of Neurosurgery, Università degli Studi di Napoli Federico II, Naples , Italy
| | - Giorgio Iaconetta
- Unit of Neurosurgery, University Hospital San Giovanni di Dio e Ruggi d'Aragona, University of Salerno, Salerno , Italy
| | - Alberto Di Somma
- Department of Neurosurgery, Hospital Clinic de Barcelona, Barcelona , Spain
- Laboratory of Surgical Neuroanatomy, Faculty of Medicine, Universitat de Barcelona, Barcelona , Spain
| | - Matteo de Notaris
- Laboratory of Neuroanatomy, EBRIS Foundation, European Biomedical Research Institute of Salerno, Salerno , Italy
- Department of Neurosurgery, Hospital Clinic de Barcelona, Barcelona , Spain
- Laboratory of Surgical Neuroanatomy, Faculty of Medicine, Universitat de Barcelona, Barcelona , Spain
- Division of Neurosurgery, Università degli Studi di Napoli Federico II, Naples , Italy
- Unit of Neurosurgery, University Hospital San Giovanni di Dio e Ruggi d'Aragona, University of Salerno, Salerno , Italy
- Department of Neuroscience, Neurosurgery Operative Unit, "San Pio" Hospital, Benevento , Italy
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Di Somma A, Codes M, Guizzardi G, Mosteiro A, Tafuto R, Ferres A, Matas J, Prats-Galino A, Enseñat J, Cavallo LM. Transorbital Route to Intracranial Space. Adv Tech Stand Neurosurg 2024; 52:183-205. [PMID: 39017795 DOI: 10.1007/978-3-031-61925-0_14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2024]
Abstract
The endoscopic superior eyelid transorbital approach has emerged as a notable and increasingly utilized surgical technique in recent years. This chapter presents an overview of the approach, tracing its historical development and highlighting its growing acceptance within the skull base community.Beginning with an introduction and historical perspective, the chapter outlines the evolution of the transorbital approach, shedding light on its origins and the factors driving its adoption. Subsequently, a comprehensive exploration of the anatomic bone pillars and intracranial spaces accessible via this approach is provided. Hence, five bone pillars of the transorbital approach were identified, namely the lesser sphenoid wing, the anterior clinoid, the sagittal crest, the middle cranial fossa, and the petrous apex. A detailed correlation of those bone targets with respective intracranial areas has been reported.Furthermore, the chapter delves into the practical application of the technique through a case example, offering insights into its clinical utility, indications, and limitations.
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Affiliation(s)
- Alberto Di Somma
- Department of Neurological Surgery, Institut Clínic de Neurociències (ICN), Hospital Clínic de Barcelona, Universidad de Barcelona, Barcelona, Spain
- Laboratory of Surgical Neuroanatomy, Universitat de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Marta Codes
- Department of Neurological Surgery, Institut Clínic de Neurociències (ICN), Hospital Clínic de Barcelona, Universidad de Barcelona, Barcelona, Spain
| | - Giulia Guizzardi
- Department of Neurological Surgery, Institut Clínic de Neurociències (ICN), Hospital Clínic de Barcelona, Universidad de Barcelona, Barcelona, Spain
- Laboratory of Surgical Neuroanatomy, Universitat de Barcelona, Barcelona, Spain
| | - Alejandra Mosteiro
- Department of Neurological Surgery, Institut Clínic de Neurociències (ICN), Hospital Clínic de Barcelona, Universidad de Barcelona, Barcelona, Spain
| | - Roberto Tafuto
- Division of Neurosurgery, Department of Neuroscience and Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli "Federico II", Naples, Italy
| | - Abel Ferres
- Department of Neurological Surgery, Institut Clínic de Neurociències (ICN), Hospital Clínic de Barcelona, Universidad de Barcelona, Barcelona, Spain
| | - Jessica Matas
- Department of Ophthalmology, Hospital Clínic de Barcelona, Universidad de Barcelona, Barcelona, Spain
| | - Alberto Prats-Galino
- Laboratory of Surgical Neuroanatomy, Universitat de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Joaquim Enseñat
- Department of Neurological Surgery, Institut Clínic de Neurociències (ICN), Hospital Clínic de Barcelona, Universidad de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Luigi Maria Cavallo
- Division of Neurosurgery, Department of Neuroscience and Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli "Federico II", Naples, Italy
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Serioli S, Nizzola M, Plou P, De Bonis A, Meyer J, Leonel LCPC, Tooley AA, Wagner LH, Bradley EA, Van Gompel JJ, Benini ME, Dallan I, Peris-Celda M. Surgical Anatomy of the Microscopic and Endoscopic Transorbital Approach to the Middle Fossa and Cavernous Sinus: Anatomo-Radiological Study with Clinical Applications. Cancers (Basel) 2023; 15:4435. [PMID: 37760405 PMCID: PMC10527149 DOI: 10.3390/cancers15184435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 08/30/2023] [Accepted: 09/01/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND The transorbital approaches (TOAs) have acquired growing notoriety, thanks to their ability to offer alternative corridors to the skull base. However, the limited access and the unfamiliarity with this surgical perspective make recognition of key landmarks difficult, especially for less experienced surgeons. The study wants to offer a detailed description of the anatomy to comprehend the potential and limitations of TOAs. METHODS Measurements of the orbit region and the surrounding areas were performed on two hundred high-resolution CT scans and thirty-nine dry skulls. Five specimens were dissected to illustrate the TOA, and one was used to perform the extradural clinoidectomy. Three clinical cases highlighted the surgical applications. RESULTS A step-by-step description of the key steps of the TOA was proposed and a comparison with the transcranial anterior clinoidectomy was discussed. The mean work distance was 6.1 ± 0.4 cm, and the lateral working angle increased 20 ± 5.4° after removing the lateral orbital rim. CONCLUSIONS TOAs are indicated in selected cases when tumor involves the lateral portion of the cavernous sinus or the middle skull base, obtaining a direct decompression of the optic nerve and avoiding excessive manipulation of the neurovascular structures. Comprehension of surgical anatomy of the orbit and its surrounding structures is essential to safely perform these approaches.
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Affiliation(s)
- Simona Serioli
- Division of Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, 25123 Brescia, Italy;
- Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, MN 55905, USA; (M.N.); (P.P.); (A.D.B.); (J.M.); (L.C.P.C.L.)
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, USA;
| | - Mariagrazia Nizzola
- Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, MN 55905, USA; (M.N.); (P.P.); (A.D.B.); (J.M.); (L.C.P.C.L.)
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, USA;
- Department of Neurosurgery and Gamma Knife Radiosurgery, I.R.C.C.S. San Raffaele Scientific Institute, Vita-Salute University, 20132 Milan, Italy
| | - Pedro Plou
- Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, MN 55905, USA; (M.N.); (P.P.); (A.D.B.); (J.M.); (L.C.P.C.L.)
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, USA;
- Neurosurgery Department, Hospital Italiano de Buenos Aires, Buenos Aires C1199, Argentina
| | - Alessandro De Bonis
- Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, MN 55905, USA; (M.N.); (P.P.); (A.D.B.); (J.M.); (L.C.P.C.L.)
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, USA;
- Department of Neurosurgery and Gamma Knife Radiosurgery, I.R.C.C.S. San Raffaele Scientific Institute, Vita-Salute University, 20132 Milan, Italy
| | - Jenna Meyer
- Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, MN 55905, USA; (M.N.); (P.P.); (A.D.B.); (J.M.); (L.C.P.C.L.)
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, USA;
- Department of Neurologic Surgery, Mayo Clinic, Phoenix, AZ 85054, USA
| | - Luciano C. P. C. Leonel
- Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, MN 55905, USA; (M.N.); (P.P.); (A.D.B.); (J.M.); (L.C.P.C.L.)
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, USA;
| | - Andrea A. Tooley
- Department of Ophthalmology, Mayo Clinic, Rochester, MN 55905, USA; (A.A.T.); (L.H.W.); (E.A.B.)
| | - Lilly H. Wagner
- Department of Ophthalmology, Mayo Clinic, Rochester, MN 55905, USA; (A.A.T.); (L.H.W.); (E.A.B.)
| | - Elizabeth A. Bradley
- Department of Ophthalmology, Mayo Clinic, Rochester, MN 55905, USA; (A.A.T.); (L.H.W.); (E.A.B.)
| | - Jamie J. Van Gompel
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, USA;
- Department of Otolaryngology/Head and Neck Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | - Maria Elena Benini
- Department of Neurosurgery—Head and Neck Surgery, Azienda Ospedaliero-Universitaria Pisana, 56126 Pisa, Italy;
| | - Iacopo Dallan
- Department of Otolaryngology—Head and Neck Surgery, Azienda Ospedaliero-Universitaria Pisana, 56126 Pisa, Italy;
| | - Maria Peris-Celda
- Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, MN 55905, USA; (M.N.); (P.P.); (A.D.B.); (J.M.); (L.C.P.C.L.)
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, USA;
- Department of Otolaryngology/Head and Neck Surgery, Mayo Clinic, Rochester, MN 55905, USA
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11
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Corvino S, Armocida D, Offi M, Pennisi G, Burattini B, Mondragon AV, Esposito F, Cavallo LM, de Notaris M. The anterolateral triangle as window on the foramen lacerum from transorbital corridor: anatomical study and technical nuances. Acta Neurochir (Wien) 2023; 165:2407-2419. [PMID: 37479917 PMCID: PMC10477108 DOI: 10.1007/s00701-023-05704-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 06/25/2023] [Indexed: 07/23/2023]
Abstract
OBJECTIVE Neurosurgical indications for the superior eyelid transorbital endoscopic approach (SETOA) are rapidly expanding over the last years. Nevertheless, as any new technique, a detailed knowledge of the anatomy of the surgical target area, the operative corridor, and the specific surgical landmark from this different perspective is required for a safest and successful surgery. Therefore, the aim of this study is to provide, through anatomical dissections, a detailed investigation of the surgical anatomy revealed by SETOA via anterolateral triangle of the middle cranial fossa. We also sought to define the relevant surgical landmarks of this operative corridor. METHODS Eight embalmed and injected adult cadaveric specimens (16 sides) underwent dissection and exposure of the cavernous sinus and middle cranial fossa via superior eyelid endoscopic transorbital approach. The anterolateral triangle was opened and its content exposed. An extended endoscopic endonasal trans-clival approach (EEEA) with exposure of the cavernous sinus content and skeletonization of the paraclival and parasellar segments of the internal carotid artery (ICA) was also performed, and the anterolateral triangle was exposed. Measurements of the surface area of this triangle from both surgical corridors were calculated in three head specimens using coordinates of its borders under image-guide navigation. RESULTS The drilling of the anterolateral triangle via SETOA unfolds a space that can be divided by the course of the vidian nerve into two windows, a wider "supravidian" and a narrower "infravidian," which reveal different anatomical corridors: a "medial supravidian" and a "lateral supravidian," divided by the lacerum segment of the ICA, leading to the lower clivus, and to the medial aspect of the Meckel's cave and terminal part of the horizontal petrous ICA, respectively. The infravidian corridor leads medially into the sphenoid sinus. The arithmetic means of the accessible surface area of the anterolateral triangle were 45.48 ± 3.31 and 42.32 ± 2.17 mm2 through transorbital approach and endonasal approach, respectively. CONCLUSION SETOA can be considered a minimally invasive route complementary to the extended endoscopic endonasal approach to the anteromedial aspect of the Meckel's cave and the foramen lacerum. The lateral loop of the trigeminal nerve represents a reliable surgical landmark to localize the lacerum segment of the ICA from this corridor. Nevertheless, as any new technique, a learning curve is needed, and the clinical feasibility should be proven.
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Affiliation(s)
- Sergio Corvino
- Division of Neurosurgery, Department of Neuroscience and Reproductive and Odontostomatological Sciences, Università Degli Studi Di Napoli Federico II, 80131, Naples, Italy.
- PhD Program in Neuroscience, Department of Neuroscience and Reproductive and Odontostomatological Sciences, Università Degli Studi Di Napoli Federico II, 80131, Naples, Italy.
| | - Daniele Armocida
- Neurosurgery Division, Human Neurosciences Department, "Sapienza" University, 00185, Rome, Italy
| | - Martina Offi
- Institute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy - Division of Neurosurgery, Catholic University of Rome, Rome, Italy
| | - Giovanni Pennisi
- Institute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy - Division of Neurosurgery, Catholic University of Rome, Rome, Italy
| | - Benedetta Burattini
- Institute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy - Division of Neurosurgery, Catholic University of Rome, Rome, Italy
| | | | - Felice Esposito
- Division of Neurosurgery, Department of Neuroscience and Reproductive and Odontostomatological Sciences, Università Degli Studi Di Napoli Federico II, 80131, Naples, Italy
| | - Luigi Maria Cavallo
- Division of Neurosurgery, Department of Neuroscience and Reproductive and Odontostomatological Sciences, Università Degli Studi Di Napoli Federico II, 80131, Naples, Italy
| | - Matteo de Notaris
- Department of Neuroscience, Neurosurgery Operative Unit, "San Pio" Hospital, 82100, Benevento, Italy
- Laboratory of Neuroanatomy, EBRIS Foundation, European Biomedical Research Institute of Salerno, Salerno, Italy
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12
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Corvino S, Villanueva-Solórzano PL, Offi M, Armocida D, Nonaka M, Iaconetta G, Esposito F, Cavallo LM, de Notaris M. A New Perspective on the Cavernous Sinus as Seen through Multiple Surgical Corridors: Anatomical Study Comparing the Transorbital, Endonasal, and Transcranial Routes and the Relative Coterminous Spatial Regions. Brain Sci 2023; 13:1215. [PMID: 37626571 PMCID: PMC10452901 DOI: 10.3390/brainsci13081215] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 07/27/2023] [Accepted: 08/16/2023] [Indexed: 08/27/2023] Open
Abstract
Background: The cavernous sinus (CS) is a highly vulnerable anatomical space, mainly due to the neurovascular structures that it contains; therefore, a detailed knowledge of its anatomy is mandatory for surgical unlocking. In this study, we compared the anatomy of this region from different endoscopic and microsurgical operative corridors, further focusing on the corresponding anatomic landmarks encountered along these routes. Furthermore, we tried to define the safe entry zones to this venous space from these three different operative corridors, and to provide indications regarding the optimal approach according to the lesion's location. Methods: Five embalmed and injected adult cadaveric specimens (10 sides) separately underwent dissection and exposure of the CS via superior eyelid endoscopic transorbital (SETOA), extended endoscopic endonasal transsphenoidal-transethmoidal (EEEA), and microsurgical transcranial fronto-temporo-orbito-zygomatic (FTOZ) approaches. The anatomical landmarks and the content of this venous space were described and compared from these surgical perspectives. Results: The oculomotor triangle can be clearly exposed only by the FTOZ approach. Unlike EEEA, for the exposure of the clinoid triangle content, the anterior clinoid process removal is required for FTOZ and SETOA. The supra- and infratrochlear as well as the anteromedial and anterolateral triangles can be exposed by all three corridors. The most recently introduced SETOA allowed for the exposure of the entire lateral wall of the CS without entering its neurovascular structures and part of the posterior wall; furthermore, thanks to its anteroposterior trajectory, it allowed for the disclosure of the posterior ascending segment of the cavernous ICA with the related sympathetic plexus through the Mullan's triangle, in a minimally invasive fashion. Through the anterolateral triangle, the transorbital corridor allowed us to expose the lateral 180 degrees of the Vidian nerve and artery in the homonymous canal, the anterolateral aspect of the lacerum segment of the ICA at the transition zone from the petrous horizontal to the ascending posterior cavernous segment, surrounded by the carotid sympathetic plexus, and the medial Meckel's cave. Conclusions: Different regions of the cavernous sinus are better exposed by different surgical corridors. The relationship of the tumor with cranial nerves in the lateral wall guides the selection of the approach to cavernous sinus lesions. The transorbital endoscopic approach can be considered to be a safe and minimally invasive complementary surgical corridor to the well-established transcranial and endoscopic endonasal routes for the exposure of selected lesions of the cavernous sinus. Nevertheless, peer knowledge of the anatomy and a surgical learning curve are required.
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Affiliation(s)
- Sergio Corvino
- Division of Neurosurgery, Department of Neuroscience and Reproductive and Odontostomatological Sciences, Università di Napoli “Federico II”, 80131 Naples, Italy; (S.C.); (L.M.C.)
- PhD Program in Neuroscience, Department of Neuroscience and Reproductive and Odontostomatological Sciences, Università di Napoli “Federico II”, 80131 Naples, Italy
| | - Pedro L. Villanueva-Solórzano
- Department of Neurosurgery, National Institute of Neurology and Neurosurgery “Manuel Velasco Suarez”, Mexico City 14269, Mexico;
| | - Martina Offi
- Institute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli, 00168 Rome, Italy;
- Division of Neurosurgery, Catholic University of Rome, 00153 Rome, Italy
| | - Daniele Armocida
- Neurosurgery Division, Human Neurosciences Department, “Sapienza” University, 00185 Rome, Italy;
| | - Motonobu Nonaka
- Department of Neurosurgery, Kochi University Hospital, 185-1, Oko-cho, Kohasu, Kochi 783-8505, Japan;
| | - Giorgio Iaconetta
- Neurosurgical Clinic A.O.U. “San Giovanni di Dio e Ruggi d’Aragona”, 84131 Salerno, Italy;
| | - Felice Esposito
- Division of Neurosurgery, Department of Neuroscience and Reproductive and Odontostomatological Sciences, Università di Napoli “Federico II”, 80131 Naples, Italy; (S.C.); (L.M.C.)
| | - Luigi Maria Cavallo
- Division of Neurosurgery, Department of Neuroscience and Reproductive and Odontostomatological Sciences, Università di Napoli “Federico II”, 80131 Naples, Italy; (S.C.); (L.M.C.)
| | - Matteo de Notaris
- Neurosurgery Operative Unit, Department of Neuroscience, Coordinator Neuroanatomy Section Italian Society of Neurosurgery, G. Rummo Hospital, 82100 Benevento, Italy;
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13
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Di Somma A, De Rosa A, Ferrés A, Mosteiro A, Guizzardi G, Fassi JM, Topczewski TE, Reyes L, Roldán P, Torné R, Alobid I, Enseñat J. Endoscopic Transorbital Approach for the Management of Spheno-Orbital Meningiomas: Literature Review and Preliminary Experience. World Neurosurg 2023; 176:43-59. [PMID: 37024084 DOI: 10.1016/j.wneu.2023.03.126] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 03/28/2023] [Accepted: 03/29/2023] [Indexed: 04/08/2023]
Abstract
OBJECTIVE The endoscopic transorbital approach (ETOA) is a minimally invasive approach that could be particularly appropriate for management of spheno-orbital meningiomas. The aim of this study was to perform a systematic review of the literature on the management of spheno-orbital meningiomas via the minimally invasive ETOA, searching for clinical scenarios in which this approach could be best indicated. A secondary aim was to describe 4 illustrative cases. METHODS A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Data including patient demographics, tumor features, and surgical and postoperative outcomes were collected. Cases from our initial experience with ETOA were included in the data. RESULTS Data of 58 patients from 9 selected records and from our surgical series were collected. Subtotal, near-total, and gross total resection rates were 44.8%, 10.3%, and 32.7%, respectively. Symptom improvement after surgery was 100% for proptosis, 93% for visual impairment, and 87% for ophthalmoplegia. The most common postoperative complications were transient ophthalmoplegia and maxillary nerve hypoesthesia. Cerebrospinal fluid leak was reported in 2 patients. CONCLUSIONS Our findings support the use of the ETOA for management of spheno-orbital meningiomas, particularly in at least 3 clinical scenarios: 1) when predominant hyperostotic bone is present; 2) when a globular tumor not showing excessive medial or inferior infiltration is being treated; 3) as part of a multistage treatment for diffuse lesions.
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Affiliation(s)
- Alberto Di Somma
- Institut Clínic de Neurociències, Department of Neurological Surgery, Hospital Clínic de Barcelona, Universidad de Barcelona, Barcelona, Spain
| | - Andrea De Rosa
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli "Federico II", Naples, Italy.
| | - Abel Ferrés
- Institut Clínic de Neurociències, Department of Neurological Surgery, Hospital Clínic de Barcelona, Universidad de Barcelona, Barcelona, Spain
| | - Alejandra Mosteiro
- Institut Clínic de Neurociències, Department of Neurological Surgery, Hospital Clínic de Barcelona, Universidad de Barcelona, Barcelona, Spain
| | - Giulia Guizzardi
- Institut Clínic de Neurociències, Department of Neurological Surgery, Hospital Clínic de Barcelona, Universidad de Barcelona, Barcelona, Spain
| | - Jessica Matas Fassi
- Department of Ophthalmology, Hospital Clínic de Barcelona, Universidad de Barcelona, Barcelona, Spain
| | - Thomaz E Topczewski
- Institut Clínic de Neurociències, Department of Neurological Surgery, Hospital Clínic de Barcelona, Universidad de Barcelona, Barcelona, Spain
| | - Luis Reyes
- Institut Clínic de Neurociències, Department of Neurological Surgery, Hospital Clínic de Barcelona, Universidad de Barcelona, Barcelona, Spain
| | - Pedro Roldán
- Institut Clínic de Neurociències, Department of Neurological Surgery, Hospital Clínic de Barcelona, Universidad de Barcelona, Barcelona, Spain
| | - Ramon Torné
- Institut Clínic de Neurociències, Department of Neurological Surgery, Hospital Clínic de Barcelona, Universidad de Barcelona, Barcelona, Spain
| | - Isam Alobid
- Skull Base Unit, ENT Department, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Centro de Investigación Biomédica en Red Enfermedades Respiratorias, Universidad de Barcelona, Barcelona, Spain
| | - Joaquim Enseñat
- Institut Clínic de Neurociències, Department of Neurological Surgery, Hospital Clínic de Barcelona, Universidad de Barcelona, Barcelona, Spain
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14
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Ozdogan S, Beton S, Gungor Y, Comert A, Bakir A, Kahilogullari G. Alternative Path for Optic Nerve Decompression in Pseudotumor Cerebri With Full Endoscopic Lateral Transorbital Approach. J Craniofac Surg 2023; 34:1089-1092. [PMID: 36730888 DOI: 10.1097/scs.0000000000009096] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 09/04/2022] [Indexed: 02/04/2023] Open
Abstract
Endonasal endoscopic approaches are the most preferred surgical methods in patients with pseudotumor cerebri because of easy access to the optic nerve, but the choice of this technique may not apply to all endoscopic endonasal cases. Moreover, there may be difficulties in practice in some cases, including the coronavirus disease 2019 pandemic. This study aimed to suggest an alternative endoscopic approach by lateral orbitotomy for optic nerve decompression in patients with pseudotumor cerebri. The study was performed using 5 fresh-frozen cadaver heads (bilaterally, total of 10 sides) injected intravenously with colored silicone preserved in the cold chain. An average of 2.5 cm skin incision was made to fit the lateral orbitotomy. The lengths of the recurrent meningeal artery (mm), the meningo-orbital band (mm), and the optic nerve (mm) to the orbital margin were measured. After these morphometric measurements, optic nerve decompression was performed endoscopically, and the length of the decompression was measured (mm). The average length (mm) between the orbital rim and meningeal recurrent artery (or meningolacrimal branch) was 16.2 mm, between the orbital rim and the meningo-orbital band was 18.5 mm, and between the orbital rim and optic nerve was 44.1 mm. The average optic nerve decompression length was 4.4 mm. The endoscopic lateral orbitotomy approach provides easy access to the optic nerve by anatomically following the recurrent meningeal artery and the meningo-orbital band. It can be a safe second-line approach after endonasal approaches for optic nerve decompression in pseudotumor cerebri.
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Affiliation(s)
- Sibel Ozdogan
- Health Sciences University, Dr Abdurrahman Yurtaslan Oncology Training and Research Hospital, Ophthalmology Clinic
| | - Suha Beton
- Department of Otolaryngology, Head and Neck Surgery
| | | | - Ayhan Comert
- Department of Otolaryngology, Head and Neck Surgery
| | - Abdurrahman Bakir
- Health Sciences University, Dr Abdurrahman Yurtaslan Oncology Training, and Research Hospital, Neurosurgery Clinic
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15
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Santos C, Guizzardi G, Di Somma A, Lopez P, Mato D, Enseñat J, Prats-Galino A. Comparison of Accessibility to Cavernous Sinus Areas Throughout Endonasal, Transorbital, and Transcranial Approaches: Anatomic Study With Quantitative Analysis. Oper Neurosurg (Hagerstown) 2023; 24:e271-e280. [PMID: 36701689 DOI: 10.1227/ons.0000000000000547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 09/22/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND The cavernous sinus (CS) is accessed through several approaches, both transcranially and endoscopically. The transorbital endoscopic approach is the newest proposed route in the literature. OBJECTIVE To quantify and observe the areas of the CS reach from 2 endoscopic and 1 transcranial approaches to the CS in the cadaver laboratory. METHODS Six CSs were dissected through endoscopic endonasal, transorbital endoscopic, and transcranial pterional approaches, with previous implanted references for neuronavigation during the dissection. Point registration was used to mark the CS exposure and limits through each approach for later area and volume quantification through a computerized technique. RESULTS The endoscopic endonasal approach reaches most of the CS except part of the sinus's superior, lateral, and posterior regions. The area exposed through this approach was 210 mm 2 , and the volume was 1165 mm 3 . The transcranial pterional approach reached the superior and part of the lateral sides of the sinus, not allowing good access to the medial side. The area exposed through this approach was 306 m 2 , whereas the volume was 815 m 3 . Finally, the transorbital endoscopic approach accessed the whole lateral side of the sinus but not the medial one. The area exposed was the greatest, 374 m 2 , but its volume was the smallest, 754 m 3 . CONCLUSION According to our results, the endonasal endoscopic approach is the direct route to access the medial, inferior, and part of the superior CS compartments. The transorbital approach is for the lateral side of the CS. Finally, the transcranial pterional approach is the one for the superior side of the CS.
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Affiliation(s)
- Carlos Santos
- Department of Neurological Surgery and Spine Unit, Hospital Universitario Marqués de Valdecilla, Santander, Spain.,Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander, Spain, Postal address, Edificio IDIVAL
| | - Giulia Guizzardi
- Division of Neurosurgery, Department of Neuroscience, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli "Federico II", Naples, Italy
| | - Alberto Di Somma
- Department of Neurological Surgery, Hospital Clínic de Barcelona, Barcelona, Spain.,Laboratory of Surgical Neuroanatomy, Universitat de Barcelona, Spain
| | - Patricia Lopez
- Department of Neurological Surgery and Spine Unit, Hospital Universitario Marqués de Valdecilla, Santander, Spain.,Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander, Spain, Postal address, Edificio IDIVAL
| | - David Mato
- Department of Neurological Surgery and Spine Unit, Hospital Universitario Marqués de Valdecilla, Santander, Spain.,Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander, Spain, Postal address, Edificio IDIVAL
| | - Joaquim Enseñat
- Department of Neurological Surgery, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Alberto Prats-Galino
- Laboratory of Surgical Neuroanatomy, Universitat de Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
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16
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Han X, Yang H, Wang Z, Li L, Li C, Han S, Wu A. Endoscopic transorbital approach for skull base lesions: a report of 16 clinical cases. Neurosurg Rev 2023; 46:74. [PMID: 36947242 DOI: 10.1007/s10143-023-01980-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 03/05/2023] [Accepted: 03/12/2023] [Indexed: 03/23/2023]
Abstract
Due to the deep location, complex anatomy, and adjacent vital neurovascular structures, skull base surgery is challenging and requires specific approaches. The emerging endoscopic transorbital approach (eTOA) technique provides a new approach to the orbital content, spheno-orbital region, lateral cavernous sinus, and Meckel's cave. In this study, the clinical utility and effectiveness of the eTOA are reported. Sixteen cases who underwent the eTOA were included in the current study. The patients were divided into 3 groups according to tumor location: Group A (intraorbital, 6 cases), group B (spheno-orbital, 7 cases), and group C (cavernous sinus, and Meckel's cave, 3 cases). The clinical data and surgical results were analyzed. Eight meningiomas, 2 hemangiomas, 1 low-grade glioma, 1 instance of inflammatory hyperplasia tissue, 1 Langerhans cell histiocytosis, 1 epidermoid cyst, 1 trigeminal schwannoma, and 1 bone fibrosis hyperplasia were observed. The mean tumor diameter was 2.4 cm. A single case in Group A and Group C underwent biopsy (12.5%), and 1 case of fibrous dysplasia in Group B underwent sufficient orbit decompression (6.25%). The remaining 13 cases underwent gross total tumor resection (81.25%). No cerebral-spinal fluid leak or infection occurred. And no cosmetic problems or significant complications were observed during the follow-up. As a minimally invasive technique, the eTOA has unique advantages for carefully selected skull base lesions because of its direct route, short working distance, and distinct attack angle.
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Affiliation(s)
- Xiaodi Han
- Department of Neurosurgery, The First Hospital of China Medical University, Shenyang, 110001, China
| | - Hongyu Yang
- Department of Neurosurgery, The First Hospital of China Medical University, Shenyang, 110001, China
- Department of Neurosurgery, Central Hospital of Chaoyang City, Chaoyang, 122000, China
| | - Zixun Wang
- Department of Neurosurgery, The First Hospital of China Medical University, Shenyang, 110001, China
| | - Longjie Li
- Department of Neurosurgery, The First Hospital of China Medical University, Shenyang, 110001, China
| | - Chenyu Li
- Department of Neurosurgery, The First Hospital of China Medical University, Shenyang, 110001, China
| | - Sheng Han
- Department of Neurosurgery, The First Hospital of China Medical University, Shenyang, 110001, China.
| | - Anhua Wu
- Department of Neurosurgery, Shengjing Hospital of China Medical University, Shenyang, 110001, China.
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17
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Guizzardi G, Prats-Galino A, Mosteiro A, Santos C, Topczewski T, Torales J, Roldan P, Reyes L, Di Somma A, Enseñat J. Multiportal Combined Endoscopic Endonasal and Transorbital Pathways: Qualitative and Quantitative Anatomic Studies of the "Connection" Skull Base Areas. Oper Neurosurg (Hagerstown) 2023; 24:e342-e350. [PMID: 36715996 DOI: 10.1227/ons.0000000000000577] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 10/07/2022] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Combined endonasal and transorbital multiportal surgery has been recently described for selected skull base pathologies. Nevertheless, a detailed anatomic description and a quantitative comprehensive anatomic study of the skull base areas where these 2 endoscopic routes converge, a so-called connection areas, are missing in the scientific literature. OBJECTIVE To identify all the skull base areas and anatomic structures where endonasal and transorbital endoscopic avenues could be connected and combined. METHODS Five cadaveric specimens (10 sides) were used for dissection. Qualitative description and quantitative analysis of each connection areas were performed. RESULTS At the anterior cranial fossa, the connection area was found at the level of the sphenoid planum; in the middle cranial fossa, it was at the Mullan triangle; finally, in the posterior cranial fossa, the connection area was just behind the medial portion of the petrous apex. The average extradural working areas through the transorbital approach were 4.93, 12.93, and 1.93 cm 2 and from the endonasal corridor were 7.75, 10.45, and 7.48 cm 2 at the level of anterior, middle, and posterior cranial fossae, respectively. CONCLUSION The combined endonasal and transorbital endoscopic approach is an innovative entity of skull base neurosurgery. From the anatomic point of view, our study demonstrated the feasibility of this combined approach to access the entire skull base, by both corridors, identifying a working connection area in each cranial fossa. These data could be extremely useful during the surgical planning to predict which portion of a lesion could be removed through each route and to optimize patients' care.
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Affiliation(s)
- Giulia Guizzardi
- Laboratory of Surgical Neuroanatomy, Universitat de Barcelona, Spain
| | - Alberto Prats-Galino
- Laboratory of Surgical Neuroanatomy, Universitat de Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Alejandra Mosteiro
- Department of Neurological Surgery, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Carlos Santos
- Department of Neurological Surgery and Spine Unit, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Thomaz Topczewski
- Department of Neurological Surgery, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Jorge Torales
- Department of Neurological Surgery, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Pedro Roldan
- Department of Neurological Surgery, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Luis Reyes
- Department of Neurological Surgery, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Alberto Di Somma
- Laboratory of Surgical Neuroanatomy, Universitat de Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Department of Neurological Surgery, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Joaquim Enseñat
- Department of Neurological Surgery, Hospital Clínic de Barcelona, Barcelona, Spain
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18
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De Rosa A, Di Somma A, Mosteiro A, Ferrés A, Reyes LA, Roldan P, Torné R, Torales J, Solari D, Cavallo LM, Enseñat J, Prats-Galino A. Superior eyelid endoscopic transorbital approach to the tentorial area: A qualitative and quantitative anatomic study. Front Surg 2022; 9:1007447. [PMID: 36338650 PMCID: PMC9634414 DOI: 10.3389/fsurg.2022.1007447] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 09/21/2022] [Indexed: 11/12/2022] Open
Abstract
Objective Superior eyelid endoscopic transorbital approach (SETOA) is nowadays gaining progressive application in neurosurgical scenarios. Both anatomic and clinical reports have demonstrated the possibility of taking advantage of the orbital corridor as a minimally invasive route to reach anterior and middle cranial fossae and manage selected surgical lesions developing in these areas. The aim of this paper is to further shed light on other anatomic regions of the skull base as seen from a transorbital perspective, namely, the posterior cranial fossa and tentorial area, describing technical feasibility and steps in reaching this area through an extradural-transtentorial approach and providing quantitative evaluations of the "working area" obtained through this route. Material and methods Four cadaveric heads (eight sides) were dissected at the Laboratory of Surgical Neuroanatomy (LSNA) of the University of Barcelona, Spain. A stepwise dissection of the transorbital approach to the tentorial area was described. Qualitative anatomical descriptions and quantitative analyses of working were evaluated by using pre- and postdissections CT and MRI scans, and three-dimensional reconstructions were made using Amira software. Results With the endoscopic transorbital approach, posterior cranial fossa dura was reached by an extradural middle cranial fossa approach and drilling of the petrous apex. After clipping the superior petrosal sinus, the tentorium was divided and cut. An endoscope was then introduced in the posterior cranial fossa at the level of the tentorial incisura. Qualitative analysis provided a description of the tentorial and petrosal surfaces of the cerebellum, middle tentorial incisura, cerebellopontine fissures, and, after arachnoid dissection, by a 30° endoscopic visualization, the posterior aspect of the cerebellomesencephalic fissure. Quantitative analysis of the "working area" obtained after bone removal was also provided. Conclusions This anatomic qualitative and quantitative study sheds light on the anatomy of the posterior cranial fossa contents, such as the tentorial area and incisura, as seen through a transorbital perspective. The first aim of the article is to enrich the anatomical knowledge as seen through this relatively new corridor and to provide quantitative details and insights into the technical feasibility of reaching these regions in a surgical scenario.
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Affiliation(s)
- Andrea De Rosa
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli “Federico II”, Naples, Italy
| | - Alberto Di Somma
- Department of Neurosurgery, Hospital Clinic, Barcelona, Spain,Correspondence: Alberto Di Somma
| | | | - Abel Ferrés
- Department of Neurosurgery, Hospital Clinic, Barcelona, Spain
| | | | - Pedro Roldan
- Department of Neurosurgery, Hospital Clinic, Barcelona, Spain
| | - Ramon Torné
- Department of Neurosurgery, Hospital Clinic, Barcelona, Spain
| | - Jorge Torales
- Department of Neurosurgery, Hospital Clinic, Barcelona, Spain
| | - Domenico Solari
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli “Federico II”, Naples, Italy
| | - Luigi Maria Cavallo
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli “Federico II”, Naples, Italy
| | - Joaquim Enseñat
- Department of Neurosurgery, Hospital Clinic, Barcelona, Spain
| | - Alberto Prats-Galino
- Laboratory of Surgical Neuroanatomy, Faculty of Medicine, Universitat de Barcelona, Barcelona, Spain,Research Group of Clinical Neurophysiology, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
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19
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Di Somma A, Kong DS, de Notaris M, Moe KS, Sánchez España JC, Schwartz TH, Enseñat J. Endoscopic transorbital surgery levels of difficulty. J Neurosurg 2022; 137:1187-1190. [PMID: 35426817 DOI: 10.3171/2022.3.jns212699] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Alberto Di Somma
- 1Institut Clínic de Neurociències (ICN), Department of Neurological Surgery, Hospital Clínic de Barcelona, Universidad de Barcelona, Barcelona, Spain
| | - Doo-Sik Kong
- 2Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | | | - Kris S Moe
- 4Department of Otolaryngology-Head and Neck Surgery, Department of Neurosurgery, University of Washington, Seattle, Washington
| | - Juan Carlos Sánchez España
- 5Department of Ophthalmology, Hospital Clínic de Barcelona, Universidad de Barcelona, Barcelona, Spain; and
| | - Theodore H Schwartz
- 6Department of Neurosurgery, Weill Cornell Medicine, NewYork-Presbyterian Hospital, New York, New York
| | - Joaquim Enseñat
- 1Institut Clínic de Neurociències (ICN), Department of Neurological Surgery, Hospital Clínic de Barcelona, Universidad de Barcelona, Barcelona, Spain
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20
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Guizzardi G, Di Somma A, de Notaris M, Corrivetti F, Sánchez JC, Alobid I, Ferres A, Roldan P, Reyes L, Enseñat J, Prats-Galino A. Endoscopic transorbital avenue to the skull base: Four-step conceptual analysis of the anatomic journey. Front Oncol 2022; 12:988131. [PMID: 36119506 PMCID: PMC9481282 DOI: 10.3389/fonc.2022.988131] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 08/04/2022] [Indexed: 11/13/2022] Open
Abstract
Background In the last decades, skull base surgery had passed through an impressive evolution. The role of neuroanatomic research has been uppermost, and it has played a central role in the development of novel techniques directed to the skull base. Indeed, the deep and comprehensive study of skull base anatomy has been one of the keys of success of the endoscopic endonasal approach to the skull base. In the same way, dedicated efforts expended in the anatomic lab has been a powerful force for the growth of the endoscopic transorbital approach to the lateral skull base. Therefore, in this conceptual paper, the main steps for the anatomic description of the endoscopic transorbital approach to the skull base have been detailed. Methods The anatomic journey for the development of the endoscopic transorbital approach to the skull base has been analyzed, and four “conceptual” steps have been highlighted. Results As neurosurgeons, the eyeball has always represented a respectful area: to become familiar with this complex and delicate anatomy, we started by examining the orbital anatomy on a dry skull (step 1). Hence, step 1 is represented by a detailed bone study; step 2 is centered on cadaveric dissection; step 3 consists in 3D quantitative assessment of the novel endoscopic transorbital corridor; and finally, step 4 is the translation of the preclinical data in the real surgical scenario by means of dedicated surgical planning. Conclusions The conceptual analysis of the anatomic journey for the description of the endoscopic transorbital approach to the skull base resulted in four main methodological steps that should not be thought strictly consequential but rather interconnected. Indeed, such steps should evolve following the drives that can arise in each specific situation. In conclusion, the four-step anatomic rehearsal can be relevant for the description, diffusion, and development of a novel technique in order to facilitate the application of the endoscopic transorbital approach to the skull base in a real surgical scenario.
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Affiliation(s)
- Giulia Guizzardi
- Laboratory of Surgical Neuroanatomy, Universitat de Barcelona, Barcelona, Spain
| | - Alberto Di Somma
- Laboratory of Surgical Neuroanatomy, Universitat de Barcelona, Barcelona, Spain
- Department of Neurological Surgery, Hospital Clínic de Barcelona, Barcelona, Spain
- *Correspondence: Alberto Di Somma,
| | - Matteo de Notaris
- Department of Neuroscience, Neurosurgery Operative Unit, “San Pio” Hospital, Benevento, Italy
- Laboratory of Neuroscience, European Biomedical Research Institute of Salerno (EBRIS) Foundation, European Biomedical Research Institute of Salerno, Salerno, Italy
| | - Francesco Corrivetti
- Department of Neuroscience, Neurosurgery Operative Unit, “San Pio” Hospital, Benevento, Italy
- Laboratory of Neuroscience, European Biomedical Research Institute of Salerno (EBRIS) Foundation, European Biomedical Research Institute of Salerno, Salerno, Italy
| | - Juan Carlos Sánchez
- Clinic Institute of Ophthalmology (ICOF), Hospital Clínic de Barcelona, Barcelona, Spain
| | - Isam Alobid
- Rhinology Unit and Smell Clinic, ENT Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Abel Ferres
- Department of Neurological Surgery, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Pedro Roldan
- Department of Neurological Surgery, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Luis Reyes
- Department of Neurological Surgery, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Joaquim Enseñat
- Department of Neurological Surgery, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Alberto Prats-Galino
- Laboratory of Surgical Neuroanatomy, Universitat de Barcelona, Barcelona, Spain
- Servei de investigación en anatomía funcional del sistema nervioso, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
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21
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Lim J, Sung KS, Yoo J, Oh J, Moon JH. Endoscopic transorbital extradural anterior clinoidectomy: A stepwise surgical technique and case series study [SevEN-013]. Front Oncol 2022; 12:991065. [PMID: 36106107 PMCID: PMC9465428 DOI: 10.3389/fonc.2022.991065] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 08/08/2022] [Indexed: 11/29/2022] Open
Abstract
Background Anterior clinoidectomy is an important procedure for approaching the central skull base lesions. However, anterior clinoidectomy through the endoscopic transorbital approach (ETOA) still has limitations due to technical difficulties and the structural complexity of the anterior clinoid process (ACP). Therefore, the authors designed a stepwise surgical technique of extradural anterior clinoidectomy through the ETOA. The purpose of this study was to evaluate the feasibility of this technique. Methods Anatomical dissections were performed in 6 cadaveric specimens using a neuroendoscope and neuro-navigation system. The extradural anterior clinoidectomy through the ETOA was performed stepwise, and based on the results, this surgical technique was performed in the 7 clinical cases to evaluate its safety and efficiency. Results Endoscopic extradural anterior clinoidectomy was successfully performed in all cadaveric specimens and patients using the proposed technique. This 5-step technique enabled detachment of the lesser wing of sphenoid bone from the ACP, safe unroofing of the optic canal, and resection of the optic strut without injuring the optic nerve and internal carotid artery. Since the sequential resection of the 3 supporting roots of the ACP was accomplished safely, anterior clinoidectomy was then successfully performed in all clinical cases. Furthermore, no complications related to the anterior clinoidectomy occurred in any clinical case. Conclusion We designed a stepwise surgical technique that allows safe and efficient anterior clinoidectomy through the ETOA. Using this technique, extradural anterior clinoidectomy can be accomplished under direct endoscopic visualization with low morbidity. Since this technique is applicable to the central skull base surgery where anterior clinoidectomy is necessary, it expands the application of the ETOA.
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Affiliation(s)
- Jaejoon Lim
- Department of Neurosurgery, Bundang CHA Medical Center, CHA University College of Medicine, Seongnam, South Korea
| | - Kyoung Su Sung
- Department of Neurosurgery, Dong-A University Hospital, Dong-A University College of Medicine, Busan, South Korea
| | - Jihwan Yoo
- Department of Neurosurgery, Brain Tumor Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Jiwoong Oh
- Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Ju Hyung Moon
- Department of Neurosurgery, Endoscopic Skull Base Center, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
- *Correspondence: Ju Hyung Moon,
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22
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Lee WJ, Kim YH, Hong SD, Rho TH, Kim YH, Dho YS, Hong CK, Kong DS. Development of 3-dimensional printed simulation surgical training models for endoscopic endonasal and transorbital surgery. Front Oncol 2022; 12:966051. [PMID: 35992880 PMCID: PMC9389537 DOI: 10.3389/fonc.2022.966051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 07/11/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundEndoscopic skull base surgery (ESBS) is complex, requiring methodical and unremitting surgical training. Herein, we describe the development and evaluation of a novel three-dimensional (3D) printed simulation model for ESBS. We further validate the efficacy of this model as educational support in neurosurgical training.MethodsA patient-specific 3D printed simulation model using living human imaging data was established and evaluated in a task-based hands-on dissection program. Endoscopic endonasal and transorbital procedures were simulated on the model by neurosurgeons and otorhinolaryngology surgeons of varying experience. All procedures were recorded using a high-definition camera coupled with digital video recorder system. The participants were asked to complete a post-procedure questionnaire to validate the efficacy of the model.ResultsFourteen experts and 22 trainees participated in simulations, and the 32 participants completed the post-procedure survey. The anatomical realism was scored as 4.0/5.0. The participants rated the model as helpful in hand-eye coordination training (4.7/5.0) and improving surgical skills (4.6/5.0) for ESBS. All participants believed that the model was useful as educational support for trainees (4.7 [ ± 0.5]). However, the color (3.6/5.0) and soft tissue feedback parameters (2.8/5) scored low.ConclusionThis study shows that high-resolution 3D printed skull base models for ESBS can be generated with high anatomical accuracy and acceptable haptic feedback. The simulation program of ESBS using this model may be supplemental or provide an alternative training platform to cadaveric dissection.
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Affiliation(s)
- Won-Jae Lee
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Yong Hwy Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University School of Medicine, Seoul, South Korea
| | - Sang-Duk Hong
- Department of Otorhinolaryngology—Head & Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Tae-Hoon Rho
- Department of Neurosurgery, Ajou University Hospital, Ajou University School of Medicine, Suwon, South Korea
| | - Young Hoon Kim
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Yun-Sik Dho
- Department of Neurosurgery, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, South Korea
| | - Chang-Ki Hong
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Doo-Sik Kong
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
- *Correspondence: Doo-Sik Kong, /
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