The Inferolateral Transorbital Endoscopic Approach: A Preclinical Anatomic Study

详细信息    查看全文

• 作者：Marco Ferrari¹ ; ^{1990marcoferrari@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; Alberto Schreiber¹ ; Davide Mattavelli¹ ; Francesco Belotti² ; Vittorio Rampinelli¹ ; Davide Lancini¹ ; Francesco Doglietto² ; Marco Maria Fontanella² ; Manfred Tschabitscher³ ; Luigi Fabrizio Rodella³ ; Piero Nicolai¹
• 关键词：Anatomy ; Cavernous sinus ; Endoscopy ; Middle cranial fossa ; Orbit ; Posterior cranial fossa ; Skull base ; Trigeminal ganglion
• 刊名：World Neurosurgery
• 出版年：2016
• 出版时间：June 2016
• 年：2016
• 卷：90
• 期：Complete
• 页码：403-413
• 全文大小：4606 K

文摘

In recent years, transorbital endoscopic approaches are increasing in popularity as they provide several corridors to reach lateral areas of the ventral skull base through the orbit. The aim of this study is to investigate the feasibility of the inferolateral transorbital endoscopic approach (ILTEA) by detailing the step-by-step dissection, anatomic landmarks, and target anatomic areas.

Methods

Seven cadaveric specimens (14 sides) were dissected in the Laboratory of Endoscopic Anatomy of the University of Brescia. Step-by-step dissection of ILTEA was performed to identify the main anatomic landmarks and corridors. Skin incision, dural incision, and boundaries of craniectomy were measured. Neuronavigation was used to check landmarks, track boundaries of surgical volumes, and measure orbital dislocation.

Results

The study on the 14 ILTEAs defined 1 anatomic area (“waterline door”) that leads to 4 corridors: Meckel's cave corridor, carotid foramen corridor, petrous corridor, and transdural middle fossa corridor. Crucial anatomic landmarks were identified and analyzed. Orbital dislocation was <10 mm.

Conclusions

ILTEA provides the surgeon with a direct route to the region of the “waterline door,” lateral areas of the ventral skull base, and middle cranial fossa. In addition, it allows an optimal view of the intracranial and extracranial portions of the maxillary and mandibular nerves. Further anatomic and clinical studies are needed to validate ILTEA in surgical practice.