Minim Invasive Neurosurg 2009; 52(3): 107-113
DOI: 10.1055/s-0029-1220931
Original Article

© Georg Thieme Verlag KG Stuttgart · New York

Endoscopic Approaches to the Orbit: A Cadaveric Study

B. Düz 1 , H. Ibrahim Secer 1 , E. Gonul 1
  • 1Department of Neurosurgery, Gulhane Military Medical Academy (GATA), Ankara, Turkey
Further Information

Publication History

Publication Date:
31 July 2009 (online)

Abstract

Introduction: The role of the endoscopic management of lesions located in the anterior cranial fossa and skull base continues to expand.

Materials and Methods: An endoscopic anatomic study was conducted on cadaver specimens. 10 orbits from 5 cadaveric heads fixed in formalin were examined after the vascular structures had been perfused with colored latex and silicone. Endoscopic dissections were performed using rigid endoscopes of 4 mm diameter, 18 cm length, and equipped with 0°, and 30° lenses, according to the different steps of the anatomic dissection protocol.

Results: We have identified and described three endoscopic approaches to the orbit: 1) an inferolateral endoscopic orbital approach (IL-EOA), 2) an endoscopic endonasal medial orbital approach (EEM-OA), and 3) a transcranial key hole endoscopic orbital approach (TCK-EOA).

Discussion: The IL-EOA provides excellent exposure of the temporal compartment of the orbit. In this approach special care should be taken to preserve the ciliary ganglion, the ciliary artery and the ciliary nerves. The EEM-OA offers direct access to the medial and inferomedial orbit, the medial part of the optic nerve and orbital apex through its anteromedial walls. The EEM-OA is simple, relatively quick and has superiority over microsurgical operations by excluding the potential complications of intracranial operations. The EEM-OA is minimally invasive and cosmetically acceptable. The TCK-EOA offers an exposure of the orbital roof and the superior part of the optic nerve as well as other intraorbital structures from above. The TCK-EOA is a potentially safe approach for tumors extending from the orbital wall to the anterior cranial fossa and the parasellar region.

References

  • 1 Kassam A, Snyderman CH, Mintz A. et al . Expanded endonasal approach: the rostrocaudal axis. Part I.  Crista galli to the sella turcica Neurosurg Focus. 2005;  19 E3 , [Review]
  • 2 Gonul E, Erdogan E, Duz B. et al . Transmaxillary approach to the orbit: an anatomic study.  Neurosurgery. 2003;  53 935-941 , ; discussion 941–942
  • 3 Gonul E, Timurkaynak E. Lateral approach to the orbit: an anatomical study.  Neurosurg Rev. 1998;  21 111-116
  • 4 Gonul E, Timurkaynak E. Inferolateral microsurgical approach to the orbit: An anatomical study.  Minim Invas Neurosurg. 1999;  42 137-141
  • 5 Gurkanlar D, Gonul E. Medial microsurgical approach to the orbit: An anatomic study.  Minim Invas Neurosurg. 2006;  49 104-109
  • 6 Ramos-Zúñiga R. Trans-supraorbital approach.  Minim Invas Neurosurg. 1999;  42 133-136
  • 7 Cooper WC, Harris GJ. Orbital surgery. In: Jones IS, Jacobiec FA (eds). Disease of the orbit. New York, Harper & Row Publisher, Inc. 1979: pp 169-196
  • 8 Karaki M, Kobayashi R, Mori N. Removal of an orbital apex hemangioma using an endoscopic transethmoidal approach: Technical note.  Neurosurgery. 2006;  59 ((1 Suppl 1)) , ONSE 159-160 , ; discussion ONSE 159–160
  • 9 Kingdom TT, DelGaudio JM. Endoscopic approach to lesions of the sphenoid sinus, orbital apex, and clivus.  Am J Otolaryngol. 2003;  24 317-322
  • 10 Xu G, Li Y, Xie M. et al . Orbital surgery by transnasal endoscopic ethmoidal-lamina papyracea approach.  Zhonghua Er Bi Yan Hou Ke Za Zhi. 2002;  37 360-362
  • 11 Gunalp I, Gunduz K. Vascular tumors of the orbit.  Doc Ophthalmol. 1995;  89 337-345
  • 12 Shields JA, Shields CL. Vascular and hemorrhagic lesions. In: Shields JA, Shield CL (eds). Atlas of orbital tumors. New York, Lippincott Williams & Wilkins 1999: pp 45-73
  • 13 Izci Y, Gonul E. The microsurgical anatomy of the ciliary ganglion and its clinical importance in orbital traumas: an anatomic study.  Minim Invas Neurosurg. 2006;  49 156-160
  • 14 Lauer SA, Snyder B, Rodriguez E. et al . Classification of orbital floor fractures.  J Craniomaxillofac Trauma. 1996;  2 6-11
  • 15 Hassler WE, Meyer B, Rohde V. et al . Pterional approach to the contralateral orbit.  Neurosurgery. 1994;  35 34-37
  • 16 Moore CC, Bromwich M, Roth K. et al . Endoscopic anatomy of the orbital floor and maxillary sinus.  J Craniofac Surg. 2008;  19 271-276

Correspondence

Assist. Prof. B. DüzMD 

Department of Neurosurgery

Gulhane Military Medical Academy (GATA)

Nöroşirürji AD

TR-06018 Etlik

Ankara

Turkey

Phone: +90/544/858 80 58

Fax: +90/312/304 53 00

Email: bduz@gata.edu.tr

    >