The Utility of Image Guidance in Developing Minimally Invasive Periorbital Approaches to the Skull Base

Introduction: Periorbital approaches, when combined with advances in image guidance and endoscopy, allow for unique access trajectories to the skull base with minimal cosmetic impact. In this cadaveric study, we identify the ideal periorbital approach to access specific subsites of the skull base with image guidance CT analysis.

Methods: Three periorbital surgical approaches: transblepharoplasty, transcaruncular, and lateral orbitotomy, were performed on human cadaver heads pre-scanned with image guidance protocol. Endoscopic images and triplanar CT-guided images were correlated to demonstrate key skull base structures that can be reached through periorbital approaches.

Results: We were able to document numerous surgical access points of the sinuses and skull base using periorbital approaches. The transblepharoplasty approach allowed access to the posterior table of the frontal sinus, orbital roof, anterior fossa and the planum sphenoidale. The transcaruncular approach allowed safe access the medial orbital apex, ethmoid sinuses, sphenoid sinus, anterior fossa as well as the anterior clinoid. The lateral orbitotomy approach allowed us to access the orbital apex, infratemporal fossa and middle fossa.

Conclusion: With the assistance of intraoperative image guidance, periorbital approaches provide a minimally invasive, safe and effective method for accessing a variety of pathology within the sinuses and skull base. Periorbital approaches should be given greater consideration in the perioperative planning of sinus and skull base pathology.