Download PDF
J Neurol Surg B Skull Base 2018; 79(02): 189-192
DOI: 10.1055/s-0037-1604405
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Compartmental Endoscopic Surgical Anatomy of the Inferior Intraconal Orbital Space

Alice Z. Maxfield
1   Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts
2   Division of Otolaryngology, Brigham and Women's Hospital, Boston, Massachusetts
,
Christopher D. Brook
3   Department of Otolaryngology, Boston University School of Medicine, Boston, Massachusetts
,
Marcel M. Miyake
4   Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts
5   Department of Otolaryngology, Faculdade de Ciencias Medicas da Santa Casa de Sao Paulo, Sao Paulo, Brazil
,
Benjamin S. Bleier
1   Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts
4   Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts
› Author Affiliations
Further Information

Publication History

22 February 2017

10 June 2017

Publication Date:
04 September 2017 (online)

Also available at
    Permissions and Reprints

Abstract

Objectives This study aims to define the endoscopic anatomy of inferior intraconal space, in terms of its neurovascular structures and relationship to fixed anatomic landmarks.

Design A cadaveric anatomical study was conducted.

Setting This study was conducted at an academic cranial base center.

Participants Cadaveric subjects have been investigated.

Main Outcome Measures After dissection of the inferior intraconal space, the number and position of ophthalmic artery (OA) and oculomotor nerve (OMN) branches to the inferior rectus muscle (IRM) were quantified relative to the fixed landmark of the posterior maxillary wall. The point where the OMN branch to the inferior oblique muscle (IOM) crossed the lateral IRM margin was quantified.

Results A total of 18 OA branches were identified with a mean ± standard deviation of 2.6 ± 0.53 branches. The mean distance of the OA branch insertion from the posterior maxillary wall was 7.11 ± 5.65 mm. The average number of OMN branches to the IRM was 1.63 ± 0.74 with a mean insertion distance of 1.88 ± 1.89 mm. The OMN branch to the IOM crossed the lateral IRM margin 5.38 ± 5.42 mm from the posterior maxillary wall.

Conclusions This cadaveric study quantifies the variability of two critical neurovascular structures salient to endoscopic approaches to the inferior intraconal space, the OMN, and OA contributions to the IRM. Knowledge of the interrelationship between these structures is essential in safe technique for dissection.

Keywords

intraconal orbital anatomy - oculomotor nerve - ophthalmic artery - endoscopic approach

Note

There was no financial support for this study.


 

  • References

  • 1 Jho HD, Carrau RL. Endoscopic endonasal transsphenoidal surgery: experience with 50 patients. J Neurosurg 1997; 87 (01) 44-51
    CrossrefPubMedGoogle Scholar
  • 2 Solari D, Morace R, Cavallo LM. , et al. The endoscopic endonasal approach for the management of craniopharyngiomas. J Neurosurg Sci 2016; 60 (04) 454-462
    PubMedGoogle Scholar
  • 3 Re M, Tarchini P, Gioacchini FM, Pasquini E. Endonasal endoscopic approach for removal of intraorbital cavernous hemangioma in childhood. Head Neck 2016; 38 (01) E1-E6
    CrossrefPubMedGoogle Scholar
  • 4 Weisman RA, Kikkawa D, Moe KS, Osguthorpe JD. Orbital tumors. Otolaryngol Clin North Am 2001; 34 (06) 1157-1174 , ix–x
    CrossrefPubMedGoogle Scholar
  • 5 Castelnuovo P, Dallan I, Locatelli D. , et al. Endoscopic transnasal intraorbital surgery: our experience with 16 cases. Eur Arch Otorhinolaryngol 2012; 269 (08) 1929-1935
    CrossrefPubMedGoogle Scholar
  • 6 Lenzi R, Bleier BS, Felisati G, Muscatello L. Purely endoscopic trans-nasal management of orbital intraconal cavernous haemangiomas: a systematic review of the literature. Eur Arch Otorhinolaryngol 2016; 273 (09) 2319-2322
    CrossrefPubMedGoogle Scholar
  • 7 McKinney KA, Snyderman CH, Carrau RL. , et al. Seeing the light: endoscopic endonasal intraconal orbital tumor surgery. Otolaryngol Head Neck Surg 2010; 143 (05) 699-701
    CrossrefPubMedGoogle Scholar
  • 8 Lee JYK, Ramakrishnan VR, Chiu AG, Palmer J, Gausas RE. Endoscopic endonasal surgical resection of tumors of the medial orbital apex and wall. Clin Neurol Neurosurg 2012; 114 (01) 93-98
    CrossrefPubMedGoogle Scholar
  • 9 Yao WC, Sedaghat AR, Yadav P, Fay A, Metson R. Orbital decompression in the endoscopic age: the modified inferomedial orbital strut. Otolaryngol Head Neck Surg 2016; 154 (05) 963-969
    CrossrefPubMedGoogle Scholar
  • 10 Bleier BS, Healy Jr DY, Chhabra N, Freitag S. Compartmental endoscopic surgical anatomy of the medial intraconal orbital space. Int Forum Allergy Rhinol 2014; 4 (07) 587-591
    CrossrefPubMedGoogle Scholar
  • 11 Dallan I, Castelnuovo P, de Notaris M. , et al. Endoscopic endonasal anatomy of superior orbital fissure and orbital apex regions: critical considerations for clinical applications. Eur Arch Otorhinolaryngol 2013; 270 (05) 1643-1649
    CrossrefPubMedGoogle Scholar
  • 12 Dutton J. Atlas of Clinical and Surgical Orbital Anatomy. Philadelphia, PA: W.B. Saunders Company; 1994
    Google Scholar
  • 13 Reymond J, Kwiatkowski J, Wysocki J. Clinical anatomy of the superior orbital fissure and the orbital apex. J Craniomaxillofac Surg 2008; 36 (06) 346-353
    CrossrefPubMedGoogle Scholar
  • 14 Perrini P, Cardia A, Fraser K, Lanzino G. A microsurgical study of the anatomy and course of the ophthalmic artery and its possibly dangerous anastomoses. J Neurosurg 2007; 106 (01) 142-150
    CrossrefPubMedGoogle Scholar
  • 15 Oester Jr AE, Sahu P, Fowler B, Fleming JC. Radiographic predictors of visual outcome in orbital compartment syndrome. Ophthal Plast Reconstr Surg 2012; 28 (01) 7-10
    CrossrefPubMedGoogle Scholar