J Neurol Surg B Skull Base 2021; 82(04): 443-449
DOI: 10.1055/s-0040-1713101
Original Article

Endoscopic Transorbital Approaches to Anterior and Middle Cranial Fossa: A Laboratory Investigation on Surgical Anatomy and Potential Routes

Beniamino A. Nannavecchia
1  Department of Neurosurgery, “G. Mazzini” Hospital Teramo, Italy
2  Department of Neurosurgery, Strasbourg University Hospital, Strasbourg, France
,
Mario Ganau
2  Department of Neurosurgery, Strasbourg University Hospital, Strasbourg, France
,
Hélène Cebula
2  Department of Neurosurgery, Strasbourg University Hospital, Strasbourg, France
,
Antonino Scibilia
2  Department of Neurosurgery, Strasbourg University Hospital, Strasbourg, France
,
Maria T. Bozzi
2  Department of Neurosurgery, Strasbourg University Hospital, Strasbourg, France
3  Department of Radiology, Strasbourg University Hospital, Strasbourg, France
4  ENT Department, Strasbourg University Hospital, Strasbourg, France
5  Departement of Neurosurgery, Azienda Ospedaliero Universitaria Policlinico di Bari, Bari Italy
,
2  Department of Neurosurgery, Strasbourg University Hospital, Strasbourg, France
,
Paolo Gallinaro
2  Department of Neurosurgery, Strasbourg University Hospital, Strasbourg, France
,
Fazel Boujan
3  Department of Radiology, Strasbourg University Hospital, Strasbourg, France
,
Jean-Louis Dietemann
3  Department of Radiology, Strasbourg University Hospital, Strasbourg, France
,
Idir Djennaoui
4  ENT Department, Strasbourg University Hospital, Strasbourg, France
,
Christian Debry
4  ENT Department, Strasbourg University Hospital, Strasbourg, France
,
Gianfranco K.I. Ligarotti
2  Department of Neurosurgery, Strasbourg University Hospital, Strasbourg, France
,
Francesco Signorelli
5  Departement of Neurosurgery, Azienda Ospedaliero Universitaria Policlinico di Bari, Bari Italy
,
Francois Proust
2  Department of Neurosurgery, Strasbourg University Hospital, Strasbourg, France
,
Salvatore Chibbaro
2  Department of Neurosurgery, Strasbourg University Hospital, Strasbourg, France
› Author Affiliations

Abstract

Background Transorbital neuroendoscopic (TONES) approaches promise to open up new horizons for skull base surgery, offering alternative routes to reach the anterior and middle cranial fossa (ACF and MCF, respectively).

Objective The aim of this anatomical study is to acquire new surgical anatomy knowledge and exploit it for the refinement of TONES approaches, as an alternative to open surgery, to reduce the distance to the target, and the risk of neurovascular lesions in pathological conditions extending beyond the orbital cavity.

Materials and Methods Six head specimens (12 orbits) were studied/dissected. The orbit was approached and divided in a four clockwise quadrants manner to simulate three transconjunctival routes: the precaruncular (PC), preseptal (PS), and lateral retrocanthal (LRC), and one transpalpebral route—the superior eyelid crease (SLC). The boundaries and the most important anatomical landmarks were identified and are herein duly detailed with particular attention to the neurovascular structures encountered in each of those routes.

Results The dissections showed that the PC approach facilitates the treatment of optic nerve and frontal sinus pathologies, whereas LRC appears safer to reach ACF and MCF allowing for a free multiplanar working channel (up to 180 degrees) to the floor, roof, and lateral-to-medial walls.

Conclusion The plane of tendon lateral canthal's insertion and the sphenofrontal suture (SFS) were identified as the key anatomical landmarks for TONES approaches. Further studies are warranted to establish a practical clinical algorithm based on the anatomical four clockwise quadrants herein implemented/proposed, and the key surgical landmarks identified.



Publication History

Received: 07 October 2019

Accepted: 08 April 2020

Publication Date:
19 June 2020 (online)

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