The Eyelid Transorbital Pretemporal Approach and Modified Orbito-Zygomatic Approach to the Anterior Communicating Artery Complex: A Quantitative Cadaveric Comparative Analysis

Traditionally, a fronto-temporal approach or its variants has been widely adopted to surgically clip the anterior communicating artery (Acom) aneurysms. The addition of orbitotomy (modified orbito-zygomatic approach, mOZ) offers more superiorly directing access trajectory or the gyrus rectus resection is often needed to fully expose the Acom complex. The novel eyelid transorbital pretemporal approach was evaluated to access the Acom complex. Six cadaveric heads were included in the study that both approaches were performed on every cadaveric head. A quantitative analysis was conducted to compare the access distance to the Acom complex, exposing length to the ipsilateral and contralateral anterior cerebral arteries (A2), surgical freedom, and difference in trajectory angle. Compared to the traditional mOZ approach, which provides maximal exposure without transgressing parenchymal tissue. The eyelid transorbital approach contains a longer access distance to the Acom complex (73.7 vs. 62.5 mm, p < 0.05) and a more inferior-superiorly directing angle of access (31.1 vs. 20.26 degrees, p < 0.05), the transorbital approach permits comparable exposing length to both ipsilateral (4.14 vs. 3.72 mm, p = 0.69) and contralateral (5.77 vs. 4.91 mm, p = 0.41) A2. The eyelid transorbital approach takes a narrower corridor but permits more inferior angle of access to the Acom complex, the use of endoscope can facilitate inspection and dissection at depth.

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Artikel online veröffentlicht:
05. Februar 2024