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J Neurol Surg B Skull Base
DOI: 10.1055/s-0044-1786373
Original Article

Quantitative Analysis of the Supraorbital, Transorbital Microscopic, and Transorbital Neuroendoscopic Approaches to the Anterior Skull Base and Paramedian Vasculature

Lena Mary Houlihan
1   The Loyal and Edith Davis Neurosurgical Research Laboratory, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, United States
,
Thanapong Loymak
1   The Loyal and Edith Davis Neurosurgical Research Laboratory, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, United States
,
Irakliy Abramov
1   The Loyal and Edith Davis Neurosurgical Research Laboratory, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, United States
,
Jubran H. Jubran
1   The Loyal and Edith Davis Neurosurgical Research Laboratory, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, United States
,
Ann J. Staudinger Knoll
1   The Loyal and Edith Davis Neurosurgical Research Laboratory, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, United States
,
Michael G. J. O'Sullivan
2   Department of Neurosurgery, Cork University Hospital, Wilton, Cork, Ireland
,
Michael T. Lawton
1   The Loyal and Edith Davis Neurosurgical Research Laboratory, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, United States
,
Mark C. Preul
1   The Loyal and Edith Davis Neurosurgical Research Laboratory, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, United States
› Institutsangaben Funding This study was supported by funds from the Newsome Chair of Neurosurgery Research held by Dr. Mark Preul and from the Barrow Neurological Foundation.
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Abstract

Objectives Our objective was to compare transorbital neuroendoscopic surgery (TONES) with open craniotomy and analyze the effect of visualization technology on surgical freedom.

Design Anatomic dissections included supraorbital craniotomy (SOC), transorbital microscopic surgery (TMS), and TONES.

Setting The study was performed in a neurosurgical anatomy laboratory.

Participants Neurosurgeons dissecting cadaveric specimens were included in the study.

Main Outcome Measures Morphometric analysis of cranial nerve (CN) accessible lengths, frontal lobe base area of exposure, and craniocaudal and mediolateral angle of attack and volume of surgical freedom (VSF) of the paraclinoid internal carotid artery (ICA), terminal ICA, and anterior communicating artery (ACoA).

Results The mean (standard deviation [SD]) frontal lobe base parenchymal exposures for SOC, TMS, and TONES were 955.4 (261.7) mm2, 846.2 (249.9) mm2, and 944.7 (158.8) mm2, respectively. Access to distal vasculature was hindered when using TMS and TONES. Multivariate analysis estimated that accessing the paraclinoid ICA with SOC would provide an 11.2- mm3 increase in normalized volume (NV) compared with transorbital corridors (p < 0.001). There was no difference between the three approaches for ipsilateral terminal ICA VSF (p = 0.71). Compared with TONES, TMS provided more access to the terminal ICA. For the ACoA, SOC produced the greatest access corridor maneuverability (mean [SD] NV: 15.6 [5.6] mm3 for SOC, 13.7 [4.4] mm3 for TMS, and 7.2 [3.5] mm3 for TONES; p = 0.01).

Conclusion SOC provides superior surgical freedom for targets that require more lateral maneuverability, but the transorbital corridor is an option for accessing the frontal lobe base and terminal ICA. Instrument freedom differs quantifiably between the microscope and endoscope. A combined visualization strategy is optimal for the transorbital corridor.

Keywords

anterior skull base - neuroanatomical quantitation - supraorbital craniotomy - TMS - TONES


Publikationsverlauf

Eingereicht: 20. Juli 2023

Angenommen: 28. März 2024

Artikel online veröffentlicht:
30. April 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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