The Eyelid Trans-orbital Trans-cavernous Approach to the Basilar Apex: A Cadaveric Proof-of-Concept Study

Abstract

Objective The pretemporal transcavernous approach is an elegant technique that provides exposure to the basilar apex, which is conventionally completed with a frontotemporal incision. This can also be performed via a minimally invasive eyelid transorbital approach, which has unique attributes. This is a proof-of-concept cadaveric study to demonstrate details of the combination of these two approaches.

Design This study is a proof-of-concept study using cadaveric heads.

Setting This study is a proof-of-concept study in a cadaveric laboratory.

Participants A latex-injected cadaveric head.

Main Outcome Measures Detailed dissection was performed and demonstrated in a step-by-step fashion.

Results The eyelid transorbital approach provides the exact exposure required to complete the pretemporal osteotomy including an anterior clinoidectomy and dissection, so that a transcavernous approach can be completed. The basilar apex and its branches can also be accessed via the eyelid transorbital approach, with comparable exposure to the traditional approach; however, the access trajectory is much narrower. It takes advantages of the inferior corridor with a more medial access angle and provides a complementary perspective to the cavernous sinus contents and basilar apex complex.

Conclusion The combination of an eyelid transorbital and pretemporal transcavernous approaches can achieve a deep exposure via a minimally invasive incision, which may add an additional approach to the cavernous sinus and basilar apex regions.

Keywords

transorbital approach - pretemporal approach - transcavernous approach - basilar apex

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