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J Neurol Surg B Skull Base 2014; 75(01): 011-017
DOI: 10.1055/s-0033-1353363
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Lateral Transorbital Neuroendoscopic Approach to the Lateral Cavernous Sinus

Randall A. Bly
1   Department of Otolaryngology, University of Washington, Seattle, Washington, United States
*   Both authors contributed equally to this work.
,
Rohan Ramakrishna
2   Department of Neurological Surgery, University of Washington, Seattle, Washington, United States
*   Both authors contributed equally to this work.
,
Manuel Ferreira
2   Department of Neurological Surgery, University of Washington, Seattle, Washington, United States
,
Kris S. Moe
1   Department of Otolaryngology, University of Washington, Seattle, Washington, United States
› Author Affiliations
Further Information

Publication History

04 February 2013

14 June 2013

Publication Date:
09 September 2013 (online)

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See also:

The Evolution of Endoscopic Approaches to the Lateral Cavernous SinusJ Neurol Surg B Skull Base 2015; 76(02): 163-164
DOI: 10.1055/s-0034-1390399

Abstract

Objective To design and assess the quality of a novel lateral retrocanthal endoscopic approach to the lateral cavernous sinus.

Design Computer modeling software was used to optimize the geometry of the surgical pathway, which was confirmed on cadaver specimens. We calculated trajectories and surgically accessible areas to the middle fossa while applying a constraint on the amount of soft tissue retraction.

Setting Virtual computer model to simulate the surgical approach and cadaver laboratory.

Participants The authors.

Main Outcome Measures Adequate surgical access to the lateral cavernous sinus and adjacent regions as determined by operations on the cadaver specimens. Additionally, geometric limitations were imposed as determined by the model so that retraction on soft tissue structures was maintained at a clinically safe distance.

Results Our calculations revealed adequate access to the lateral cavernous sinus, Meckel cave, orbital apex, and middle fossa floor. Cadaveric testing revealed sufficient access to these areas using <10 mm of orbital retraction.

Conclusions Our study validates not only the use of computer simulation to plan operative approaches but the feasibility of the lateral retrocanthal approach to the lateral cavernous sinus.

Keywords

cavernous sinus - endoscopic - pituitary - transnasal - transsphenoidal - transorbital

Funding

RAB was supported by NIH T32 DC00018 Training Grant and University of Washington Housestaff Association Grant.


 

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