Anatomical meningo-orbital band evaluation and clinical implications: a cadaveric dissection study

Anania, Pasquale; Lucas, R. Mirapeix; Todaro, Gabriele; Zona, Gianluigi; Cortés, Carlos Asencio; Hernández, Fernando Muñoz

doi:10.23736/s0390-5616.19.04794-5

Cited by 2 publications

(1 citation statement)

References 17 publications

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“…However, other authors argue that dissecting the dura propria from the lateral wall of the CS at the SOF before cutting the MOB may be safer. 25,26 We find that transecting the MOB before the dissection is particularly helpful because of safer exposure of the anterior clinoid process. In addition, transecting the MOB is necessary in later stages of the dissection to achieve the appropriate release.…”

Section: Discussionmentioning

confidence: 98%

The Final Cut: Evolution of Cavernous Sinus Decompression Beyond the Dolenc Cut

Peto

Matos-Cruz

Flores-Milan

et al. 2022

Operative Neurosurgery

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BACKGROUND:Meningiomas involving the cavernous sinus (CS) represent a formidable challenge to neurosurgeons. Because of high morbidity, aggressive tumor resection within the CS has been largely replaced by extracavernous tumor resection and decompression of the CS. The widely used Dolenc method involves blind dural transection over the oculomotor nerve, potentially placing the crossing trochlear nerve at risk.OBJECTIVE:To provide a safer way for the decompression of the CS and at the same time, circumferential resection of the temporal lobe dura.METHODS:Cadaveric dissection of 8 cadaveric heads (16 sides) was performed. Frontotemporal craniotomy with zygomatic osteotomy was performed. Extradural and intradural dissection of the lateral wall of the CS and free edge of tentorium was performed. Photographic documentation, artistic illustrations, and illustrative video cases are provided.RESULTS:Three tether points were released: anterior—the meningo-orbital band, lateral—dura over the V2 and V3, and medial—superficial layer of the free edge of tentorium. Transection of the superficial layer of the free edge of the tentorium along its edge, in conjunction with a lateral cut over the temporal convexity, constitutes the final cut, allowing a resection of the lateral CS wall and the circumferential resection of temporal lobe dura.CONCLUSION:Using the “final cut” technique allows for a circumferential resection of the temporal lobe dura and lateral CS wall while avoiding blind cuts that could put cranial nerves at risk. All dural transections are performed in anatomically separated layers under constant visualization.

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Section: Discussionmentioning

confidence: 98%

The Final Cut: Evolution of Cavernous Sinus Decompression Beyond the Dolenc Cut

Peto

Matos-Cruz

Flores-Milan

et al. 2022

Operative Neurosurgery

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Endoscopic Transnasal Transmaxillary Approach to Orbital Apex through the Meningo-Orbital Band

et al. 2022

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Background: Extradural transcranial release of the meningo-orbital band occupying the lateral part of the superior orbital fissure is used to approach the orbital apex and middle cranial fossa. The authors tested the feasibility of the release of the meningo-orbital band via an endonasal transmaxillary approach. Materials and Methods: Five injected cadaveric heads were assessed for dimensions of superior orbital fissure by computerized tomography. An endonasal transsphenoid transpterygoid approach was done to the superior orbital fissure and annulus of Zinn medially, down to the maxillary nerve. The periorbita was dissected superolaterally to expose the greater wing of the sphenoid and the meningo-orbital band. The superior orbital fissure was decompressed inferiorly by drilling the greater wing of the sphenoid and the maxillary strut after transposition of the maxillary nerve. The meningoorbital band was cut at the junction of the lateral part of the superior orbital fissure and the periorbita exposing the frontotemporal dural junction. The edge of the lesser wing of the sphenoid was drilled toward the annulus of Zinn and the optic canal. The temporal lobe dura was separated from the periorbita and lateral cavernous dural wall at the meningo-orbital band and the ophthalmic nerve. Results: The superior orbital fissure had an oblique angle (mean: 39 ± 2.75 degrees) to the midsagittal plane, the length of its lateral part corresponding to the meningo-orbital band was (mean: 6.08 ± 2.58 mm) and the distance from its lateral end to midline was (mean 2.97 ± 0.11 cm). The meningo-orbital band was released in 10 cadaveric head sides with a distinct plane between the periorbita and the dura propria. Transmaxillary endoscopy provided less orbital retraction and better visualization of the lateral wall of the cavernous sinus. Conclusion: Endonasal transmaxillary release of the meningoorbital band is feasible, allowing exposure of the orbital apex and the middle cranial fossa.

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Anatomical meningo-orbital band evaluation and clinical implications: a cadaveric dissection study

Cited by 2 publications

References 17 publications

The Final Cut: Evolution of Cavernous Sinus Decompression Beyond the Dolenc Cut

The Final Cut: Evolution of Cavernous Sinus Decompression Beyond the Dolenc Cut

Endoscopic Transnasal Transmaxillary Approach to Orbital Apex through the Meningo-Orbital Band

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