Endoscopic transorbital approach to the cavernous sinus lateral compartment (anatomical cadaver study)

Çaklılı, Melih; Emengen, Atakan; Çabuk, Burak; Anık, İhsan; Ceylan, Savaş

doi:10.5137/1019-5149.jtn.34972-21.2

Cited by 12 publications

(12 citation statements)

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“…Initially, 2583 articles underwent evaluation. Ultimately, 38 articles met the required criteria and were included in this meta-analysis [ 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 ]. The studies that were included in the analysis presented a low risk of bias in the AQUA score [ 50 ].…”

Section: Resultsmentioning

confidence: 99%

The Complete Anatomy of the Anterior Ethmoidal Artery: A Meta-Analysis with Implications for Sinus and Skull Base Surgery

Szczepanek,

Toppich,

Ostrowski

et al. 2024

JCM

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Background: The anatomical characteristics of the anterior ethmoidal artery (AEA) exhibit a high degree of variability, especially regarding its topography. Methods: PubMed, Scopus, Embase, Web of Science, Cochrane Library, and Google Scholar were searched to identify all studies that included information regarding the morphometric and topographical characteristics of the AEA. Results: Ultimately, a compilation of 38 studies meeting the predetermined criteria, and possessing comprehensive and pertinent data, were incorporated into the current meta-analysis. In the overall analysis, reports of the AEA being embedded within the skull base or at the level of the skull base producing a bony protrusion were found in 56.91% of cases (95% CI: 43.55–69.80%). The mean diameters of the AEA in the intraorbital and intracranial areas were 0.94 mm and 0.76 mm, respectively. Moreover, the artery coursed most commonly between the second and third lamellae, with a prevalence of 65.82% (95% CI: 55.39–75.56%). Conclusions: The AEA may be at a high risk of iatrogenic injury during various sinus and skull base surgeries, especially if the surgeon performing these procedures is unfamiliar with the vast number of variations this vessel may exhibit. The spatial relationship between this vessel and the skull base is especially variable, and understanding this variability goes hand in hand with intraoperative safety.

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Section: Resultsmentioning

confidence: 99%

The Complete Anatomy of the Anterior Ethmoidal Artery: A Meta-Analysis with Implications for Sinus and Skull Base Surgery

Szczepanek,

Toppich,

Ostrowski

et al. 2024

JCM

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“…Transorbital approaches represent an innovative surgical route not only for the treatment of orbital pathologies, but also offer a direct surgical corridor to the LWCS [ 13 , 20 , 25 , 29 , 40 , 51 , 52 ], and anterior [ 8 , 13 , 28 , 30 , 49 ] and middle cranial fossae [ 13 , 19 , 22 , 26 , 27 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 49 , 53 , 54 , 55 , 56 ]. Furthermore, even intraparenchymal targets and specific pathologies can be treated via this route [ 46 , 47 ].…”

Section: Discussionmentioning

confidence: 99%

“…The application of TOAs has been subsequently extended to the lesions of the anterolateral skull base such as meningiomas, schwannomas, dermoid cysts, CSF leak, and infections [ 8 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 ], using the orbital cavity as a corridor to offer several trajectories [ 8 , 13 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 ]. Moreover, recent anatomical and initial clinical studies have also highlighted the potential versatility of these approaches, to the tentorial area [ 41 , 42 ], petrous apex [ 43 , 44 , 45 ], and the insular region [ 46 , 47 ].…”

Section: Introductionmentioning

confidence: 99%

Surgical Anatomy of the Microscopic and Endoscopic Transorbital Approach to the Middle Fossa and Cavernous Sinus: Anatomo-Radiological Study with Clinical Applications

Serioli,

Nizzola,

Plou

et al. 2023

Cancers

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Background: The transorbital approaches (TOAs) have acquired growing notoriety, thanks to their ability to offer alternative corridors to the skull base. However, the limited access and the unfamiliarity with this surgical perspective make recognition of key landmarks difficult, especially for less experienced surgeons. The study wants to offer a detailed description of the anatomy to comprehend the potential and limitations of TOAs. Methods: Measurements of the orbit region and the surrounding areas were performed on two hundred high-resolution CT scans and thirty-nine dry skulls. Five specimens were dissected to illustrate the TOA, and one was used to perform the extradural clinoidectomy. Three clinical cases highlighted the surgical applications. Results: A step-by-step description of the key steps of the TOA was proposed and a comparison with the transcranial anterior clinoidectomy was discussed. The mean work distance was 6.1 ± 0.4 cm, and the lateral working angle increased 20 ± 5.4° after removing the lateral orbital rim. Conclusions: TOAs are indicated in selected cases when tumor involves the lateral portion of the cavernous sinus or the middle skull base, obtaining a direct decompression of the optic nerve and avoiding excessive manipulation of the neurovascular structures. Comprehension of surgical anatomy of the orbit and its surrounding structures is essential to safely perform these approaches.

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“…The technique began with an incision in the left superior eyelid and was extended laterally to include the canthus (Figure 2A). 3,10,11 Although not necessary for a cadaver, a corneal protector can be used for ophthalmic preservation during this step. However, it is important to periodically remove the corneal This article is protected by copyright.…”

Section: Surgical Techniquementioning

confidence: 99%

“…2A). 3,10,11 Although not necessary for a cadaver, a corneal protector can be used for ophthalmic preservation during this step. However, it is important to periodically remove the corneal protector to monitor pupillary dilation and symmetry, considering that force applied on the globe during this surgical approach can cause visual damage.…”

Section: Surgical Techniquementioning

confidence: 99%

TransOrbital NeuroEndoscopic Surgery for Biopsy of the Left Cavernous Sinus: A Literature Review, Case Report, and Cadaveric Proof of Concept

Frontera,

Rosado-Philippi,

Díaz

et al. 2023

J Neurol Surg Rep

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The aim of this report is to describe Transorbital Neuroendoscopic Surgery (TONES) as a safe alternative for obtaining a cavernous sinus biopsy. We describe this technique in a patient with a diffuse Large B-cell Lymphoma mimicking Tolosa-Hunt Syndrome. Articles were gathered querying PubMed, EMBASE, and SCOPUS databases with the following terms: (“Transorbital neuroendoscopic approach” OR “Transorbital neuroendoscopic surgery” OR “TONES” OR “transorbital approach” OR “endoscopic transorbital approach”) AND (“cavernous sinus”). The literature search was performed by two independent authors (N.F. and J.R.), with inconsistencies resolved by the senior author (M.M.). After screening abstracts for relevance, full-length articles were reviewed for pertinent variables. A comparison was conducted with the illustrative case of a 69-year-old woman who presented to the emergency department with vertigo, ophthalmoplegia, and diplopia for two months. A Brain MRI revealed an infiltrative lesion at the left cavernous sinus. A presumptive diagnosis of Tolosa-Hunt was made but a confirmatory biopsy was performed using TONES. Based on our cadaveric study, literature review, and case report the TONES approach was safe, effective for tissue diagnosis and associated with minor morbidity and reduced hospital stay. Additional prospective studies are required to study its viability and safety in a larger group of patients.

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Endoscopic transorbital approach to the cavernous sinus lateral compartment (anatomical cadaver study)

Cited by 12 publications

References 0 publications

The Complete Anatomy of the Anterior Ethmoidal Artery: A Meta-Analysis with Implications for Sinus and Skull Base Surgery

The Complete Anatomy of the Anterior Ethmoidal Artery: A Meta-Analysis with Implications for Sinus and Skull Base Surgery

Surgical Anatomy of the Microscopic and Endoscopic Transorbital Approach to the Middle Fossa and Cavernous Sinus: Anatomo-Radiological Study with Clinical Applications

TransOrbital NeuroEndoscopic Surgery for Biopsy of the Left Cavernous Sinus: A Literature Review, Case Report, and Cadaveric Proof of Concept

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