Meningo-orbital band detachment: A key step for the extradural exposure of the cavernous sinus and anterior clinoid process

Saenz, Amparo; Villalonga, Juan F.; Solari, Domenico; Baldoncini, Matías; Mantese, Beatriz; López-Elizalde, Ramiro; Campero, Álvaro

doi:10.1016/j.jocn.2020.09.055

Cited by 7 publications

(2 citation statements)

References 20 publications

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“…Anatomic studies and clinical examples regarding the endoscopic transorbital approach technique are presented together 34,43–46. Anatomic studies and clinical equivalents revealed the MOB as an important anatomic landmark in the approach to this area 24,43,46,47 but its distance from the orbital rim was 18.5 mm in our study. In this approach, the small arterial structure observed in the immediate vicinity of the band and on the path was observed in all cadavers, and the distance from the orbital rim was 16.2 mm.…”

Section: Discussionmentioning

confidence: 59%

Alternative Path for Optic Nerve Decompression in Pseudotumor Cerebri With Full Endoscopic Lateral Transorbital Approach

Özdoĝan

Beton²,

Güngör³

et al. 2022

Journal of Craniofacial Surgery

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Endonasal endoscopic approaches are the most preferred surgical methods in patients with pseudotumor cerebri because of easy access to the optic nerve, but the choice of this technique may not apply to all endoscopic endonasal cases. Moreover, there may be difficulties in practice in some cases, including the coronavirus disease 2019 pandemic. This study aimed to suggest an alternative endoscopic approach by lateral orbitotomy for optic nerve decompression in patients with pseudotumor cerebri. The study was performed using 5 fresh-frozen cadaver heads (bilaterally, total of 10 sides) injected intravenously with colored silicone preserved in the cold chain. An average of 2.5 cm skin incision was made to fit the lateral orbitotomy. The lengths of the recurrent meningeal artery (mm), the meningo-orbital band (mm), and the optic nerve (mm) to the orbital margin were measured. After these morphometric measurements, optic nerve decompression was performed endoscopically, and the length of the decompression was measured (mm). The average length (mm) between the orbital rim and meningeal recurrent artery (or meningolacrimal branch) was 16.2 mm, between the orbital rim and the meningo-orbital band was 18.5 mm, and between the orbital rim and optic nerve was 44.1 mm. The average optic nerve decompression length was 4.4 mm. The endoscopic lateral orbitotomy approach provides easy access to the optic nerve by anatomically following the recurrent meningeal artery and the meningo-orbital band. It can be a safe second-line approach after endonasal approaches for optic nerve decompression in pseudotumor cerebri.

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Section: Discussionmentioning

confidence: 59%

Alternative Path for Optic Nerve Decompression in Pseudotumor Cerebri With Full Endoscopic Lateral Transorbital Approach

Özdoĝan

Beton²,

Güngör³

et al. 2022

Journal of Craniofacial Surgery

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“…Second, the direction of surgical corridor in the ETOA which is parallel to the longitudinal axis of the ACP is more feasible for the ACP removal ( 7 , 31 , 45 ). The direction to access the ACP in the classic transcranial approach is from lateral to medial, requiring incision of the MOB and peeling of the temporal dura from the lateral wall of the CS for sufficient exposure of its distal end ( 46 , 47 ). This is mandatory for the safe resection of the ACP in transcranial approach ( 20 , 48 ).…”

Section: Discussionmentioning

confidence: 99%

Endoscopic transorbital extradural anterior clinoidectomy: A stepwise surgical technique and case series study [SevEN-013]

et al. 2022

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BackgroundAnterior clinoidectomy is an important procedure for approaching the central skull base lesions. However, anterior clinoidectomy through the endoscopic transorbital approach (ETOA) still has limitations due to technical difficulties and the structural complexity of the anterior clinoid process (ACP). Therefore, the authors designed a stepwise surgical technique of extradural anterior clinoidectomy through the ETOA. The purpose of this study was to evaluate the feasibility of this technique.MethodsAnatomical dissections were performed in 6 cadaveric specimens using a neuroendoscope and neuro-navigation system. The extradural anterior clinoidectomy through the ETOA was performed stepwise, and based on the results, this surgical technique was performed in the 7 clinical cases to evaluate its safety and efficiency.ResultsEndoscopic extradural anterior clinoidectomy was successfully performed in all cadaveric specimens and patients using the proposed technique. This 5-step technique enabled detachment of the lesser wing of sphenoid bone from the ACP, safe unroofing of the optic canal, and resection of the optic strut without injuring the optic nerve and internal carotid artery. Since the sequential resection of the 3 supporting roots of the ACP was accomplished safely, anterior clinoidectomy was then successfully performed in all clinical cases. Furthermore, no complications related to the anterior clinoidectomy occurred in any clinical case.ConclusionWe designed a stepwise surgical technique that allows safe and efficient anterior clinoidectomy through the ETOA. Using this technique, extradural anterior clinoidectomy can be accomplished under direct endoscopic visualization with low morbidity. Since this technique is applicable to the central skull base surgery where anterior clinoidectomy is necessary, it expands the application of the ETOA.

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Microsurgical Anatomy of the Superior and Inferior Orbital Fissures

Bernardo,

Evins,

Corvino

2023

Cranio-Orbital Mass Lesions

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Meningo-orbital band detachment: A key step for the extradural exposure of the cavernous sinus and anterior clinoid process

Cited by 7 publications

References 20 publications

Alternative Path for Optic Nerve Decompression in Pseudotumor Cerebri With Full Endoscopic Lateral Transorbital Approach

Alternative Path for Optic Nerve Decompression in Pseudotumor Cerebri With Full Endoscopic Lateral Transorbital Approach

Endoscopic transorbital extradural anterior clinoidectomy: A stepwise surgical technique and case series study [SevEN-013]

Microsurgical Anatomy of the Superior and Inferior Orbital Fissures

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