Microsurgical Anatomy of the Superior and Inferior Orbital Fissures

Bernardo, Antonio; Evins, Alexander I.; Corvino, Sergio

doi:10.1007/978-3-031-35771-8_3

Cranio-Orbital Mass Lesions 2023

DOI: 10.1007/978-3-031-35771-8_3

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Microsurgical Anatomy of the Superior and Inferior Orbital Fissures

Antonio Bernardo,

Alexander I. Evins,

Sergio Corvino

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2024

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“…1,2 Extradural exposure and preparation of this region, whether as initial preparation for a combined intraextradural approach or as the main avenue of surgical exposure, is necessary to safely access and enlarge surgical corridors. [1][2][3][4] In recent years, the endoscopic superior eyelid transorbital approach (SETA) has emerged as a potential alterna-ABBREVIATIONS CN = cranial nerve; CS = cavernous sinus; FTOZ = frontotemporal-orbitozygomatic; ICA = internal carotid artery; SETA = superior eyelid transorbital approach.…”

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confidence: 99%

A quantitative comparative surgical analysis of the endoscopic transorbital approach and frontotemporal-orbitozygomatic approach for extradural exposure of the cavernous sinus

Evins,

Sistiaga,

Quispe-Flores

et al. 2024

Neurosurgical Focus

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OBJECTIVE Recently, the endoscopic superior eyelid transorbital approach (SETA) has emerged as a potential alternative to access the cavernous sinus (CS). Several previous studies have attempted to quantitatively compare the traditional open anterolateral skull base approaches with transorbital exposure; however, these comparisons have been limited to the area of exposure provided by the bone opening and trajectory, and fail to account for the main avenues of exposure provided by subsequent requisite surgical maneuvers. The authors quantitatively compare the surgical access provided by the frontotemporal-orbitozygomatic (FTOZ) approach and the SETA following applicable periclinoid surgical maneuvers, evaluate the surgical exposure of key structures in each, and discuss optimal approach selection. METHODS SETA and FTOZ approaches were performed with subsequent applicable surgical maneuvers on 8 cadaveric heads. The lengths of exposure of cranial nerves (CNs) II–VI and the cavernous internal carotid artery; the areas of the space accessed within the supratrochlear, infratrochlear, and supramaxillary (anteromedial) triangles; the total area of exposure; and the angles of attack were measured and compared. RESULTS Exposure of the extradural CS was comparable between approaches, whereas access was significantly greater in the FTOZ approach compared with the SETA. The lengths of extradural exposure of CN III, V1, V2, and V3 were comparable between approaches. The FTOZ approach provided marginally increased exposure of CNs IV (20.9 ± 2.36 mm vs 13.4 ± 3.97 mm, p = 0.023) and VI (14.1 ± 2.44 mm vs 9.22 ± 3.45 mm, p = 0.066). The FTOZ also provided significantly larger vertical (44.5° ± 6.15° vs 18.4° ± 1.65°, p = 0.002) and horizontal (41.5° ± 5.40° vs 15.3° ± 5.06°, p < 0.001) angles of attack, and thus significantly greater surgical freedom, and provided significantly greater access to the supratrochlear (p = 0.021) and infratrochlear (p = 0.007) triangles, and significantly greater exposure of the cavernous internal carotid artery (17.2 ± 1.70 mm vs 8.05 ± 2.37 mm, p = 0.001). Total area of exposure was also significantly larger in the FTOZ, which provided wide access to the lateral wall of the CS as well as the possibility for intradural access. CONCLUSIONS This is the first study to quantitatively identify the relative advantages of the FTOZ and transorbital approaches at the target region following requisite surgical maneuvers. Understanding these data will aid in selecting an optimal approach and maneuver set based on target lesion size and location.

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confidence: 99%

A quantitative comparative surgical analysis of the endoscopic transorbital approach and frontotemporal-orbitozygomatic approach for extradural exposure of the cavernous sinus

Evins,

Sistiaga,

Quispe-Flores

et al. 2024

Neurosurgical Focus

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show abstract

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Microsurgical Anatomy of the Superior and Inferior Orbital Fissures

Cited by 1 publication

References 15 publications

A quantitative comparative surgical analysis of the endoscopic transorbital approach and frontotemporal-orbitozygomatic approach for extradural exposure of the cavernous sinus

A quantitative comparative surgical analysis of the endoscopic transorbital approach and frontotemporal-orbitozygomatic approach for extradural exposure of the cavernous sinus

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