Pure Endoscopic Lateral Orbitotomy Approach to the Cavernous Sinus, Posterior, and Infratemporal Fossae: Anatomic Study

Abstract

Objective The aim of this anatomic study is to describe a fully endoscopic lateral orbitotomy extradural approach to the cavernous sinus, posterior, and infratemporal fossae. Material and Methods Three prefixed latex-injected head specimens (six orbital exposures) were used in the study. Before and after dissection, a computed tomography scan was performed on each cadaver head and a neuronavigation system was used to guide the approach. The extent of bone removal and the area of exposure of the targeted corridor were evaluated with the aid of OsiriX software (Pixmeo, Bernex, Switzerland). Results The lateral orbital approach offers four main endoscopic extradural routes: the anteromedial, posteromedial, posterior, and inferior. The anteromedial route allows a direct route to the optic canal by removal of the anterior clinoid process, whereas the posteromedial route allows for exposure of the lateral wall of the cavernous sinus. The posterior route is targeted to Meckel's cave and provides access to the posterior cranial fossa by exposure and drilling of the petrous apex, whereas the inferior route gives access to the pterygopalatine and infratemporal fossae by drilling the floor of the middle cranial fossa and the bone between the second and third branches of the trigeminal nerve. Conclusion The lateral orbitotomy endoscopic approach provides direct access to the cavernous sinus, posterior, and infratemporal fossae. Advantages of the approach include a favorable angle of attack, minimal brain retraction, and the possibility of dissection within the two dural layers of the cavernous sinus without entering its neurovascular compartment.

Transorbital endoscopic approaches to the skull base: a systematic literature review and anatomical description

“…3, 4, 5, 6, 7, 8, and 9) [47]. Several variants of these pillar approaches have been described over the last decade in clinical and anatomical studies, each aiming to facilitate surgical goals [8,9,20,24,25,29,33,44,[50][51][52]59]. A thorough understanding of the anatomy of the eyelid is essential in each approach, and possible need for a reconstruction and additional corridors (i.e., multiportal approach) must also be precisely planned before surgery.…”

Transorbital Endoscopic Approach to the Pterygopalatine Fossa: A Less Invasive Alternative to Traditional Access

“…Although trans-nasal endoscopic and periorbital approaches minimize morbidity compared with traditional techniques, they may still require skin incisions, large maxillectomies, and/or septectomies. 2,[6][7][8][9][10][11] The transorbital endoscopic approach can be considered a complimentary alternative, with unique advantages in selected cases. First, it utilizes a small conjunctival incision that leaves no cutaneous scar.…”

“…Similarly, periorbital techniques have also been described, utilizing smaller and more strategically placed incisions to gain direct access to the PPF. [9][10][11] However, for optimal visualization, both of these approaches tend to require osteotomies of varying degrees and a moderate amount of soft tissue dissection. 2,6,9,10 Although certainly an improvement over traditional approaches, cases with pathology requiring only an incisional biopsy could benefit from an even more targeted, less invasive technique.…”

Modified Endoscopic Denker's Approach for a Meckel's Cave Meningioma: 2-Dimensional Operative Video

“…Newer techniques, including transorbital and endoscopic endonasal approaches, have increased the range of surgical options available for resection of these tumors. [1][2][3][4][5] Here, we present the case of a 14-year-old male, with a history of receiving craniospinal radiation in infancy for neuroblastoma resulting in short stature, who presented with V2 neuropathy in the setting of a rapidly growing Meckel's cave meningioma. We discuss the relevant anatomy, approaches to Meckel's cave, and a rationale for approach selection in these cases.…”