Quantitative Anatomic Comparison of Endoscopic Transnasal and Microsurgical Transcranial Approaches to the Anterior Cranial Fossa

Abstract

BACKGROUND:Several microsurgical transcranial approaches (MTAs) and endoscopic transnasal approaches (EEAs) to the anterior cranial fossa (ACF) have been described.OBJECTIVE:To provide a preclinical, quantitative, anatomic, comparative analysis of surgical approaches to the ACF.METHODS:Five alcohol-fixed specimens underwent high-resolution computed tomography. The following approaches were performed on each specimen: EEAs (transcribriform, transtuberculum, and transplanum), anterior MTAs (transfrontal sinus interhemispheric, frontobasal interhemispheric, and subfrontal with unilateral and bilateral frontal craniotomy), and anterolateral MTAs (supraorbital, minipterional, pterional, and frontotemporal orbitozygomatic approach). An optic neuronavigation system and dedicated software (ApproachViewer, part of GTx-Eyes II—UHN) were used to quantify the working volume of each approach and extrapolate the exposure of different ACF regions. Mixed linear models with random intercepts were used for statistical analyses.RESULTS:EEAs offer a large and direct route to the midline region of ACF, whose most anterior structures (ie, crista galli, cribriform plate, and ethmoidal roof) are also well exposed by anterior MTAs, whereas deeper ones (ie, planum sphenoidale and tuberculum sellae) are also well exposed by anterolateral MTAs. The orbital roof region is exposed by both anterolateral and lateral MTAs. The posterolateral region (ie, sphenoid wing and optic canal) is well exposed by anterolateral MTAs.CONCLUSION:Anterior and anterolateral MTAs play a pivotal role in the exposure of most anterior and posterolateral ACF regions, respectively, whereas midline regions are well exposed by EEAs. Furthermore, certain anterolateral approaches may be most useful when involvement of the optic canal and nerves involvement are suspected.

Surgical Approaches to Resection of Olfactory Groove Meningiomas: Comparative Meta-analysis of the Endoscopic Endonasal versus Transcranial and Unilateral versus Bilateral Approaches

“…In their recent cadaveric study, Agosti et al compared the access afforded by the endoscopic transnasal, anterior microsurgical transcranial, and anterolateral microsurgical TCAs for pathologies of the anterior cranial fossa. 30,31 While the EEA offered good access for all midline structures, it was severely limited in antero-and posterolateral regions, affording little to no access to territories over the orbital roof. By contrast, anterolateral TCAs, such as the pterional and orbitozygomatic approach offered the best access to these lateral positions.…”

Surgical Treatment of Spheno-Orbital Meningiomas: A Systematic Review and Meta-Analysis of Surgical Techniques and Outcomes

“…Endoscopic approaches offer less invasive corridors and aesthetically pleasing results. However, due to the limitations in achieving GTR, these approaches should be reserved for selected patients with suspected benign SOMs exhibiting minimal intradural growth [ 14 , 60 , 61 ]. In such cases, the primary goal is symptom relief through decompression of the optic canal, with subsequent consideration of adjuvant radiotherapy (RT) for any residual tumor.…”

Quantitative Anatomical Studies in Neurosurgery: A Systematic and Critical Review of Research Methods

“…Over the years, our research group has published several anatomical quantitative studies [ 96 , 98 , 99 , 100 , 106 , 107 , 109 , 110 , 113 , 114 , 116 , 127 , 130 ], focusing on the quantification of both the surgical volume and the exposure area. In accordance with our experience and with the aim of promoting standardization of the methods of quantification, we detail the minimum instrumentation necessary for an anatomical laboratory that wants to carry out quantitative studies.…”