Superior Eyelid Crease Approach for Transobital Neuroendoscopic Surgery of the Anterior Cranial Fossa

Koppe, Matthieu; Gleizal, A.; Orset, Emmanuelle; Bachelet, Jean Thomas; Jouanneau, Emmanuel; Rougeot, Amélie

doi:10.1097/scs.0b013e3182a2d635

Cited by 16 publications

(12 citation statements)

References 18 publications

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“…When the defect is extended beyond the limits of the orbit (e.g., frontal sinus, cribriform plate, planum sphenoidale, lateral recess of the sphenoid), watertight closure should be achieved following the principles of transnasal endoscopic SB reconstruction [3,41,47,48,58]. Various materials such as autologous grafts (e.g., fascia lata, temporalis fascia, iliotibial tract, abdominal fat, septal mucoperichondrium) or synthetic materials (e.g., TachoSil®, AlloDerm®, DuraGen®) have been used either alone or in combination [8,12,14,16,28,29,31,32,34,38,40,41,43,48,53,58]. In the majority of the studies, a multilayer reconstruction was conducted.…”

Section: Reconstructionmentioning

confidence: 99%

“…In the majority of the studies, a multilayer reconstruction was conducted. A total of 74 patients required dural reconstruction, and postoperative CSF leak was reported in 3 (4.1%) [8,12,15,16,28,29,31,32,34,40,41,48,53,58]. Even after the reconstruction of large defects, the risk of CSF leak appears to be low as the orbital contents keep the reconstruction in place and tight [1,12,14,46,48,56].…”

Section: Reconstructionmentioning

confidence: 99%

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

et al. 2021

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Transorbital endoscopic approaches are increasing in popularity as they provide corridors to reach various areas of the ventral skull base through the orbit. They can be used either alone or in combination with different approaches when dealing with the pathologies of the skull base. The objective of the current study is to evaluate the surgical anatomy of transorbital endoscopic approaches by cadaver dissections as well as providing objective clinical data on their actual employment and morbidity through a systematic review of the current literature. Four cadaveric specimens were dissected, and step-by-step dissection of each endoscopic transorbital approach was performed to identify the main anatomic landmarks and corridors. A systematic review with pooled analysis of the current literature from January 2000 to April 2020 was performed and the related studies were analyzed. Main anatomical landmarks are presented based on the anatomical study and systematic review of the literature. With emphasis on the specific transorbital approach used, indications, surgical technique, and complications are reviewed through the systematic review of 42 studies (19 in vivo and 23 anatomical dissections) including 193 patients. In conclusion, transorbital endoscopic approaches are promising and appear as feasible techniques for the surgical treatment of skull base lesions. Surgical anatomy of transorbital endoscopic approaches can be mastered through knowledge of a number of anatomical landmarks. Based on data available in the literature, transorbital endoscopic approaches represent an important complementary that should be included in the armamentarium of a skull base team.

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Section: Reconstructionmentioning

confidence: 99%

Section: Reconstructionmentioning

confidence: 99%

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

et al. 2021

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“…20 A growing number of publications describe how the technique allows a multiportal, multiangled approach to lesions of the skull base that are extremely difficult to reach, even with expanded transnasal endoscopic procedures. 16,18,19,28,48,[87][88][89][90] The transorbital approaches have the cosmetic advantage of having limited or no skin incision and eliminate the danger to the frontal branch of the facial nerve, as may occur in a standard frontotemporal approach. One of the major disadvantages of ventral transorbital approaches is the unfamiliar perspective of the anatomy of this region as seen from a ventral viewpoint.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2018

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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.

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“…6,32,35,39,49 One TONES corridor is the superior eyelid route, proven in clinical settings as a possible way to select mainly laterally placed anterior and middle skull base targets. 30 Its superior eyelid skin incision offers the advantage of being hidden when the patient's eyes are open, provides dissection in natural anatomical planes, and affords preservation of the temporalis muscle, thus facilitating an acceptable cosmetic outcome, as described in initial surgical experiences and anatomical reports. 2,9,13,15 With no dedicated study that addressed a schematic classification of the intracranial structures approached via this novel route, we undertook the anatomical analysis presented in this paper in order to determine the applicability of the various transorbital routes to the neurosurgical pathologies of the anterior and middle cranial fossae.…”

Section: Transorbital Neuroendoscopic Surgerymentioning

confidence: 99%

Endoscopic transorbital superior eyelid approach: anatomical study from a neurosurgical perspective

Somma

Andaluz²,

Cavallo

et al. 2018

Journal of Neurosurgery

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OBJECTIVE Recent studies have proposed the superior eyelid endoscopic transorbital approach as a new minimally invasive route to access orbital lesions, mostly in otolaryngology and maxillofacial surgeries. The authors undertook this anatomical study in order to contribute a neurosurgical perspective, exploring the anterior and middle cranial fossa areas through this purely endoscopic transorbital trajectory. METHODS Anatomical dissections were performed in 10 human cadaveric heads (20 sides) using 0° and 30° endoscopes. A step-by-step description of the superior eyelid transorbital endoscopic route and surgically oriented classification are provided. RESULTS The authors' cadaveric prosection of this approach defined 3 modular routes that could be combined. Two corridors using bone removal lateral to the superior and inferior orbital fissures exposed the middle and anterior cranial fossa (lateral orbital corridors to the anterior and middle cranial base) to unveil the temporal pole region, lateral wall of the cavernous sinus, middle cranial fossa floor, and frontobasal area (i.e., orbital and recti gyri of the frontal lobe). Combined, these 2 corridors exposed the lateral aspect of the lesser sphenoid wing with the Sylvian region (combined lateral orbital corridor to the anterior and middle cranial fossa, with lesser sphenoid wing removal). The medial corridor, with extension of bone removal medially to the superior and inferior orbital fissure, afforded exposure of the opticocarotid area (medial orbital corridor to the opticocarotid area). CONCLUSIONS Along with its minimally invasive nature, the superior eyelid transorbital approach allows good visualization and manipulation of anatomical structures mainly located in the anterior and middle cranial fossae (i.e., lateral to the superior and inferior orbital fissures). The visualization and management of the opticocarotid region medial to the superior orbital fissure are more complex. Further studies are needed to prove clinical applications of this relatively novel surgical pathway.

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Superior Eyelid Crease Approach for Transobital Neuroendoscopic Surgery of the Anterior Cranial Fossa

Cited by 16 publications

References 18 publications

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

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

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

Endoscopic transorbital superior eyelid approach: anatomical study from a neurosurgical perspective

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