The Extended Transbasal Approach: A Quantitative Anatomical and Histological Study

Honeybul, Stephen; Neil‐Dwyer, G.; Lang, Dorothy; Evans, B.T.; Weller, Roy O.; Gill, Jagjit S.

doi:10.1007/s007010050295

Cited by 18 publications

(8 citation statements)

References 31 publications

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“…The 15 patients in group 2 underwent resections including optic nerve decompression, via an extended transbasal approach 7 for a variety of tumours, between 1993 and 1999. In total, 11 patients required intradural surgery, and four patients required extradural surgery.…”

Section: Clinical Studymentioning

confidence: 99%

Visual function following neurosurgical optic nerve decompression for compressive optic neuropathy

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Hodgkins

Honeybul

et al. 2003

Eye

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Aims To assess the course of visual function after neurosurgical decompression of the optic nerve during resection of intracranial tumours. To obtain information that may be used to counsel patients. Methods A retrospective review of the acuity and visual fields of 27 patients undergoing neurosurgical decompression of 36 optic nerves in a regional neurosurgical centre. Two groups were considered, those undergoing craniotomy for sphenoid wing meningioma en plaque, and those undergoing an extended transbasal approach to intracranial tumours. Results At the last follow-up (1-97 months), improvement in acuity was seen in 47% of eyes with decompressed nerves. One-third of these showed late improvement, and twothirds showed immediate improvement. In total, 20% of eyes had worse acuity at the last follow-up compared with preoperative values, just under one-third of these showed late deterioration, and the remainder showed immediate deterioration. In total, 33% of eyes achieved acuities equal to those recorded preoperatively, 6% improving to this level postoperatively. Conclusions The majority of eyes in this study maintained or improved acuity after decompression. A proportion of eyes continue to improve after surgery, and a proportion deteriorate. There is no relation between duration of preoperative symptoms or the level of preoperative acuity and the change in acuity achieved.

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Section: Clinical Studymentioning

confidence: 99%

Visual function following neurosurgical optic nerve decompression for compressive optic neuropathy

Sleep

Hodgkins

Honeybul

et al. 2003

Eye

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“…Telecanthal approach 30 Standard subfrontal approach 31 Enlarged transbasal approach 32 Extended transbasal approach 17,31 Radical transbasal approach 33 Extradural transbasal approach 34 Supraorbital approach 35 Telecanthal approach Level III transfacial approach 1 Frontal transbasal approach 36 Transfrontal extradural approach 39 Standard transbasal approach 41 Traditional transbasal approach 43 Classic transbasal approach, type 1, subtypes A-C 2…”

mentioning

confidence: 99%

“…Supraorbital subfrontal approach* 47 Bifrontal transbasal approach 48 Transfrontal approach 50 Transfrontal approach 1 Transbasal approach 31 Extended frontal approach 42 Extended subfrontal approach 44,45 Subcranial approach 46 Extensive subfrontal approach 49 Extensive transbasal approach 51,52 Fronto-orbital ridge deposition (FORD) approach 26 Extended subcranial approach, type B…”

mentioning

confidence: 99%

Proposed Classification for the Transbasal Approach and Its Modifications

et al. 2008

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The transbasal approach offers extradural exposure of the anterior midline skull base transcranially. It can be used to treat a variety of conditions, including trauma, craniofacial deformity, and tumors. This approach has been modified to enhance basal access. This article reviews the principle differences among modifications to the transbasal approach and introduces a new classification scheme. The rationale is to offer a uniform nomenclature to facilitate discussion of these approaches, their indications, and related issues.

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“…1,9,11 Surgical angles relative to the pituitary stalk were measured after the 1-piece TBA, then repeated after further osteotomy to approximate a 2-piece Level I TBA, as previously described by Acharya et al 1 For these secondary measurements, the dura was stripped off the entire anterior cranial fossa floor after completion of the 1-piece TBA. The crista galli was removed.…”

Section: Surgical Corridor Relative To the Pituitary Stalkmentioning

confidence: 99%

The 1-piece transbasal approach: operative technique and anatomical study

Effendi¹,

Rao²,

Momin³

et al. 2014

JNS

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Object The transbasal approach (TBA) is an anterior skull base approach, which provides access to the anterior skull base, sellar-suprasellar region, and clivus. The TBA typically involves a bifrontal craniotomy with orbital bar and/or nasal bone osteotomies performed in 2 separate steps. The authors explored the feasibility of routinely performing this approach in 1 piece with a quantitative cadaveric anatomical study, and present an operative case example of their approach. Methods Seven latex-injected cadaveric heads underwent a 1-piece TBA, followed by additional bone removal typical for a traditional 2-piece approach. Six surgical angles relative to the pituitary stalk, as well as the surface area of the orbital roof osteotomy, were measured before and after additional bone removal. The vertical angle from the frontonasal suture to the foramen cecum was measured in all specimens. In addition to an anatomical study, the authors have used this technique in the operating room, and present an illustrative case of resection of an anterior skull base meningioma. Results Morphometric results were as follows: the vertical angle from the frontonasal suture to the foramen cecum ranged from 17.4° to 29.7° (mean 23.8° ± 4.8°) superiorly. Of the 6 surgical angle measures, only the middle horizontal angle was increased in the 2-piece versus the 1-piece approach (mean 43.4° ± 4.6° vs 43.0° ± 4.3°, respectively; p = 0.049), with a mean increase of 0.4°. The surface area of the orbital osteotomy was increased in the 2-piece versus the 1-piece approach (mean 2467 mm2 ± 360 mm2 vs 2045 mm2 ± 352 mm2, respectively; p < 0.001). The patient in the illustrative clinical case had a good outcome, both clinically and cosmetically. Conclusions The 1-piece TBA provides an alternative to the traditional 2-piece approach. It allows easier reconstruction, potentially decreased operative time, and improved cosmesis. While more of the orbital roof can be removed with the 2-piece approach, this additional bone removal offers only a small increase in 1 of 6 surgical angles that were measured.

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The Extended Transbasal Approach: A Quantitative Anatomical and Histological Study

Cited by 18 publications

References 31 publications

Visual function following neurosurgical optic nerve decompression for compressive optic neuropathy

Visual function following neurosurgical optic nerve decompression for compressive optic neuropathy

Proposed Classification for the Transbasal Approach and Its Modifications

The 1-piece transbasal approach: operative technique and anatomical study

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