Analysis of anterior and posterior maneuvers to enhance intraconal exposure

Abstract

Background:The medial and inferior recti encompass the ideal surgical corridor to approach the intraconal space endonasally. Here, we describe 3 different maneuvers to achieve greater access to orbital contents through an expanded endonasal approach (EEA). Methods:Four human cadaver heads were dissected bilaterally (n = 8). EEA to the medial intraconal orbit was executed. The following 3 maneuvers were performed: (1) anterior: extraocular muscles control (EOM); (2) posterior: annulus of Zinn (AZ) release; and (3) anterior/posterior combined. Measurements of the inferior and medial rectus corridor at the level of anterior ethmoidal artery (AEA) and posterior ethmoidal artery (PEA) and extent of optic nerve and medial rectus visualization was performed before and a er each maneuver.Results: Medial rectus length (MRL) and optic nerve length (ONL) achieved were 1.72 ± 0.28 cm and 0.85 ± 0.2 cm, respectively. Mean caudal-rostral distances between the rectus muscles at the level of the AEA and PEA were 3.45 ± 0.7 mm and 1.30 ± 0.3 mm, respectively. A er EOM control, mean caudal-rostral distances at the same level were as follows: AEA 4.90 ± 1.15 mm (p = 0.009) and PEA 1.70 ± 0.20 mm (p = 0.016). With AZ release, MRL was 2.20 ± 0.7 cm (p = 0.002) and ONL was 1.30 ± 0.2 cm (p = 0.003), with mean rostral-caudal distance at the level of AEA at 4.03 ± 0.8 mm (p = 0.16) and PEA at 1.71 ± 0.36 mm (p = 0.039). Mean caudal-rostral distances achieved with AZ release and EOM control were as follows: AEA 5.6 ± 1.2 mm (p = 0.001) and PEA 2.15 ± 0.4 mm (p = 0.001). Conclusion:Progressive access to the orbital contents is afforded with the 3 delineated maneuvers. The magnitude of access is optimized with the combined maneuver. The actual anterior/posterior location of the target will determine which maneuvers are required. C 2018 ARS-AAOA, LLC. Key Words: orbital/ocular; endoscopy; endoscopic minimally invasive surgery of the skull base; FESS; endoscopic skull base surgery How to Cite this Article: Lemos-Rodriguez AM, Farzal Z, Overton LJ, et al. Analysis of anterior and posterior maneuvers to enhance intraconal exposure. Int Forum Allergy Rhinol. 2019;9:556-561. E ndoscopic endonasal approaches have evolved through the years, from the resection of pituitary and transsellar

The Complete Anatomy of the Anterior Ethmoidal Artery: A Meta-Analysis with Implications for Sinus and Skull Base Surgery

“…Initially, 2583 articles underwent evaluation. Ultimately, 38 articles met the required criteria and were included in this meta-analysis [ 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 ]. The studies that were included in the analysis presented a low risk of bias in the AQUA score [ 50 ].…”

“…Year of Publication Continent Country Method Arteries Studied Livashin Naidu [24] 2023 Africa South Africa CT + Cadavers 126 Nikma Fadlati Umar [26] 2022 Asia Malaysia CT 370 Melih Caklili [48] 2021 Asia Turkey Cadavers 6 Gian Luca Fadda [44] 2021 Europe Italy CT 440 Amr F. Hamour [40] 2020 North America Canada CT 60 Mustafa Cemil Kilinc [37] 2020 Asia Turkey Cadavers + CT 14 Mohamed A. Taha [28] 2020 North America USA CT 100 Teppei Takeda [27] 2020 Asia Japan CT 366 [26] 2022 Asia Malaysia CT 370 Melih Caklili [48] 2021 Asia Turkey Cadavers 6 Gian Luca Fadda [44] 2021 Europe Italy CT 440 Amr F. Hamour [40] 2020 North America Canada CT 60 Mustafa Cemil Kilinc [37] 2020 Asia Turkey Cadavers + CT 14 Mohamed A. Taha [28] 2020 North America USA CT 100 Teppei Takeda [27] 2020 Asia Japan CT 366 Mohammad Waheed El-Anwar [4] 2019 Africa/Asia Egypt CT 300 Baharudin Abdullah [51] 2018 Asia Malaysia CT 252 Jasmine P. Y. Kho [38] 2018 Asia Malaysia CT 108 Ana M. Lemos-Rodriguez [34] 2018 North America USA Cadavers 8 Marco Ferrari [43] 2017 Europe Italy Cadavers 28 Vinicius Tomadon Bortoli [33] 2017 South America Brazil CT 600 Eric Mason [32] 2015 North America USA CT 100 David W. Jang [39] 2014 North America USA CT 78 Young-Bum Ko [5] 2014 Asia South Korea CT 119 Yu Zong [25] 2014 Asia China Cadavers 16 Erdem Eren [45] 2013 Asia Turkey CT 298 Christian Güldner [41] 2011 Europe Germany CT 282 Francisco G. Pernas [31] 2011 North America USA CT 138 [20] 2010 Asia India CT 100 Bashar Abuzayed [49] 2009 Asia Turkey Cadavers 24 C. Arturo Solares [30] 2009 North America USA CT 8 You-xiong Yang [11] 2009 Asia China Cadavers 28 S. E. McDonald [21] 2008 Europe United Ki...…”

Endoscopic Endonasal Approaches to the Medial Intraconal Space: Comparison of Transethmoidal and Prelacrimal Corridors

“…[9][10][11] In previous studies, a corridor between the medial and inferior recti muscles via a transethmoidal approach was used to provide exposure of the inferomedial intraconal space. 12,13 However, the medial rectus muscle is a hurdle for visualization during endoscopic access. Therefore, retraction of the medial rectus muscle is unavoidable to obtain adequate exposure.…”