Endoscopic superior eyelid transorbital approach: how I do it

Somma, Alberto Di; España, Juan Carlos Sánchez; Alobid, Isam; Enseñat, Joaquim

doi:10.1007/s00701-022-05177-y

Cited by 17 publications

(24 citation statements)

References 12 publications

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“…process, becoming one of the reference centers in the use of the endoscopic transorbital approach in our country (25). Considering our positive experience, we decided to share the process that made this possible, from the initial ideas to the first surgical cases.…”

Section: Discussionmentioning

confidence: 99%

“…Without this anatomical information that came from anatomical laboratory investigations, an efficient intraoperative orientation and a safe surgical limit would be hard to identify. As for the endonasal pathway, in the same way, dedicated efforts expended in the anatomic lab has been a powerful force for the growth of the endoscopic transorbital approach to the lateral skull base (23)(24)(25)(26)(27)(28)(29). Specifically, in our anatomic laboratory, our group has been focused, in the last decade, on the study of the application and technical variations necessary to develop the endoscopic transorbital route (25,(30)(31)(32)(33).…”

Section: Introductionmentioning

confidence: 99%

“…As for the endonasal pathway, in the same way, dedicated efforts expended in the anatomic lab has been a powerful force for the growth of the endoscopic transorbital approach to the lateral skull base (23)(24)(25)(26)(27)(28)(29). Specifically, in our anatomic laboratory, our group has been focused, in the last decade, on the study of the application and technical variations necessary to develop the endoscopic transorbital route (25,(30)(31)(32)(33). Thus, in this conceptual paper, we report the four main steps for the anatomic description of the endoscopic transorbital approach to the skull base which have been detailed and validated, according to our anatomic laboratory experience.…”

Section: Introductionmentioning

confidence: 99%

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Endoscopic transorbital avenue to the skull base: Four-step conceptual analysis of the anatomic journey

et al. 2022

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BackgroundIn the last decades, skull base surgery had passed through an impressive evolution. The role of neuroanatomic research has been uppermost, and it has played a central role in the development of novel techniques directed to the skull base. Indeed, the deep and comprehensive study of skull base anatomy has been one of the keys of success of the endoscopic endonasal approach to the skull base. In the same way, dedicated efforts expended in the anatomic lab has been a powerful force for the growth of the endoscopic transorbital approach to the lateral skull base.Therefore, in this conceptual paper, the main steps for the anatomic description of the endoscopic transorbital approach to the skull base have been detailed.MethodsThe anatomic journey for the development of the endoscopic transorbital approach to the skull base has been analyzed, and four “conceptual” steps have been highlighted.ResultsAs neurosurgeons, the eyeball has always represented a respectful area: to become familiar with this complex and delicate anatomy, we started by examining the orbital anatomy on a dry skull (step 1). Hence, step 1 is represented by a detailed bone study; step 2 is centered on cadaveric dissection; step 3 consists in 3D quantitative assessment of the novel endoscopic transorbital corridor; and finally, step 4 is the translation of the preclinical data in the real surgical scenario by means of dedicated surgical planning.ConclusionsThe conceptual analysis of the anatomic journey for the description of the endoscopic transorbital approach to the skull base resulted in four main methodological steps that should not be thought strictly consequential but rather interconnected. Indeed, such steps should evolve following the drives that can arise in each specific situation. In conclusion, the four-step anatomic rehearsal can be relevant for the description, diffusion, and development of a novel technique in order to facilitate the application of the endoscopic transorbital approach to the skull base in a real surgical scenario.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Endoscopic transorbital avenue to the skull base: Four-step conceptual analysis of the anatomic journey

et al. 2022

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“…Data were uploaded to the Medtronic Workstation System to allow navigation guidance and point registration during dissection. A superior eyelid endoscopic transorbital approach was then performed as previously described (5)(6)(7)(8)(9).…”

Section: Methodsmentioning

confidence: 99%

“…A curvilinear incision along an eyelid wrinkle, extended about 1.5 cm laterally, was performed. The skin, subcutaneous tissue, and orbicularis muscle were divided until the "white plane," made of the orbital septum and superior tarsus, was reached and respected (5). Dissection proceeded laterally to expose the lateral orbital rim, which was fully skeletonized.…”

Section: Endoscopic Transorbital Approachmentioning

confidence: 99%

Superior eyelid endoscopic transorbital approach to the tentorial area: A qualitative and quantitative anatomic study

Rosa

Somma²,

Mosteiro³

et al. 2022

Front. Surg.

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ObjectiveSuperior eyelid endoscopic transorbital approach (SETOA) is nowadays gaining progressive application in neurosurgical scenarios. Both anatomic and clinical reports have demonstrated the possibility of taking advantage of the orbital corridor as a minimally invasive route to reach anterior and middle cranial fossae and manage selected surgical lesions developing in these areas. The aim of this paper is to further shed light on other anatomic regions of the skull base as seen from a transorbital perspective, namely, the posterior cranial fossa and tentorial area, describing technical feasibility and steps in reaching this area through an extradural-transtentorial approach and providing quantitative evaluations of the “working area” obtained through this route.Material and methodsFour cadaveric heads (eight sides) were dissected at the Laboratory of Surgical Neuroanatomy (LSNA) of the University of Barcelona, Spain. A stepwise dissection of the transorbital approach to the tentorial area was described. Qualitative anatomical descriptions and quantitative analyses of working were evaluated by using pre- and postdissections CT and MRI scans, and three-dimensional reconstructions were made using Amira software.ResultsWith the endoscopic transorbital approach, posterior cranial fossa dura was reached by an extradural middle cranial fossa approach and drilling of the petrous apex. After clipping the superior petrosal sinus, the tentorium was divided and cut. An endoscope was then introduced in the posterior cranial fossa at the level of the tentorial incisura. Qualitative analysis provided a description of the tentorial and petrosal surfaces of the cerebellum, middle tentorial incisura, cerebellopontine fissures, and, after arachnoid dissection, by a 30° endoscopic visualization, the posterior aspect of the cerebellomesencephalic fissure. Quantitative analysis of the “working area” obtained after bone removal was also provided.ConclusionsThis anatomic qualitative and quantitative study sheds light on the anatomy of the posterior cranial fossa contents, such as the tentorial area and incisura, as seen through a transorbital perspective. The first aim of the article is to enrich the anatomical knowledge as seen through this relatively new corridor and to provide quantitative details and insights into the technical feasibility of reaching these regions in a surgical scenario.

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