Minimally Invasive Approaches to the Lateral Cavernous Sinus and Meckel's Cave: Comparison of Transorbital and Subtemporal Endoscopic Techniques

TransOrbital NeuroEndoscopic Surgery for Biopsy of the Left Cavernous Sinus: A Literature Review, Case Report, and Cadaveric Proof of Concept

“…The dura mater of the temporal lobe is peeled starting with V3 until CS is exposed. 4 This approach may result in considerable morbidity if not performed properly by experienced teams as cases in the literature have showed Fig. 7 Follow-up measurements after the patient was found with worsening ophthalmoplegia, now presenting with a frozen globe, which is complete limitation in extraocular muscle.…”

“…The dura mater of the temporal lobe is peeled starting with V3 until CS is exposed. 4 This approach may result in considerable morbidity if not performed properly by experienced teams as cases in the literature have showed oculomotor palsy, trochlear palsy, contralateral hemiparesis, homonymous hemianopsia, aphasia. In contrast, the pretemporal frontotemporal craniotomy begins at the upper border of the zygomatic arch, anterior to the superficial temporal artery; the incision continues superiorly towards the upper tip of the external ear, and curves anteriorly to end behind the hairline in the frontal region.…”

“…2,3 The sub-temporal middle fossa craniotomy and the fronto-temporal craniotomy with or without orbital and orbito-zygomatic variations have been long considered the standard for access to the cavernous sinus when complemented by the Dolenc, Hakuba or Kawaze approaches. 4 With an increasing trend towards more minimally This article is protected by copyright. All rights reserved.…”

“…2,3 The subtemporal middle fossa craniotomy and the frontotemporal craniotomy with or without orbital and orbitozygomatic variations have been long considered the standard for access to the CS when complemented by the Dolenc, Hakuba, or Kawaze approaches. 4 With an increasing trend toward more minimally invasive techniques, the endoscopic endonasal approach such as transmaxillary and transpterygoid approaches have also been gaining traction. However, these approaches have the disadvantage of extensive bone loss, vidian nerve injury, and risk of vascular injury to the sphenopalatine artery or its branches.…”

Endoscopic Multiportal Approaches to Meckel's Cave: A Cadaveric Study and a Three-Dimensional Anatomical Video

“…Although approaching the PA is feasible, the narrow surgical corridor limited by the petrous ICA and tentorium and the complex anatomy would require significant retraction of both orbit and brain. 8,9,[15][16][17][18] Additionally, the LTO approach spares the VN, as opposed to the EEA and the scar is hidden within the eyelid crease. The potential injury to the eye due to excessive retraction (>1 cm) seems more theoretical than practical.…”