Multiport Minimally Invasive Skull Base Surgery: How Many Ports Are Too Many?

Moshel, Yaron A.; Schwartz, Theodore H.

doi:10.1016/j.wneu.2010.05.015

Cited by 2 publications

(1 citation statement)

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“…26-29 Optimizing surgery by combining multiple ports allows to optimize visualization, trajectory, and working distance, and to maximize the working space between the surgeon's hands and instruments. 6,25,30 In this context, the SE transorbital approach appeared to be a natural complementary route to the endonasal pathway, providing an avenue that gets access to paramedian space. These ideas, well defined in the anatomic laboratory setting, 1,2,4,8,31-33 boosted the endoscopic transorbital approach to access, in clinical practice, the lateral portion of the middle skull base, particularly cavernous sinus and Meckel cave lesions.…”

Section: Discussionmentioning

confidence: 99%

“Sagittal Crest”: Definition, Stepwise Dissection, and Clinical Implications From a Transorbital Perspective

Corrivetti

Notaris

Somma

et al. 2022

Operative Neurosurgery

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BACKGROUND:The recent development of the superior eyelid endoscopic transorbital approach (SETOA) offered a new route for the management of cavernous sinus and middle cranial fossa tumors. As a result, a constant anatomic landmark of the surgical pathway after drilling the medial edge of the greater sphenoid wing (GSW) is represented by a triangular-shaped bone ridge appearing as a "crest." OBJECTIVE: To perform an anatomic study to define this surgical landmark, named the "sagittal crest" (SC) as seen from the transorbital endoscopic view. METHODS: Four adult cadaveric specimens (8 sides) were dissected performing an endoscopic transorbital approach to the middle fossa and the SC was removed to perform interdural opening of the cavernous sinus. Computed tomography scans were made before and after removal of the SC to perform quantitative analysis and building a 3dimensional model of the bone resection of the GSW via the SETOA. RESULTS: The SC is a bone ridge triangle shaping dorsally the superior orbital fissure resulting as the residual fragment after drilling the lateral aspect of the greater sphenoid wing. Predissection and postdissection computed tomography scans allowed to objectively assess SC features and dimensions (mean 1.08 ± 0.2 cm). CONCLUSION: The SC is a constant anatomic landmark constituted of the residual medial portion of the GSW. Complete resection of this key landmark provides adequate working space and appears to be mandatory during SETOA to guide the subsequent interdural dissection of the lateral wall of cavernous sinus.

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