Quantitative comparison of endoscopically assisted endonasal, sublabial and transorbital transmaxillary approaches to the anterolateral skull base

Abstract

Objectives: The aim of this anatomical study is to make quantitative comparison among three endoscopic approaches, encompassing contralateral endonasal transseptal transmaxillary transpterygoid approach (contralateral EEA), endoscopic sublabial transmaxillary transalisphenoid (Caldwell-Luc) approach and endoscopic transorbital transmaxillary approach through inferior orbital fissure (ETOA), to the anterolateral skull base for assisting preoperative planning. Design & Participants: Anatomical dissections were performed in four adult cadaveric heads bilaterally using three endoscopic transmaxillary approaches described above.

When multidisciplinary surgical trans-orbital approaches should be considered to reach the skull base

“…In endoscopic-assisted surgery to Meckel's cave and petrous apex, among the advantages of the transorbital approach over the endonasal patways, Lee reports the shorter access route and the possibility to perform an "interdural" dissection within the lateral wall of the cavernous sinus with a easier manipulation of tumors at their lateral and posterior borders, sparing the vidian nerve 13 . Literature on the topic is in steady growth with several anatomical comparative studies performed to value the feasibility of the transorbital approaches over endonasal and open patways 14,15 . Among published clinical series, the superior eyelid approaches to the middle skull base have been successfully used to manage spheno-orbital meningiomas (even if the en-plaque types remain a challenge) 16 and neoplastic diseases such as trigeminal schwannomas 17 and metastatic lesions 10 .…”