Surgical Limitations of the Microscopic Transciliary Supraorbital Keyhole Approach to the Anterior and Middle Skull Base

Borghei-Razavi, Hamid; Eguiluz‐Melendez, Aldo; Xiong, Wei; Truong, Huy Q.; Fernandes-Cabral, David; Najera, Edinson; Stefko, Tonya; Fernández-Miranda, Juan C.; Gardner, Paul A.

doi:10.1016/j.wneu.2022.09.071

Cited by 6 publications

(7 citation statements)

References 23 publications

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“…The craniotomy is performed above the orbital rim, and the roof of the orbit can be flattened with the drill to favor a more basal exposure (Figure 2J). The dura is opened in a "C" shape and inferiorly retracted to expose the frontal pole and the frontal base (Figure 2I,K) [22].…”

Section: Eyebrow Supraorbital Approachmentioning

confidence: 99%

Surgical Anatomy and Approaches of the Anterior Cranial Fossa from a Transcranial and Endonasal Perspective

Plou

Serioli

Leonel

et al. 2023

Cancers

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The technical development in skull base surgery, especially to the anterior cranial fossa, has allowed for improvement in the quality of life and the long-term prognosis of patients suffering from different types of tumors that can affect this anatomical area. Applying these advanced techniques requires a thorough understanding of the skull base anatomy and surrounding structures to perform surgery without potential intraoperative complications related to the pathology itself as well as potential complications related to the surgical approach that has been chosen to treat this pathology. The purpose of this paper is to offer a comprehensive review of the surgical anatomy of the anterior skull base and the technical nuances of the surgical approaches that are more frequently used in this region. Detailed knowledge of these aspects is essential both for the choice of the surgical approach and for its correct execution when an anterior cranial fossa lesion need to be resected.Abstract: The anterior cranial fossa (ACF) is a complex anatomical region that can be affected by a broad spectrum of pathology. For the surgical treatment of these lesions, many approaches have been described, each of them with different scope and potential surgical complications, often associated with significant morbidity. Traditionally, tumors involving the ACF have been operated by transcranial approaches; however, in the last two decades, endoscopic endonasal approaches (EEAs) have been gaining popularity. In this work, the authors review and describe the anatomical aspects of the ACF and the technical nuances of transcranial and endoscopic approaches for tumors located in this region. Four approaches were performed in embalmed cadaveric specimens and the key steps were documented. Four illustrative cases of ACF tumors were selected to demonstrate the clinical application of anatomical and technical knowledge, which are essential in the preoperative decision-making process.

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Section: Eyebrow Supraorbital Approachmentioning

confidence: 99%

Surgical Anatomy and Approaches of the Anterior Cranial Fossa from a Transcranial and Endonasal Perspective

Plou

Serioli

Leonel

et al. 2023

Cancers

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“…According to earlier study conducted by Borghei-Razavi et al [18] found that the right side had significantly higher distance on male cranial right side. In contrast, Polermo et al [19] found left sides to have greater IOF to IOB distance.…”

Section: Discussionmentioning

confidence: 87%

Morphometric Analysis of Infraorbital Foramen in Human Dry Skulls

Jafri¹,

Muneeb²,

Qureshi³

et al. 2022

PJMHS

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Background and aim: The infraorbital foramen morphometric and anatomical variations is the critical factor for avoiding iatrogenic nerve injuries during surgery on the middle third of the face with safe regional anesthesia. The present study aimed to carry out the morphometric analysis of infra orbital foramen in human dry skull. Material and Methods: This morphometric study was carried out on 72 dry human skulls in the Department of Anatomy, Surayya Azeem Teaching Hospital, Lahore from January 2022 to June 2022. Research and ethical committee approved the study protocol. Skulls of identified age and gender with no apparent pathology, traumatic lesions, and deformity were enrolled. Skulls (>18 years) with bone resorption in the alveolar region and had orbital and nasal cavities damaged were excluded. Vernier caliper was used for the measurement of infra orbital foramen exact location on both sides. Transverse and sagittal diameter were measured. Infraorbital foramen and inferior margins of infraorbital margin were measured in order to determine the sagittal diameter. Infraorbital foramen medial margin to lateral margin of pyriform aperture was measured transversely. This study examined the relationship between the infraorbital foramen and the 1st premolar as well as its shape. There was also an indication of accessory foramen. SPSS version 26 was used for descriptive statistics. Results: Of the total 72 dry human skulls, there were 58 (80.6%) male and 14 (19.4%) females. The incidence of oval, triangular, semilunar, and round shape infra orbital foramen (left versus right) was (38.4% vs. 40.3%), (17.8% vs. 16.9%), (26.7% vs. 28.6%), and (17.1% vs. 14.2%) respectively. The occurrence of single and accessory intra orbital foramen was 91.8% and 8.2% respectively. The intra orbital foramen opening was directed medially downward, medially in, and downward was 34 (47.2%), 32 (44.4%), and 6 (8.3%) respectively. In association with upper teeth, the intra orbital foramen on the right and left side was 38.4% and 54.9% respectively; the buccal cusps of the maxillary second premolar teeth were located on the same vertical axis. Conclusion: The present study concluded that accurate localization of the IOF is essential to prevent infraorbital nerve injury. Additionally, foramen oval shape was the most prevalent shape followed by round shape. Knowledge regarding IOF location is critical in maxillofacial region during numerous surgery procedures which might lead to infraorbital vessels and nerve. Thus careful approach should be followed to avoid damage to foramen. Keywords: Infra orbital foramen, human skulls, morphometric analysis

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“…4 E and F ) . For both approaches, the contralateral edge was represented by the midpoint of the sphenoid ridge [ 24 ]. It is important to emphasize the effect of cerebrospinal fluid (CSF) drainage and its effect on brain tissue relaxation and enhanced exposure.…”

Section: Discussionmentioning

confidence: 99%

Exploring optimal microscopic keyhole access to the skull base: an anatomical evaluation of transciliary supraorbital and transpalpebral orbitofrontal craniotomy approaches

Corecha Santos,

Gupta,

Sabahi

et al. 2024

Neurosurg Rev

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Purpose: The past two decades have witnessed the rise of keyhole microscopic minimally invasive surgeries, including the transciliary supraorbital approach (TCA) and transpalpebral approach (TPA), commonly known as the transorbital approach. This study aims to elucidate the nuances, specific indications, and advantages of each approach. Methods: A series of dissections were conducted on five formalin-fixed, alcohol-preserved cadaver heads. The TCA was performed on one side, and the TPA on the other. Virtual measurements of working angles for both approaches were recorded. Additionally, three clinical cases were presented to illustrate the practical application of the techniques. Results: For TCA, the craniotomy dimensions were 1.7 cm x 2.5 cm (Cranial-Caudal (CC) x Lateral-Lateral (LL)), while for TPA, they measured 2.1 cm x 2.9 cm (CC x LL). The measurements of anterior clinoid processes (ACP) were obtained and compared between approaches. In the TCA, the mean ipsilateral ACP measurement was 62 mm (Range: 61 –63 mm), and the mean contralateral ACP measurement was 71.2 mm (Range: 70 –72 mm). In TPA, these measurements were 47.8 mm (Range: 47 –49 mm) and 62.8 mm (Range: 62 –64 mm), respectively. TCA exhibited an average cranial-caudal angle of 14.9°, while TPA demonstrated an average of 8.3°. Conclusion: The anterior cranial fossa was better exposed by a TCA, which also featured shorter operative times, enhanced midline visualization, and a quicker learning curve. Conversely, the middle fossa was better exposed by a TPA, making it an excellent option for middle fossa pathologies, including those in the anterior temporal lobe. After sphenoid bone wing drilling, the TPA offers superior visualization from the lateral to the medial aspect and enhances the CC angle. Additionally, the TPA reduces the risk of postoperative frontalis palsy based on anatomic landmarks. However, the TPA requires a greater cranial osteotomy, and due to unfamiliarity with eyelid anatomy, the learning curve for most neurosurgeons is lengthier for this procedure.

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Surgical Limitations of the Microscopic Transciliary Supraorbital Keyhole Approach to the Anterior and Middle Skull Base

Cited by 6 publications

References 23 publications

Surgical Anatomy and Approaches of the Anterior Cranial Fossa from a Transcranial and Endonasal Perspective

Surgical Anatomy and Approaches of the Anterior Cranial Fossa from a Transcranial and Endonasal Perspective

Morphometric Analysis of Infraorbital Foramen in Human Dry Skulls

Exploring optimal microscopic keyhole access to the skull base: an anatomical evaluation of transciliary supraorbital and transpalpebral orbitofrontal craniotomy approaches

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