The feasibility of three port endonasal, transorbital, and sublabial approach to the petroclival region: neurosurgical audit and multiportal anatomic quantitative investigation

Corvino, Sergio; Guizzardi, Giulia; Sacco, Matteo Antonio; Corrivetti, Francesco; Bove, Ilaria; Enseñat, Joaquim; Colamaria, Antonio; Prats‐Galino, Alberto; Solari, Domenico; Cavallo, Luigi Maria; Somma, Alberto Di; Notaris, Matteo de

doi:10.1007/s00701-023-05498-6

Cited by 12 publications

(15 citation statements)

References 44 publications

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“…However, this limitation could be reduced by transient the removal of the orbital rim. Alternatively or additionally, the use of a multi-portal strategy where two or three surgical corridors are exploited simultaneously may improve the visualization and range of motion in deep-seated areas of the skull base ( Corvino et al, 2023 ; Zoia et al, 2023 ).…”

Section: Discussionmentioning

confidence: 99%

Transorbital approach to the cavernous sinus: an anatomical study of the related cranial nerves

Mosteiro,

Codes,

Tafuto

et al. 2024

Front. Neuroanat.

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BackgroundThe cavernous sinus (CS) is a demanding surgical territory, given its deep location and the involvement of multiple neurovascular structures. Subjected to recurrent discussion on the optimal surgical access, the endoscopic transorbital approach has been recently proposed as a feasible route for selected lesions in the lateral CS. Still, for this technique to safely evolve and consolidate, a comprehensive anatomical description of involved cranial nerves, dural ligaments, and arterial relations is needed.ObjectiveDetailed anatomical description of the CS, the course of III, IV, VI, and V cranial nerves, and C3-C7 segments of the carotid artery, all described from the ventrolateral endoscopic transorbital perspective.MethodsFive embalmed human cadaveric heads (10 sides) were dissected. An endoscopic transorbital approach with lateral orbital rim removal, anterior clinoidectomy, and petrosectomy was performed. The course of the upper cranial nerves was followed from their apparent origin in the brainstem, through the middle fossa or cavernous sinus, and up to their entrance to the orbit. Neuronavigation was used to follow the course of the nerves and to measure their length of surgical exposure.ResultsThe transorbital approach allowed us to visualize the lateral wall of the CS, with cranial nerves III, IV, V1-3, and VI. Anterior clinoidectomy and opening of the frontal dura and the oculomotor triangle revealed the complete course of the III nerve, an average of 37 (±2) mm in length. Opening the trigeminal pore and cutting the tentorium permitted to follow the IV nerve from its course around the cerebral peduncle up to the orbit, an average of 54 (±4) mm. Opening the infratrochlear triangle revealed the VI nerve intracavernously and under Gruber’s ligament, and the extended petrosectomy allowed us to see its cisternal portion (27 ± 6 mm). The trigeminal root was completely visible and so were its three branches (46 ± 2, 34 ± 3, and 31 ± 1 mm, respectively).ConclusionComprehensive anatomic knowledge and extensive surgical expertise are required when addressing the CS. The transorbital corridor exposes most of the cisternal and the complete cavernous course of involved cranial nerves. This anatomical article helps understanding relations of neural, vascular, and dural structures involved in the CS approach, essential to culminating the learning process of transorbital surgery.

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Section: Discussionmentioning

confidence: 99%

Transorbital approach to the cavernous sinus: an anatomical study of the related cranial nerves

Mosteiro,

Codes,

Tafuto

et al. 2024

Front. Neuroanat.

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“…The evolution of the transorbital approach has been notorious, going from being a controversial surgical technique to becoming an accepted and important approach of the skull base surgical practice, with or without combination with other such as endoscopic endonasal or transmaxilary 15,25,[35][36][37] .…”

Section: Discussionmentioning

confidence: 99%

Transorbital Approach Scientific Trend: Analysis of Publications and Citations Over Years

Codes,

Somma,

Ferrés

et al. 2023

Preprint

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Background: Transorbital approach has gained significant consideration over the last few years, as evidenced by the growing number of publications. The present study aims to describe and quantify the number of publications and citations over the years in order to identify key moments in its history. Methods: Data from annual publications and citations of the transorbital approach between 1950 and 2022 have been extracted from the Web of Science and later uploaded to Microsoft Excel. Three parameters were analyzed: 1) absolute number of publications; 2) annual absolute growth of citations; 3) trend of publications. Results: Results showed an average number of publications of 18.6 with 266 citations per year. Regarding the number of publications, the analysis showed four key moments in history: 1985, 2001, 2010-2011, and 2018-2019. Around 1985, related to studies on transorbital lobotomy. Around 2001, due to experimental studies in vascular pathology. During 2010-2011, when the concept of transorbital neuroendoscopic surgery was introduced. Around 2018-2019, when different case series were published. However, analyzing the annual absolute growth of citations, one key moment was detected: 2019, achieving a significant positive annual growth of +522 citations. The analysis of the publication trend shows a positive trend line, forecasting 60-63 publications per year in the next 3-5 years. Conclusions: Despite the inherent limitation of this study, this analysis showed that the recent 2019 is a turning point for transorbital surgery being the year with the most citations and publications. The following years will determine the exact place of this technique in the skull base armamentarium.

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“…According to previously published studies [3,7,25], the skin incision was made through the superior eyelid crease and the orbicularis oculi muscle, and a skin-muscle flap was raised superiorly and inferiorly until the lateral orbital rim was clearly identified.…”

Section: Key Anatomical Transorbital Principles To Access the Middle ...mentioning

confidence: 99%

“…In addition, transorbital and endonasal approaches can be used in combination as part of a multiportal approach to access, simultaneously or not, different median and paramedian areas of the skull base [22][23][24], starting from a key anatomical paradigm: the endonasal approach involves accessing the midline skull base, while the transorbital approach involves accessing the paramedian areas laterally to the parasellar and paraclival segments of the internal carotid artery (Figure 1A) [25]. By combining these approaches in Furthermore, transorbital endoscopic approaches have been demonstrated to be feasible for the resection of certain types of tumors, such as trigeminal schwannomas and spheno-orbital meningiomas, with encouraging results [15][16][17].…”

Section: Introductionmentioning

confidence: 99%

The Transorbital Approach, A Game-Changer in Neurosurgery: A Guide to Safe and Reliable Surgery Based on Anatomical Principles

de Notaris,

Sacco,

Corrivetti

et al. 2023

JCM

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During the last few years, the superior eyelid endoscopic transorbital approach has been proposed as a new minimally invasive pathway to access skull base lesions, mostly in ophthalmologic, otolaryngologic, and maxillofacial surgeries. However, most neurosurgeons performing minimally invasive endoscopic neurosurgery do not usually employ the orbit as a surgical corridor. The authors undertook this technical and anatomical study to contribute a neurosurgical perspective, exploring the different possibilities of this novel route. Ten dissections were performed on ten formalin-fixed specimens to further refine the transorbital technique. As part of the study, the authors also report an illustrative transorbital surgery case to further detail key surgical landmarks. Herein, we would like to discuss equipment, key anatomical landmarks, and surgical skills and stress the steps and details to ensure a safe and successful procedure. We believe it could be critical to promote and encourage the neurosurgical community to overcome difficulties and ensure a successful surgery by following these key recommendations.

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The feasibility of three port endonasal, transorbital, and sublabial approach to the petroclival region: neurosurgical audit and multiportal anatomic quantitative investigation

Cited by 12 publications

References 44 publications

Transorbital approach to the cavernous sinus: an anatomical study of the related cranial nerves

Transorbital approach to the cavernous sinus: an anatomical study of the related cranial nerves

Transorbital Approach Scientific Trend: Analysis of Publications and Citations Over Years

The Transorbital Approach, A Game-Changer in Neurosurgery: A Guide to Safe and Reliable Surgery Based on Anatomical Principles

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