The inferolateral transorbital endoscopic approach: a preclinical anatomical study.

The inferolateral transorbital endoscopic approach: a preclinical anatomical study.

World Neurosurg. 2016 Mar 14;

Authors: Ferrari M, Schreiber A, Mattavelli D, Belotti F, Rampinelli V, Lancini D, Doglietto F, Tschabitscher M, Rodella LF, Nicolai P

Abstract
BACKGROUND: In recent years, transorbital endoscopic approaches (TEA) are increasing in popularity as they provide several corridors to reach lateral areas of the ventral skull base through the orbit. The aim of this study is to investigate the feasibility of the inferolateral transorbital endoscopic approach (ILTEA) by detailing the step-by-step dissection, anatomical landmarks, and target anatomical areas.
METHODS: Seven cadaveric specimens (14 sides) were dissected in the Laboratory of Endoscopic Anatomy of the University of Brescia. Step-by-step dissection of ILTEA was performed to identify the main anatomical landmarks and corridors. Skin incision, dural incision, and boundaries of craniectomy were measured. Neuronavigation was used to check landmarks, track boundaries of surgical volumes, and measure orbital dislocation.
RESULTS: The study on 14 ILTEAs defined one anatomical area (called "waterline door"), which guides to 4 corridors: Meckel's cave corridor, carotid foramen corridor, petrous corridor, and transdural middle fossa corridor. Crucial anatomical landmarks were identified and analyzed. Orbital dislocation was less than 10 mm.
CONCLUSIONS: ILTEA provides the surgeon with a direct route to the region of the "waterline door", lateral areas of the ventral skull base, and middle cranial fossa. Moreover, it allows an optimal view of the intra- and extra-cranial portions of the maxillary and mandibular nerves. Further anatomical and clinical studies are needed to validate ILTEA in surgical practice.

PMID: 26987633 [PubMed - as supplied by publisher]

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