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Endoscopic transorbital route to the petrous apex: a feasibility anatomic study.
Endoscopic transorbital route to the petrous apex: a feasibility anatomic study.
- Source :
-
Acta neurochirurgica [Acta Neurochir (Wien)] 2018 Apr; Vol. 160 (4), pp. 707-720. Date of Electronic Publication: 2017 Dec 29. - Publication Year :
- 2018
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Abstract
- Background: While the subtemporal approach represents the surgical module milestone designed to reach the petrous apex, a novel ventral route, which is the superior eyelid endoscopic transorbital approach, has been proposed to access the skull base. Accordingly, we aimed to evaluate the feasibility of this route to the petrous apex, providing a qualitative and quantitative analysis of this relatively novel pathway.<br />Methods: Five human cadaveric heads were dissected at the Laboratory of Surgical NeuroAnatomy of the University of Barcelona. After proper dissection planning, anterior petrosectomy via the endoscopic transorbital route was performed. Specific quantitative analysis, as well as dedicated three-dimensional reconstruction, was done.<br />Results: Using the endoscopic transorbital approach, it was possible to reach the petrous apex with an average volume bone removal of 1.33 ± 0.21 cm <superscript>3</superscript> . Three main intradural spaces were exposed: cerebellopontine angle, middle tentorial incisura, and ventral brainstem. The first one was bounded by the origin of the trigeminal nerve medially and the facial and vestibulocochlear nerves laterally, the second extended from the origin of the oculomotor nerve to the entrance of the trochlear nerve into the tentorium free edge while the ventral brainstem area was hardly accessible through the straight, ventral endoscopic transorbital trajectory.<br />Conclusion: This is the first qualitative and quantitative anatomic study concerning details of the lateral aspect of the incisura and ventrolateral posterior fossa reached via the transorbital window. This manuscript is intended as a feasibility anatomic study, and further clinical contributions are mandatory to confirm the effectiveness of this approach, defining its possible role in the neurosurgical armamentarium.
- Subjects :
- Brain Stem anatomy & histology
Brain Stem surgery
Cadaver
Cerebellopontine Angle anatomy & histology
Cerebellopontine Angle surgery
Cranial Nerves anatomy & histology
Dissection
Eyelids anatomy & histology
Eyelids surgery
Feasibility Studies
Humans
Image Processing, Computer-Assisted
Skull Base anatomy & histology
Skull Base surgery
Trigeminal Nerve anatomy & histology
Vestibulocochlear Nerve anatomy & histology
Endoscopy methods
Neurosurgical Procedures methods
Orbit anatomy & histology
Orbit surgery
Petrous Bone anatomy & histology
Petrous Bone surgery
Subjects
Details
- Language :
- English
- ISSN :
- 0942-0940
- Volume :
- 160
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- Acta neurochirurgica
- Publication Type :
- Academic Journal
- Accession number :
- 29288394
- Full Text :
- https://doi.org/10.1007/s00701-017-3448-x