Hamid Borghei-Razavi1, Huy Q Truong1, David T Fernandes-Cabral1, Emrah Celtikci1, Joseph D Chabot1, S Tonya Stefko2, Eric W Wang3, Carl H Snyderman3, Aaron Cohen-Gadol4, Paul A Gardner1, Juan C Fernández-Miranda5. 1. Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA. 2. Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA. 3. Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA. 4. Department of Neurosurgery, Indiana University School of Medicine, Goodman Campbell Brain and Spine, Indianapolis, Indiana, USA. 5. Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA. Electronic address: fernandezmirandajc@upmc.edu.
Abstract
BACKGROUND: Minimally invasive accesses to the anterior skull base include the endoscopic endonasal approach (EEA) and the supraorbital eyebrow approach. These 2 are often seen as competing approaches, not alternative or combinatory approaches. In this study, we evaluated the anatomic limitations of each approach and the combined approach for accessing the anterior skull base. METHODS: Ten neurovascular injected cadaver heads were used for the study. The supraorbital approach to the anterior skull base was performed on 5 heads, and EEA was done on the other 5 heads. Then, the supraorbital approach was added to the 5 heads receiving EEA. Visualization and surgical limitations were recorded by the ability to perform resection of the crista galli, anterior clinoid, cribriform plate, and planum sellae. RESULTS: The maximal lateral extension of EEA for anterior skull base was the midorbit line anteriorly but narrowing down toward the orbital apex. The limitation of the supraorbital approach was found mostly medial and anterior. Drilling of anterior skull base was impossible medially between the sphenoethmoidal suture and the posterior aspect of the crista galli. The combined approach showed complementary areas of visualization and surgical maneuverability. Three clinical cases were presented to illustrate the indications for the stand-alone supraorbital approach, EEA, and combined approach. CONCLUSION: The limitations of the EEA when dealing with lateral extension of anterior skull base meningiomas, and the limitations of the supraorbital eyebrow approach for medial skull base drilling and reconstruction, can be overcome by a judicious, anatomically based combination of both approaches.
BACKGROUND: Minimally invasive accesses to the anterior skull base include the endoscopic endonasal approach (EEA) and the supraorbital eyebrow approach. These 2 are often seen as competing approaches, not alternative or combinatory approaches. In this study, we evaluated the anatomic limitations of each approach and the combined approach for accessing the anterior skull base. METHODS: Ten neurovascular injected cadaver heads were used for the study. The supraorbital approach to the anterior skull base was performed on 5 heads, and EEA was done on the other 5 heads. Then, the supraorbital approach was added to the 5 heads receiving EEA. Visualization and surgical limitations were recorded by the ability to perform resection of the crista galli, anterior clinoid, cribriform plate, and planum sellae. RESULTS: The maximal lateral extension of EEA for anterior skull base was the midorbit line anteriorly but narrowing down toward the orbital apex. The limitation of the supraorbital approach was found mostly medial and anterior. Drilling of anterior skull base was impossible medially between the sphenoethmoidal suture and the posterior aspect of the crista galli. The combined approach showed complementary areas of visualization and surgical maneuverability. Three clinical cases were presented to illustrate the indications for the stand-alone supraorbital approach, EEA, and combined approach. CONCLUSION: The limitations of the EEA when dealing with lateral extension of anterior skull base meningiomas, and the limitations of the supraorbital eyebrow approach for medial skull base drilling and reconstruction, can be overcome by a judicious, anatomically based combination of both approaches.
Authors: Scott C Seaman; Muhammad S Ali; Anthony Marincovich; Luyuan Li; Jarrett E Walsh; Jeremy D W Greenlee Journal: J Neurol Surg B Skull Base Date: 2020-12-29
Authors: Won-Jae Lee; Sang Duk Hong; Kyung In Woo; Ho Jun Seol; Jung Won Choi; Jung-Il Lee; Do-Hyun Nam; Doo-Sik Kong Journal: Acta Neurochir (Wien) Date: 2022-04-29 Impact factor: 2.816
Authors: Scott Christopher Seaman; Muhammad Salman Ali; Anthony Marincovich; Carlos Osorno-Cruz; Jeremy D W Greenlee Journal: Surg Neurol Int Date: 2020-12-22