Bon-Jour Lin1,2, Kun-Ting Hong1, Tzu-Tsao Chung1, Wei-Hsiu Liu1, Dueng-Yuan Hueng1, Yuan-Hao Chen1, Da-Tong Ju1, Hsin-I Ma1, Ming-Ying Liu1, Hung-Chang Hung3,4, Chi-Tun Tang5. 1. Department of Neurological Surgery, National Defense Medical Center, Tri-Service General Hospital, No 325, Section 2, Cheng-Kung Road, Neihu, 114, Taipei, Taiwan, Republic of China. 2. Department of Surgery, Nantou Hospital, Nantou, Taiwan, Republic of China. 3. Department of Internal Medicine, Nantou Hospital, Nantou, Taiwan, Republic of China. 4. Department of Healthcare Administration, Central Taiwan University of Science and Technology, Taichung, Taiwan, Republic of China. 5. Department of Neurological Surgery, National Defense Medical Center, Tri-Service General Hospital, No 325, Section 2, Cheng-Kung Road, Neihu, 114, Taipei, Taiwan, Republic of China. coleman0719@gmail.com.
Abstract
BACKGROUND: Endoscopic transorbital approach is a novel development of minimally invasive skull base surgery. Recently, anatomical studies have started to discuss the expanded utilization of endoscopic transorbital route for intracranial intradural lesions. The goal of this cadaveric study is to assess the feasibility of endoscopic transorbital transtentorial approach for exposure of middle incisural space. METHODS: Anatomical dissections were performed in four human cadaveric heads (8 sides) using 0- and 30-degree endoscopes. A stepwise description of endoscopic transorbital transtentorial approach to middle incisural space and related anatomy was provided. RESULTS: Orbital manipulation following superior eyelid crease incision with lateral canthotomy and cantholysis established space for bone drilling. Extradural stage consisted of extensive drilling of orbital roof of frontal bone, lessor, and greater wings of sphenoid bone. Intradural stage was composed of dissection of sphenoidal compartment of Sylvian fissure, lateral mobilization of mesial temporal lobe, and penetration of tentorium. A cross-shaped incision of tentorium provided direct visualization of crural cistern with anterolateral aspect of cerebral peduncle and upper pons. Interpeduncular cistern, prepontine cistern, and anterior portions of ambient and cerebellopontine cisterns were exposed by 30-degree endoscope. CONCLUSION: The endoscopic transorbital transtentorial approach can be used as a minimally invasive surgery for exposure of middle incisural space. Extensive drilling of sphenoid wing and lateral mobilization of mesial temporal lobe are the main determinants of successful dissection. Further studies are needed to confirm the clinical feasibility of this novel approach.
BACKGROUND: Endoscopic transorbital approach is a novel development of minimally invasive skull base surgery. Recently, anatomical studies have started to discuss the expanded utilization of endoscopic transorbital route for intracranial intradural lesions. The goal of this cadaveric study is to assess the feasibility of endoscopic transorbital transtentorial approach for exposure of middle incisural space. METHODS: Anatomical dissections were performed in four human cadaveric heads (8 sides) using 0- and 30-degree endoscopes. A stepwise description of endoscopic transorbital transtentorial approach to middle incisural space and related anatomy was provided. RESULTS: Orbital manipulation following superior eyelid crease incision with lateral canthotomy and cantholysis established space for bone drilling. Extradural stage consisted of extensive drilling of orbital roof of frontal bone, lessor, and greater wings of sphenoid bone. Intradural stage was composed of dissection of sphenoidal compartment of Sylvian fissure, lateral mobilization of mesial temporal lobe, and penetration of tentorium. A cross-shaped incision of tentorium provided direct visualization of crural cistern with anterolateral aspect of cerebral peduncle and upper pons. Interpeduncular cistern, prepontine cistern, and anterior portions of ambient and cerebellopontine cisterns were exposed by 30-degree endoscope. CONCLUSION: The endoscopic transorbital transtentorial approach can be used as a minimally invasive surgery for exposure of middle incisural space. Extensive drilling of sphenoid wing and lateral mobilization of mesial temporal lobe are the main determinants of successful dissection. Further studies are needed to confirm the clinical feasibility of this novel approach.
Authors: Alperen Vural; Andrea Luigi Camillo Carobbio; Marco Ferrari; Vittorio Rampinelli; Alberto Schreiber; Davide Mattavelli; Francesco Doglietto; Barbara Buffoli; Luigi Fabrizio Rodella; Stefano Taboni; Michele Tomasoni; Tommaso Gualtieri; Alberto Deganello; Lena Hirtler; Piero Nicolai Journal: Neurosurg Rev Date: 2021-01-22 Impact factor: 3.042