Cristina Barrena López1, Alberto Di Somma2,3,4, Santiago Cepeda5, Ignacio Arrese5, Rosario Sarabia5, Javier Herrero Agustín6, Thomaz E Topczewski7,8, Joaquim Enseñat7, Alberto Prats-Galino8. 1. Department of Neurosurgery, University Hospital Complex of Albacete, Albacete, Spain. 2. Department of Neurosurgery, Hospital Clinic, Barcelona, Spain. adisomma@clinic.cat. 3. Laboratory of Surgical Neuroanatomy, Faculty of Medicine, University of Barcelona, Barcelona, Spain. adisomma@clinic.cat. 4. Department of Neurological Surgery, Institut Clínic de Neurociències (ICN), Hospital Clínic de Barcelona, Carrer de Villaroel, 170, 08036, Barcelona, Spain. adisomma@clinic.cat. 5. Department of Neurosurgery, Hospital Universitario Río Hortega, Valladolid, Spain. 6. Department of Otolaryngology-Head and Neck Surgery, Hospital Universitario Rio Hortega, Valladolid, Spain. 7. Department of Neurosurgery, Hospital Clinic, Barcelona, Spain. 8. Laboratory of Surgical Neuroanatomy, Faculty of Medicine, University of Barcelona, Barcelona, Spain.
Abstract
BACKGROUND: The endoscopic transorbital approach (eTOA) is a new mini-invasive procedure used to explore different areas of the skull base. Authors propose an extradural anterior clinoidectomy (AC) through this corridor, defining the anatomical landmarks of the anterior clinoid process (ACP) projection onto the posterior orbit wall and the technical feasibility of this approach. We describe the exposure of the opticocarotid region and the surgical freedom and the angles of attack obtained with this novel approach. METHODS: Five cadaver heads underwent an eTOA at the Laboratory of Surgical Neuroanatomy of the University of Barcelona. A step-by-step description of the extradural endoscopic transorbital clinoidectomy was provided. A volumetric analysis of the morphometrics characteristics of the sphenoid wings was evaluated before and after dissection using CT scans. Pterional approach was performed to ascertain ACP removal. RESULTS: In all the specimens, it was possible to resect the ACP endo-orbitally aiming an optimal optic canal (OC) unroofing. The surface of the triangle corresponding to the ACP projection onto the posterior orbit wall was 0.42 ± 0.20 cm2. The drilled area to perform the extradural clinoidectomy via eTOA was 3.11 ± 2.27 cm2, and the volume of bone removal corresponding to the greater sphenoid wing (GSW) and lesser sphenoid wing (LSW) was 2.55 ± 1.41 and 0.26 ± 0.18 cm3 respectively. The area of surgical freedom provided by the eTOA was (3.11 ± 2.27cm2), and the angles of attack were 21.39 ± 9.13° in the horizontal axel and 30.63 ± 18.51° in the vertical. CONCLUSIONS: The described extradural anterior clinoidectomy by eTOA uses specific landmarks to localize the ACP on the posterior orbit wall. Resection of the ACP is a technically feasible approach, achieving the main goals of any clinoidectomy.
BACKGROUND: The endoscopic transorbital approach (eTOA) is a new mini-invasive procedure used to explore different areas of the skull base. Authors propose an extradural anterior clinoidectomy (AC) through this corridor, defining the anatomical landmarks of the anterior clinoid process (ACP) projection onto the posterior orbit wall and the technical feasibility of this approach. We describe the exposure of the opticocarotid region and the surgical freedom and the angles of attack obtained with this novel approach. METHODS: Five cadaver heads underwent an eTOA at the Laboratory of Surgical Neuroanatomy of the University of Barcelona. A step-by-step description of the extradural endoscopic transorbital clinoidectomy was provided. A volumetric analysis of the morphometrics characteristics of the sphenoid wings was evaluated before and after dissection using CT scans. Pterional approach was performed to ascertain ACP removal. RESULTS: In all the specimens, it was possible to resect the ACP endo-orbitally aiming an optimal optic canal (OC) unroofing. The surface of the triangle corresponding to the ACP projection onto the posterior orbit wall was 0.42 ± 0.20 cm2. The drilled area to perform the extradural clinoidectomy via eTOA was 3.11 ± 2.27 cm2, and the volume of bone removal corresponding to the greater sphenoid wing (GSW) and lesser sphenoid wing (LSW) was 2.55 ± 1.41 and 0.26 ± 0.18 cm3 respectively. The area of surgical freedom provided by the eTOA was (3.11 ± 2.27cm2), and the angles of attack were 21.39 ± 9.13° in the horizontal axel and 30.63 ± 18.51° in the vertical. CONCLUSIONS: The described extradural anterior clinoidectomy by eTOA uses specific landmarks to localize the ACP on the posterior orbit wall. Resection of the ACP is a technically feasible approach, achieving the main goals of any clinoidectomy.
Authors: Luigi M Cavallo; Andrea Messina; Paolo Cappabianca; Felice Esposito; Enrico de Divitiis; Paul Gardner; Manfred Tschabitscher Journal: Neurosurg Focus Date: 2005-07-15 Impact factor: 4.047
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Authors: Alberto Di Somma; Norberto Andaluz; Luigi Maria Cavallo; Matteo de Notaris; Iacopo Dallan; Domenico Solari; Lee A Zimmer; Jeffrey T Keller; Mario Zuccarello; Alberto Prats-Galino; Paolo Cappabianca Journal: J Neurosurg Date: 2018-11-01 Impact factor: 5.115
Authors: Giulia Guizzardi; Alberto Di Somma; Matteo de Notaris; Francesco Corrivetti; Juan Carlos Sánchez; Isam Alobid; Abel Ferres; Pedro Roldan; Luis Reyes; Joaquim Enseñat; Alberto Prats-Galino Journal: Front Oncol Date: 2022-09-02 Impact factor: 5.738