Anatomical Step-by-Step Dissection of Complex Skull Base Approaches for Trainees: Endoscopic Endonasal Approach to the Orbit

Laura Salgado-Lopez; Luciano C. P. C. Leonel; Michael O'brien; Adedamola Adepoju; Christopher S. Graffeo; Lucas P. Carlstrom; Michael J. Link; Carlos D. Pinheiro-Neto; Maria Peris-Celda

doi:10.1055/a-1723-1675

Journal of Neurological Surgery Part B: Skull Base, Table of Contents

J Neurol Surg B Skull Base 2023; 84(01): 079-088
DOI: 10.1055/a-1723-1675

Original Article

Anatomical Step-by-Step Dissection of Complex Skull Base Approaches for Trainees: Endoscopic Endonasal Approach to the Orbit

Authors

Laura Salgado-Lopez

¹Department of Neurosurgery, Albany Medical Center, Albany, New York, United States

²Department of Neuroscience and Experimental Therapeutics, Northeast Skull Base Dissection Laboratory, Albany Medical Center, Albany, New York, United States
Luciano C. P. C. Leonel

¹Department of Neurosurgery, Albany Medical Center, Albany, New York, United States

²Department of Neuroscience and Experimental Therapeutics, Northeast Skull Base Dissection Laboratory, Albany Medical Center, Albany, New York, United States

³Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, United States

⁴Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, Minnesota, United States
Michael O'brien

¹Department of Neurosurgery, Albany Medical Center, Albany, New York, United States

²Department of Neuroscience and Experimental Therapeutics, Northeast Skull Base Dissection Laboratory, Albany Medical Center, Albany, New York, United States
Adedamola Adepoju

¹Department of Neurosurgery, Albany Medical Center, Albany, New York, United States
Christopher S. Graffeo

³Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, United States
Lucas P. Carlstrom

³Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, United States
Michael J. Link

³Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, United States

⁴Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, Minnesota, United States

⁵Department of Otolaryngology, Mayo Clinic, Rochester, Minnesota, United States
Carlos D. Pinheiro-Neto

³Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, United States

⁴Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, Minnesota, United States

⁵Department of Otolaryngology, Mayo Clinic, Rochester, Minnesota, United States
Maria Peris-Celda

¹Department of Neurosurgery, Albany Medical Center, Albany, New York, United States

²Department of Neuroscience and Experimental Therapeutics, Northeast Skull Base Dissection Laboratory, Albany Medical Center, Albany, New York, United States

³Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, United States

⁴Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, Minnesota, United States

⁵Department of Otolaryngology, Mayo Clinic, Rochester, Minnesota, United States

Abstract

Introduction Although endonasal endoscopic approaches (EEA) to the orbit have been previously reported, a didactic resource for educating neurosurgery and otolaryngology trainees regarding the pertinent anatomy, techniques, and decision-making pearls is lacking.

Methods Six sides of three formalin-fixed, color latex–injected cadaveric specimens were dissected using 4-mm 0- and 30-degree rigid endoscopes, as well as standard endoscopic equipment, and a high-speed surgical drill. The anatomical dissection was documented in stepwise three-dimensional (3D) endoscopic images. Following dissection, representative case applications were reviewed.

Results EEA to the orbit provides excellent access to the medial and inferior orbital regions. Key steps include positioning and preoperative considerations, middle turbinate medialization, uncinate process and ethmoid bulla removal, complete ethmoidectomy, sphenoidotomy, maxillary antrostomy, lamina papyracea resection, orbital apex and optic canal decompression, orbital floor resection, periorbita opening, dissection of the extraconal fat, and final exposure of the orbit contents via the medial-inferior recti corridor.

Conclusion EEA to the orbit is challenging, in particular for trainees unfamiliar with nasal and paranasal sinus anatomy. Operatively oriented neuroanatomy dissections are crucial didactic resources in preparation for practical endonasal applications in the operating room (OR). This approach provides optimal exposure to the inferior and medial orbit to treat a wide variety of pathologies. We describe a comprehensive step-by-step curriculum directed to any audience willing to master this endoscopic skull base approach.

Keywords

antrostomy - education - lamina papyracea - medial maxillectomy - orbital floor - transethmoidal sphenoidotomy - uncinectomy

Full Text

References

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