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J Neurol Surg B Skull Base 2019; 80(03): 295-305
DOI: 10.1055/s-0038-1669937
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Pure Endoscopic Lateral Orbitotomy Approach to the Cavernous Sinus, Posterior, and Infratemporal Fossae: Anatomic Study

Lili Laleva
1   Department of Neurosurgery, Acibadem City Clinic Tokuda Hospital, Sofia, Bulgaria
,
Toma Spiriev
1   Department of Neurosurgery, Acibadem City Clinic Tokuda Hospital, Sofia, Bulgaria
,
Iacopo Dallan
2   First Otorhinolaryngologic Unit, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
,
Alberto Prats-Galino
3   Laboratory of Surgical Neuroanatomy (LSNA), Faculty of Medicine, Universitat de Barcelona, Barcelona, Spain
,
Giuseppe Catapano
4   Department of Neuroscience, Neurosurgery Operative Unit “G. Rummo” Hospital, Benevento, Italy
,
Vladimir Nakov
1   Department of Neurosurgery, Acibadem City Clinic Tokuda Hospital, Sofia, Bulgaria
,
Matteo de Notaris
4   Department of Neuroscience, Neurosurgery Operative Unit “G. Rummo” Hospital, Benevento, Italy
› Author Affiliations Funding None.
Further Information

Publication History

09 July 2018

01 August 2018

Publication Date:
06 September 2018 (online)

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Abstract

Objective The aim of this anatomic study is to describe a fully endoscopic lateral orbitotomy extradural approach to the cavernous sinus, posterior, and infratemporal fossae.

Material and Methods Three prefixed latex-injected head specimens (six orbital exposures) were used in the study. Before and after dissection, a computed tomography scan was performed on each cadaver head and a neuronavigation system was used to guide the approach. The extent of bone removal and the area of exposure of the targeted corridor were evaluated with the aid of OsiriX software (Pixmeo, Bernex, Switzerland).

Results The lateral orbital approach offers four main endoscopic extradural routes: the anteromedial, posteromedial, posterior, and inferior. The anteromedial route allows a direct route to the optic canal by removal of the anterior clinoid process, whereas the posteromedial route allows for exposure of the lateral wall of the cavernous sinus. The posterior route is targeted to Meckel's cave and provides access to the posterior cranial fossa by exposure and drilling of the petrous apex, whereas the inferior route gives access to the pterygopalatine and infratemporal fossae by drilling the floor of the middle cranial fossa and the bone between the second and third branches of the trigeminal nerve.

Conclusion The lateral orbitotomy endoscopic approach provides direct access to the cavernous sinus, posterior, and infratemporal fossae. Advantages of the approach include a favorable angle of attack, minimal brain retraction, and the possibility of dissection within the two dural layers of the cavernous sinus without entering its neurovascular compartment.

Keywords

lateral orbital approach - endoscopic surgery - skull base surgery - anatomy
 

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