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J Neurol Surg B Skull Base 2024; 85(06): 587-595
DOI: 10.1055/a-2175-8105
Original Article

Anatomical Step-by-Step Dissection of Complex Skull Base Approaches for Trainees: Lateral Supraorbital Approach with Expanded Indications

Xiaochun Zhao
1   Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States
,
Kiana Y. Prather 
1   Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States
,
Andrew M. Bauer
1   Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States
,
Ian F. Dunn
1   Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States
,
Christopher S. Graffeo 
1   Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States
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Abstract

Objectives The lateral supraorbital (LSO) approach is a less-invasive alternative to the pterional craniotomy that provides rapid transsylvian access. Establishing familiarity with the LSO technique and its features as compared with other anterolateral approaches is an important component of advanced skull base training. We present a step-by-step demonstration of the LSO approach using cadaveric dissection in a manner that is digestible for trainees at various levels.

Design This is anatomic step-by-step dissection and representative case series.

Setting This study was carried out in the cadaveric dissection laboratory.

Participants A formalin-fixed, latex-injected cadaveric head specimen was dissected under microscopic magnification by a neurosurgery resident under faculty supervision. Following dissection, representative case applications were reviewed.

Main Outcome Measures Dissection and case illustration were the main outcome measures.

Results A single-layer myocutaneous flap is developed, and a single-burr-hole technique is used, followed by extensive drilling of the sphenoid wing. The dura is opened in a C-shaped fashion centered on the Sylvian fissure, exposing the inferior frontal and superior temporal lobes. Labeled photographs of dissections with pertinent anatomical structures are presented. Three case examples illustrating the versatility of the LSO approach, including the resection of a large pituitary adenoma, an inferior frontal melanoma metastasis presenting to the Sylvian surface, and a frontoinsular low-grade glioma, are reviewed.

Conclusion As compared with the pterional craniotomy, the LSO approach involves a shorter incision, smaller craniotomy, and faster exposure; it can be conveniently tailored to various indications. Understanding the step-by-step dissection and indications of the LSO approach is of paramount importance to neurosurgery trainees.

Keywords

awake craniotomy - cadaver - complex - craniotomy - lateral supraorbital - low-grade glioma - pituitary adenoma - skull base - trainee


Publication History

Received: 03 July 2023

Accepted: 12 September 2023

Accepted Manuscript online:
14 September 2023

Article published online:
08 November 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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