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J Neurol Surg B Skull Base
DOI: 10.1055/s-0044-1787148
Original Article

The Eyelid Trans-orbital Trans-cavernous Approach to the Basilar Apex: A Cadaveric Proof-of-Concept Study

Xiaochun Zhao
1   Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States
,
Jeremy Tan
2   Department of Ophthalmic Plastic and Reconstructive Surgery, Dean McGee Eye Institute, University of Oklahoma, Oklahoma City, Oklahoma, United States
,
Mohamed A. Labib
3   Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, Maryland, United States
,
Rupen Desai 
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
,
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
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Abstract

Objective The pretemporal transcavernous approach is an elegant technique that provides exposure to the basilar apex, which is conventionally completed with a frontotemporal incision. This can also be performed via a minimally invasive eyelid transorbital approach, which has unique attributes. This is a proof-of-concept cadaveric study to demonstrate details of the combination of these two approaches.

Design This study is a proof-of-concept study using cadaveric heads.

Setting This study is a proof-of-concept study in a cadaveric laboratory.

Participants A latex-injected cadaveric head.

Main Outcome Measures Detailed dissection was performed and demonstrated in a step-by-step fashion.

Results The eyelid transorbital approach provides the exact exposure required to complete the pretemporal osteotomy including an anterior clinoidectomy and dissection, so that a transcavernous approach can be completed. The basilar apex and its branches can also be accessed via the eyelid transorbital approach, with comparable exposure to the traditional approach; however, the access trajectory is much narrower. It takes advantages of the inferior corridor with a more medial access angle and provides a complementary perspective to the cavernous sinus contents and basilar apex complex.

Conclusion The combination of an eyelid transorbital and pretemporal transcavernous approaches can achieve a deep exposure via a minimally invasive incision, which may add an additional approach to the cavernous sinus and basilar apex regions.

Keywords

transorbital approach - pretemporal approach - transcavernous approach - basilar apex

Previous Presentation

This study has been presented as a podium presentation in the 33rd NASBS meeting in Atlanta, Georgia, United States on February 17, 2024.




Publication History

Received: 25 February 2024

Accepted: 29 April 2024

Article published online:
24 May 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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