Roth Jonathan, Fraser Justin F, Singh Ameet, Bernardo Antonio, Anand Vijay K, Schwartz Theodore H
Department of Neurosurgery, Weill Medical College of Cornell University, New York Presbyterian Hospital, New York, NY 10021, USA.
Orbit. 2011 Jan;30(1):43-8. doi: 10.3109/01676830.2010.543004.
Extended endoscopic endonasal approaches are increasingly applied to treat a variety of orbital pathologies. We performed a cadaveric study, comparing the endonasal approach with a transcranial approach to the orbital apex, using a two-dimensional (2D) and novel three-dimensional (3D) endoscope.
Dissection was performed on two fresh cadaver heads using a novel 3D endoscope for the endonasal approach to the orbit and orbital apex. On the same heads, a fronto-orbito-zygomatic (FOZ) approach was performed to expose the orbital apex region. Anatomical boundaries and limitations of each exposure were noted. 2D and 3D images of the approaches and anatomical dissections were captured and recorded.
The endonasal endoscopic approach achieved direct exposure to the inferior and medial aspects of the orbit. The FOZ approach, on the other hand, provided excellent access to the superior and lateral aspects of the orbit. Appreciation of the spatial relationships of the intracranial skull base anatomy was significantly improved using the 3D endoscope compared with the 2D endoscope.
The endoscopic endonasal approach achieves direct exposure to the inferomedial aspect of the orbit and orbital apex, which is not exposed using the transcranial approach, hence the two approaches are complementary. 3D endoscopes augment the spatial orientation of extracranial and intracranial anatomical structures. This may improve patient's safety and hasten the learning curve for endoscopic approaches to the midline skull base.
扩大经鼻内镜入路越来越多地应用于治疗各种眼眶疾病。我们进行了一项尸体研究，使用二维（2D）和新型三维（3D）内镜，比较经鼻入路与经颅入路至眶尖的情况。
使用新型3D内镜对两个新鲜尸体头部进行解剖，采用经鼻入路至眼眶和眶尖。在相同的头部，采用额眶颧（FOZ）入路暴露眶尖区域。记录每种暴露的解剖边界和局限性。采集并记录入路和解剖分离的2D和3D图像。
经鼻内镜入路可直接暴露眼眶的下内侧部分。另一方面，FOZ入路能很好地暴露眼眶的上外侧部分。与2D内镜相比，使用三维内镜对颅内颅底解剖结构的空间关系的认识有显著提高。
经鼻内镜入路可直接暴露眼眶和眶尖内侧下部，这是经颅入路无法暴露的，因此两种入路具有互补性。3D内镜增强了颅外和颅内解剖结构的空间定位。这可能提高患者的安全性，并加快中线颅底内镜入路的学习曲线。
