Department of Neurosurgery, University of Florida, College of Medicine, Gainesville, Florida, USA; Department of Neurosurgery, El Cruce Hospital, Florencio Varela, Buenos Aires, Argentina.
Cerebrovascular and Skull Base Department, Institute of Neurosurgery, Asenjo, Providencia, Santiago, Chile; Department of Neurological Sciences, University of Chile, Santiago, Chile.
World Neurosurg. 2019 Sep;129:e502-e513. doi: 10.1016/j.wneu.2019.05.196. Epub 2019 May 29.
Several diseases that involve the optic canal or its contained structures may cause visual impairment. Several techniques have been developed to decompress the optic nerve.
To describe minimally invasive extradural anterior clinoidectomy (MiniEx) for optic nerve decompression, detail its surgical anatomy, present clinical cases, and established a proof of concept.
Anatomic dissections were performed in cadaver heads to show the surgical anatomy and to show stepwise the MiniEx approach. In addition, these surgical concepts were applied to decompress the optic nerve in 6 clinical cases.
The MiniEx approach allowed the extradural anterior clinoidectomy and a nearly 270° optic nerve decompression using the no-drill technique. In the MiniEx approach, the skin incision, dissection of the temporal muscle, and craniotomy were smaller and provided the same extent of exposure of the optic nerve, anterior clinoid process, and superior orbital fissure as that usually provided by standard techniques. All patients who underwent operation with this technique had improved visual status.
The MiniEx approach is an excellent alternative to traditional approaches for extradural anterior clinoidectomy and optic nerve decompression. It may be used as a part of more complex surgery or as a single surgical procedure.
一些涉及视神经管或其包含结构的疾病可能导致视力障碍。已经开发了几种技术来对视神经进行减压。
描述用于视神经减压的微创经颅前床突切除术（MiniEx），详细介绍其手术解剖结构，展示临床病例，并提出概念验证。
对头骨进行解剖学解剖，以展示手术解剖结构，并逐步展示 MiniEx 入路。此外，这些手术概念被应用于 6 例临床病例以进行视神经减压。
MiniEx 入路允许进行经颅前床突的硬膜外切除术，并使用无钻技术进行近 270°的视神经减压。在 MiniEx 入路中，皮肤切口、颞肌解剖和开颅术更小，提供了与标准技术相同的视神经、前床突和眶上裂暴露范围。接受该技术手术的所有患者的视力状况都有所改善。
MiniEx 入路是经颅前床突切除术和视神经减压的传统入路的极佳替代方法。它可以用作更复杂手术的一部分，也可以作为单一手术程序。
