López Cristina Barrena, Di Somma Alberto, Cepeda Santiago, Arrese Ignacio, Sarabia Rosario, Agustín Javier Herrero, Topczewski Thomaz E, Enseñat Joaquim, Prats-Galino Alberto
Department of Neurosurgery, University Hospital Complex of Albacete, Albacete, Spain.
Department of Neurosurgery, Hospital Clinic, Barcelona, Spain.
Acta Neurochir (Wien). 2021 Aug;163(8):2177-2188. doi: 10.1007/s00701-021-04896-y. Epub 2021 Jun 10.
The endoscopic transorbital approach (eTOA) is a new mini-invasive procedure used to explore different areas of the skull base. Authors propose an extradural anterior clinoidectomy (AC) through this corridor, defining the anatomical landmarks of the anterior clinoid process (ACP) projection onto the posterior orbit wall and the technical feasibility of this approach. We describe the exposure of the opticocarotid region and the surgical freedom and the angles of attack obtained with this novel approach.
Five cadaver heads underwent an eTOA at the Laboratory of Surgical Neuroanatomy of the University of Barcelona. A step-by-step description of the extradural endoscopic transorbital clinoidectomy was provided. A volumetric analysis of the morphometrics characteristics of the sphenoid wings was evaluated before and after dissection using CT scans. Pterional approach was performed to ascertain ACP removal.
In all the specimens, it was possible to resect the ACP endo-orbitally aiming an optimal optic canal (OC) unroofing. The surface of the triangle corresponding to the ACP projection onto the posterior orbit wall was 0.42 ± 0.20 cm. The drilled area to perform the extradural clinoidectomy via eTOA was 3.11 ± 2.27 cm, and the volume of bone removal corresponding to the greater sphenoid wing (GSW) and lesser sphenoid wing (LSW) was 2.55 ± 1.41 and 0.26 ± 0.18 cm respectively. The area of surgical freedom provided by the eTOA was (3.11 ± 2.27cm), and the angles of attack were 21.39 ± 9.13° in the horizontal axel and 30.63 ± 18.51° in the vertical.
The described extradural anterior clinoidectomy by eTOA uses specific landmarks to localize the ACP on the posterior orbit wall. Resection of the ACP is a technically feasible approach, achieving the main goals of any clinoidectomy.
内镜经眶入路（eTOA）是一种用于探查颅底不同区域的新型微创手术。作者提出通过该通道进行硬膜外前床突切除术（AC），明确前床突（ACP）在眶后壁的投影的解剖标志以及该入路的技术可行性。我们描述了通过这种新入路获得的视交叉颈动脉区暴露、手术自由度和攻击角度。
在巴塞罗那大学外科神经解剖实验室对5个尸体头部进行了eTOA手术。提供了硬膜外内镜经眶床突切除术的分步描述。使用CT扫描在解剖前后评估蝶骨翼形态学特征的体积分析。采用翼点入路确定ACP切除情况。
在所有标本中，通过眶内切除ACP以实现最佳的视神经管（OC）去顶是可行的。与ACP在眶后壁投影相对应的三角形表面面积为0.42±0.20平方厘米。通过eTOA进行硬膜外床突切除术的钻孔面积为3.11±2.27平方厘米，对应于大翼（GSW）和小翼（LSW）的骨切除体积分别为2.55±1.41和0.26±0.18立方厘米。eTOA提供的手术自由度面积为（3.11±2.27平方厘米），水平轴上的攻击角度为21.39±9.13°，垂直轴上为30.63±18.51°。
所描述的通过eTOA进行的硬膜外前床突切除术使用特定标志来定位眶后壁上的ACP。ACP切除是一种技术上可行的方法，实现了任何床突切除术的主要目标。
