The Loyal and Edith Davis Neurosurgical Research Laboratory, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
Department of Neurosurgery, Cork University Hospital, Wilton, Cork, Ireland.
Oper Neurosurg (Hagerstown). 2022 Feb 1;22(2):66-74. doi: 10.1227/ONS.0000000000000044.
Both the pterional and supraorbital approaches have been proposed as optimal access corridors to deep and paramedian anatomy.
To assess key intracranial structures accessed through the surgical approaches using the angle of attack (AOA) and the volume of surgical freedom (VSF) methodologies.
Ten pterional and 10 supraorbital craniotomies were completed. Data points were measured using a neuronavigation system. A comparative analysis of the craniocaudal AOA, mediolateral AOA, and VSF of the ipsilateral paraclinoid internal carotid artery (ICA), terminal ICA, and anterior communicating artery (ACoA) complex was completed.
For the paraclinoid ICA, the pterional approach produced larger craniocaudal AOA, mediolateral AOA, and VSF than the supraorbital approach (28.06° vs 10.52°, 33.76° vs 23.95°, and 68.73 vs 22.59 mm3 normalized unit [NU], respectively; P < .001). The terminal ICA showed similar superiority of the pterional approach in all quantitative parameters (27.43° vs 11.65°, 30.62° vs 25.31°, and 57.41 vs 17.36 mm3 NU; P < .05). For the ACoA, there were statistically significant differences between the results obtained using the pterional and supraorbital approaches (18.45° vs 10.11°, 29.68° vs 21.01°, and 26.81 vs 16.53 mm3 NU; P < .005).
The pterional craniotomy was significantly superior in all instrument maneuverability parameters for approaching the ipsilateral paraclinoid ICA, terminal ICA, and ACoA. This global evaluation of 2-dimensional and 3-dimensional surgical freedom and instrument maneuverability by amalgamating the craniocaudal AOA, mediolateral AOA, and VSF produces a comprehensive assessment while generating spatially and anatomically accurate corridor models that provide improved visual depiction for preoperative planning and surgical decision-making.
翼点入路和眶上锁孔入路都被认为是到达深部和旁正中区域解剖结构的最佳通道。
使用攻角（AOA）和手术自由度（VSF）方法评估通过手术入路到达的关键颅内结构。
完成 10 例翼点入路和 10 例眶上锁孔入路。使用神经导航系统测量数据点。对同侧颈内动脉海绵窦段（ICA）、终段 ICA 和前交通动脉复合体（ACoA）的颅尾向 AOA、内外侧 AOA 和同侧 VSF 进行了比较分析。
对于颈内动脉海绵窦段，翼点入路产生的颅尾向 AOA、内外侧 AOA 和 VSF 均大于眶上锁孔入路（28.06°比 10.52°、33.76°比 23.95°和 68.73 比 22.59 mm3 归一化单位[NU]；P <.001）。终段 ICA 在所有定量参数上也显示出翼点入路的相似优势（27.43°比 11.65°、30.62°比 25.31°和 57.41 比 17.36 mm3 NU；P <.05）。对于 ACoA，翼点入路和眶上锁孔入路的结果存在统计学差异（18.45°比 10.11°、29.68°比 21.01°和 26.81 比 16.53 mm3 NU；P <.005）。
翼点开颅术在所有器械可操作性参数方面均显著优于同侧颈内动脉海绵窦段、终段 ICA 和 ACoA 的手术入路。通过整合颅尾向 AOA、内外侧 AOA 和 VSF 对 2 维和 3 维手术自由度和器械可操作性进行全面评估，生成空间和解剖上准确的通道模型，为术前规划和手术决策提供了更好的视觉描述。
