Division of Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy.
Division of Neurosurgery, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy.
Oper Neurosurg (Hagerstown). 2022 Oct 1;23(4):e256-e266. doi: 10.1227/ons.0000000000000312. Epub 2022 Jul 6.
Several microsurgical transcranial approaches (MTAs) and endoscopic transnasal approaches (EEAs) to the anterior cranial fossa (ACF) have been described.
To provide a preclinical, quantitative, anatomic, comparative analysis of surgical approaches to the ACF.
Five alcohol-fixed specimens underwent high-resolution computed tomography. The following approaches were performed on each specimen: EEAs (transcribriform, transtuberculum, and transplanum), anterior MTAs (transfrontal sinus interhemispheric, frontobasal interhemispheric, and subfrontal with unilateral and bilateral frontal craniotomy), and anterolateral MTAs (supraorbital, minipterional, pterional, and frontotemporal orbitozygomatic approach). An optic neuronavigation system and dedicated software (ApproachViewer, part of GTx-Eyes II-UHN) were used to quantify the working volume of each approach and extrapolate the exposure of different ACF regions. Mixed linear models with random intercepts were used for statistical analyses.
EEAs offer a large and direct route to the midline region of ACF, whose most anterior structures (ie, crista galli, cribriform plate, and ethmoidal roof) are also well exposed by anterior MTAs, whereas deeper ones (ie, planum sphenoidale and tuberculum sellae) are also well exposed by anterolateral MTAs. The orbital roof region is exposed by both anterolateral and lateral MTAs. The posterolateral region (ie, sphenoid wing and optic canal) is well exposed by anterolateral MTAs.
Anterior and anterolateral MTAs play a pivotal role in the exposure of most anterior and posterolateral ACF regions, respectively, whereas midline regions are well exposed by EEAs. Furthermore, certain anterolateral approaches may be most useful when involvement of the optic canal and nerves involvement are suspected.
已经描述了几种经颅微创手术入路（MTAs）和经鼻内镜入路（EEAs）到前颅窝（ACF）。
提供一种针对 ACF 的手术入路的临床前、定量、解剖、比较分析。
对 5 个酒精固定标本进行高分辨率计算机断层扫描。在每个标本上进行了以下入路：EEAs（筛骨、鞍结节和鞍上）、前 MTAs（额窦间脑半球、额基底间脑半球和额下单侧和双侧额骨开颅术）和前外侧 MTAs（眶上、迷你翼点、翼点和额眶颧入路）。视神经导航系统和专用软件（ApproachViewer，GTx-Eyes II-UHN 的一部分）用于量化每种入路的工作容积，并推断出不同 ACF 区域的暴露情况。使用带有随机截距的混合线性模型进行统计分析。
EEAs 提供了一个通往 ACF 中线区域的大而直接的途径，其最前部结构（即鸡冠、筛板和筛骨顶）也可以通过前 MTAs 很好地暴露，而深部结构（即蝶骨体和鞍结节）也可以通过前外侧 MTAs 很好地暴露。眶顶区域可通过前外侧和外侧 MTAs 暴露。后外侧区域（即蝶骨翼和视神经管）可通过前外侧 MTAs 很好地暴露。
前 MTAs 和前外侧 MTAs 分别在前 ACF 区域和后外侧 ACF 区域的暴露中起着关键作用，而中线区域则由 EEAs 很好地暴露。此外，当怀疑涉及视神经管和神经时，某些前外侧入路可能最有用。
