Division of Neurosurgery, Department of Neuroscience, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli "Federico II", Naples, Italy.
Department of Neurological Surgery, Hospital Clínic de Barcelona, Barcelona, Spain.
Oper Neurosurg (Hagerstown). 2022 Oct 1;23(4):e267-e275. doi: 10.1227/ons.0000000000000308. Epub 2022 Jul 6.
The endoscopic superior eyelid transorbital route to the skull base is gaining progressive popularity in the neurosurgical community.
To evaluate the anatomy of the middle cranial fossa from this novel ventral perspective to reach the skull base through the transorbital route and to show limits for possible safe middle fossa drilling from the transorbital route.
Anatomic study was performed; 5 cadaveric specimens (ie, 10 sides) and 2 dry skulls (ie, 4 sides) were dissected.
To obtain a functional result, there are boundaries that correspond to neurovascular structures that traverse, enter, or leave the middle fossa that must be respected: inferiorly, the lateral pterygoid muscle; medially, the Gasserian ganglion and the lateral border of the foramen rotundum; laterally, the foramen spinosum with the middle meningeal artery; superiorly, the lesser sphenoid wing; posteriorly, the anterior border of the foramen ovale. Average bone resected was 6.49 ± 0.80 cm3 which is the 63% of total middle fossa floor. The mean axial surgical length calculated was 3.85 cm (3.18-5.19 cm) while the mean sagittal surgical length was 5.23 cm (4.87-6.55 cm). The mean horizontal angle of approach was 38.14° (32.87°-45.63°), while the mean vertical angle of approach was 18.56° (10.81°-26.76°).
Detailed anatomy of the middle cranial fossa is presented, and herewith we demonstrated that from the endoscopic superior eyelid transorbital approach removal of middle cranial fossa floor is possible when anatomic landmarks are respected.
经眼眶颅底内窥镜上眼睑入路在神经外科领域日益普及。
从这个新的腹侧视角评估中颅窝的解剖结构，通过经眶入路到达颅底，并展示经眶入路从中颅窝进行可能安全的颅底钻孔的限度。
进行解剖学研究；解剖了 5 具尸体标本（即 10 侧）和 2 具干颅骨（即 4 侧）。
为了获得功能结果，必须尊重穿过、进入或离开中颅窝的神经血管结构的界限：下方为翼外肌；内侧为三叉神经节和圆孔外侧缘；外侧为棘孔和脑膜中动脉；上方为小翼；后方为卵圆孔前缘。平均切除骨量为 6.49±0.80cm³，占中颅窝底的 63%。计算的平均轴向手术长度为 3.85cm（3.18-5.19cm），而平均矢状手术长度为 5.23cm（4.87-6.55cm）。平均入路水平角为 38.14°（32.87°-45.63°），而平均入路垂直角为 18.56°（10.81°-26.76°）。
详细介绍了中颅窝的解剖结构，在此我们证明，当遵循解剖学标志时，经眼眶颅底内窥镜上眼睑入路可以去除中颅窝底。
