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经眶和眶上单孔多通道入路至眼眶、前颅窝、中颅窝和后颅窝:解剖学研究

Transorbital and supraorbital uniportal multicorridor approach to the orbit, anterior, middle and posterior cranial fossa: Anatomic study.

作者信息

Zoia Cesare, Mastantuoni Ciro, Solari Domenico, de Notaris Matteo, Corrivetti Francesco, Spena Giannantonio, Cavallo Luigi Maria

机构信息

UOC Neurochirurgia, Ospedale Moriggia Pelascini, Gravedona, Italy.

Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Universita Degli Studi di Napoli Federico II, Naples, Italy.

出版信息

Brain Spine. 2023 Dec 5;4:102719. doi: 10.1016/j.bas.2023.102719. eCollection 2024.


DOI:10.1016/j.bas.2023.102719
PMID:38163002
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10753433/
Abstract

INTRODUCTION: The transorbital route has been proposed for addressing orbital and paramedian skull base lesions. It can be complemented by further marginotomies, as per "extended-transorbital approach" and combined with others ventro-basal approaches featuring the concept of "multiportal surgery". Nevertheless, it cannot address some anatomical regions like the clinoid, carotid bifurcation and the Sylvian fissure. Therefore, we propose a combined transorbital and a supraorbital approach, attainable by a single infra-brow incision, and we called it "Uniportal multicorridor" approach. RESEARCH QUESTION: The aim of our study is to verify its feasibility and deep anatomical targets through a cadaveric study. MATERIALS AND METHODS: Anatomic dissections were performed at the Laboratory of ICLO Teaching and Research Center (Verona, Italy) on four formalin-fixed cadaveric heads injected with colored neoprene latex (8 sides). A stepwise dissection of the supraorbital and transorbital approaches (with an infra-brow skin incision) to the anterior tentorial incisura, clinoid area, lateral wall of the cavernous sinus, middle temporal fossa, posterior fossa, and Sylvian fissure is described. RESULTS: We analyzed the anatomic areas reached by the transorbital corridor dividing them as follow: lateral wall of the cavernous sinus, middle temporal fossa, posterior fossa, and Sylvian fissure; while the anatomic areas addressed by the supraorbital craniotomy were the clinoid area and the anterior tentorial incisura. CONCLUSIONS: The described uniportal multi-corridor approach combines a transorbital corridor and a supraorbital craniotomy, providing a unique intra and extradural control over the anterior, middle, and posterior fossa, tentorial incisura and the Sylvian fissure, via an infra-brow skin incision.

摘要

引言:经眶入路已被提出用于处理眼眶及眶旁颅底病变。根据“扩大经眶入路”,可通过进一步的边缘切开术对其进行补充,并与其他以“多通道手术”概念为特色的腹侧基底入路相结合。然而,它无法处理一些解剖区域,如床突、颈动脉分叉和外侧裂。因此,我们提出了一种经眶和眶上联合入路,可通过单一的眉下切口实现,我们将其称为“单通道多走廊”入路。 研究问题:我们研究的目的是通过尸体研究验证其可行性和深部解剖靶点。 材料与方法:在意大利维罗纳ICLO教学与研究中心实验室,对4个注射了彩色氯丁橡胶乳胶的福尔马林固定尸体头部(8侧)进行解剖。描述了经眶上和经眶入路(采用眉下皮肤切口)至小脑幕切迹前部、床突区、海绵窦外侧壁、颞中窝、后颅窝和外侧裂的逐步解剖过程。 结果:我们分析了经眶通道所到达的解剖区域,并将其分为以下几类:海绵窦外侧壁、颞中窝、后颅窝和外侧裂;而眶上开颅术所处理的解剖区域为床突区和小脑幕切迹前部。 结论:所描述的单通道多走廊入路结合了经眶通道和眶上开颅术,通过眉下皮肤切口,可对前颅窝、中颅窝和后颅窝、小脑幕切迹及外侧裂提供独特的硬膜内和硬膜外控制。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/741a/10753433/c511179b6984/gr11.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/741a/10753433/0521bdd760da/gr1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/741a/10753433/24f6584a56b2/gr2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/741a/10753433/17b514f28ee3/gr3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/741a/10753433/3bdea800af0c/gr4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/741a/10753433/c3edac99939c/gr5.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/741a/10753433/9f293754357e/gr6.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/741a/10753433/c6de1b21c81e/gr7.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/741a/10753433/ce2d49cc8cc4/gr8.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/741a/10753433/49d8e99843db/gr9.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/741a/10753433/4edd81cb7a9d/gr10.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/741a/10753433/c511179b6984/gr11.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/741a/10753433/0521bdd760da/gr1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/741a/10753433/24f6584a56b2/gr2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/741a/10753433/17b514f28ee3/gr3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/741a/10753433/3bdea800af0c/gr4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/741a/10753433/c3edac99939c/gr5.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/741a/10753433/9f293754357e/gr6.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/741a/10753433/c6de1b21c81e/gr7.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/741a/10753433/ce2d49cc8cc4/gr8.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/741a/10753433/49d8e99843db/gr9.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/741a/10753433/4edd81cb7a9d/gr10.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/741a/10753433/c511179b6984/gr11.jpg

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本文引用的文献

[1]
Endoscopic Transorbital Approach for the Management of Spheno-Orbital Meningiomas: Literature Review and Preliminary Experience.

World Neurosurg. 2023-8

[2]
Endoscopic transorbital approach for skull base lesions: a report of 16 clinical cases.

Neurosurg Rev. 2023-3-22

[3]
Functional and clinical outcomes after superior eyelid transorbital endoscopic approach for spheno-orbital meningiomas: illustrative case and literature review.

Neurosurg Rev. 2022-12-14

[4]
Superior eyelid endoscopic transorbital approach to the tentorial area: A qualitative and quantitative anatomic study.

Front Surg. 2022-10-21

[5]
Eyebrow incision with a crescent-shaped orbital rim craniotomy for microscopic and endoscopic transorbital approach to the anterior and middle cranial fossa: A cadaveric study and case presentation.

Brain Spine. 2022-4-28

[6]
Endoscopic transorbital approach to the cavernous sinus: Cadaveric anatomy study and clinical application (SevEN-009).

Front Oncol. 2022-8-26

[7]
A Frontal Route to Middle and Posterior Cranial Fossa: Quantitative Study for the Lateral Transorbital Endoscopic Approach and Comparison with the Subtemporal Approach.

World Neurosurg. 2022-11

[8]
Midline Skull Base Meningiomas: Transcranial and Endonasal Perspectives.

Cancers (Basel). 2022-6-10

[9]
Anatomical Triangles for Use in Skull Base Surgery: A Comprehensive Review.

World Neurosurg. 2022-8

[10]
"Sagittal Crest": Definition, Stepwise Dissection, and Clinical Implications From a Transorbital Perspective.

Oper Neurosurg (Hagerstown). 2022-5-1

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