1Department of Neuroscience and Reproductive and Odontostomatological Sciences, Division of Neurosurgery, Università degli Studi di Napoli "Federico II," Naples, Italy.
2Department of Neuroscience and Reproductive and Odontostomatological Sciences, PhD Program in Neuroscience, Università degli Studi di Napoli "Federico II," Naples, Italy.
Neurosurg Focus. 2024 Apr;56(4):E7. doi: 10.3171/2024.1.FOCUS23838.
The superior eyelid endoscopic transorbital approach (SETOA) provides a direct and short minimally invasive route to the anterior and middle skull base. Nevertheless, it uses a narrow corridor that limits its angles of attack. The aim of this study was to evaluate the feasibility and potential benefits of an "extended" conservative variant of the "standard" endoscopic transorbital approach-termed "open-door"-to enhance the exposure of lesions affecting the paramedian aspect of the anterior and middle cranial fossae.
First, the authors described the technical nuances of the open-door extended transorbital approach (ODETA). Next, they documented its morphometric advantages over standard SETOA. Finally, they provided a clinical-anatomical application to demonstrate enhanced exposure and better angles of attack to treat lesions occupying the paramedian anterior and middle cranial fossae. Five adult cadaveric specimens (10 sides) initially underwent standard SETOA and then extended open-door SETOA (ODETA to the paramedian anterior and middle fossae). The adjunct of hinge-orbitotomy, through three surgical steps and straddling the frontozygomatic suture, converted conventional SETOA to its extended open-door variant. CT scans were performed before dissection and uploaded to the neuronavigation system for quantitative analysis. The angles of attack on the axial plane that addressed four key landmarks, namely the tip of the anterior clinoid process (ACP), foramen rotundum (FR), foramen ovale (FO), and trigeminal impression (TI), were calculated for both operative techniques and compared.
Hinge-orbitotomy of the extended open-door SETOA resulted in several surgical, functional, and esthetic advantages: it provided wider axial angles of attack for each of the target points, with a gain angle of 26.68° ± 1.31° for addressing the ACP (p < 0.001), 29.50° ± 2.46° for addressing the FR (p < 0.001), 19.86° ± 1.98° for addressing the FO (p < 0.001), and 17.44° ± 2.21° for addressing the lateral aspect of the TI (p < 0.001), while hiding the skin scar, avoiding temporalis muscle dissection, preserving flap vascularization, and decreasing the rate of bone infection and degree of orbital content retraction.
The extended open-door technique may be specifically suited for selected patients affected by paramedian anterior and middle fossae lesions, with prevalent anteromedial extension toward the anterior clinoid, the foremost compartment of the cavernous sinus and FR and not completely controlled with the pure endoscopic transorbital approach.
上眼睑内窥镜经眶颅底入路（SETOA）为前颅底和中颅底提供了一条直接、微创的短路径。然而，它使用了一个狭窄的通道，限制了其攻击角度。本研究的目的是评估一种“标准”内窥镜经眶颅底入路的“扩展”保守变体（称为“开门”）的可行性和潜在益处，以增强对影响前颅窝和中颅窝正中旁侧病变的暴露。
首先，作者描述了“开门”扩展经眶颅底入路（ODETA）的技术细节。接下来，他们记录了它相对于标准 SETOA 的形态学优势。最后，他们提供了一个临床解剖应用，以展示增强的暴露和更好的攻击角度，以治疗占据正中旁前颅窝和中颅窝的病变。5 个成人尸体标本（10 侧）首先进行标准 SETOA，然后进行扩展的开门 SETOA（ODETA 到正中旁前颅窝和中颅窝）。通过三个手术步骤跨越额颧缝的铰链-眶切开术，将传统的 SETOA 转换为其扩展的开门变体。在解剖前进行 CT 扫描，并上传到神经导航系统进行定量分析。计算了两种手术技术在轴平面上针对四个关键标志（即前床突尖端、圆孔、卵圆孔和三叉神经压迹）的攻击角度，并进行了比较。
扩展开门 SETOA 的铰链-眶切开术产生了几个手术、功能和美容方面的优势：它为每个目标点提供了更宽的轴向攻击角度，对于前床突（ACP），获得的角度为 26.68°±1.31°（p<0.001），对于圆孔（FR）为 29.50°±2.46°（p<0.001），对于卵圆孔（FO）为 19.86°±1.98°（p<0.001），对于三叉神经外侧（TI）为 17.44°±2.21°（p<0.001），同时隐藏了皮肤疤痕，避免了颞肌解剖，保留了皮瓣的血管化，并降低了骨感染率和眶内容物回缩程度。
扩展开门技术可能特别适用于前颅窝和中颅窝正中旁侧病变的患者，这些病变以向眶颅底入路最前的前床突、海绵窦前腔和圆孔的前内侧为主，单纯经眶颅底入路无法完全控制。
