Corvino Sergio, Kassam Amin, Piazza Amedeo, Corrivetti Francesco, Esposito Felice, Iaconetta Giorgio, de Notaris Matteo
Division of Neurosurgery, Department of Neuroscience and Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli "Federico II", Naples , Italy.
PhD Program in Neuroscience, Department of Neuroscience and Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli "Federico II", Naples , Italy.
Oper Neurosurg (Hagerstown). 2025 Mar 1;28(3):391-398. doi: 10.1227/ons.0000000000001274. Epub 2024 Jul 12.
McCarty keyhole (MCK) is the most important entry point during orbitocranial and cranio-orbital approaches; nevertheless, its anatomic coordinates have never been detailedly described from transorbital perspective. To provide the spatial coordinates for intraorbital projection of the "mirror" MCK by using the well-established main anatomic-surgical bony landmarks met along transorbital corridor.
MCK was identified in 15 adult dry skulls (30 sides) on exocranial surface of pterional region based on the well-defined external bony landmarks: on the frontosphenoid suture, 5 to 6 mm behind the joining point (JP) of frontozygomatic suture (FZS), frontosphenoid suture (FSS), and sphenozygomatic suture (SZS). A 1-mm burr hole was performed and progressively enlarged to identify the intracranial and intraorbital compartments. Exit site of the intraorbital part of burr hole was referenced to the FZS on the orbital rim, the superior orbital fissure, and the inferior orbital fissure and to the JP of FZS, FSS, and SZS. To electronically validate the results, 3-dimensional photorealistic and interactive models were reconstructed with photogrammetry. Finally, for a further validation, McCarty mirror keyhole was also exposed, based on results achieved, through endoscopic transorbital approach in 10 head specimens (20 sides).
Intraorbital projection of MCK was identified on the FSS on intraorbital surface, 1.5 ± 0.5 mm posterior to JP, 11.5 ± 1.1 mm posterior to the FZS on orbital rim following the suture, 13.0 ± 1.2 mm from most anterior end of superior orbital fissure, 15.5 ± 1.4 mm from the most anterior end of the inferior orbital fissure in vertical line, on measurements under direct macroscopic visualization (mean ± SD). These values were electronically confirmed on the photogrammetric models with mean difference within 1 mm.
To be aware of exact position of intraorbital projection of MCK during an early stage of transorbital approaches provides several surgical, clinical, and aesthetic advantages.
麦卡蒂锁孔（MCK）是眶颅和颅眶入路中最重要的进入点；然而，从经眶视角来看，其解剖坐标从未被详细描述过。通过使用沿经眶通道遇到的成熟的主要解剖 - 手术骨性标志，来提供“镜像”MCK的眶内投影的空间坐标。
基于明确的外部骨性标志，在15个成人干燥颅骨（30侧）的翼点区域颅外表面确定MCK：位于额蝶缝上，在额颧缝（FZS）、额蝶缝（FSS）和蝶颧缝（SZS）的交汇点（JP）后方5至6毫米处。钻一个1毫米的骨孔并逐渐扩大，以确定颅内和眶内间隙。骨孔眶内部的出口位置以眶缘的FZS、眶上裂和眶下裂以及FZS、FSS和SZS的JP为参照。为了以电子方式验证结果，使用摄影测量法重建了三维逼真且交互式模型。最后，为了进一步验证，基于所取得的结果，还通过内镜经眶入路在10个头部标本（20侧）中暴露了麦卡蒂镜像锁孔。
在眶内表面的FSS上确定了MCK的眶内投影，在直接宏观观察下测量，其位于JP后方1.5±0.5毫米处，沿缝线在眶缘FZS后方11.5±1.1毫米处，距眶上裂最前端13.0±1.2毫米，在垂直线上距眶下裂最前端15.5±1.4毫米（平均值±标准差）。这些值在摄影测量模型上得到电子确认，平均差异在1毫米以内。
在经眶入路的早期阶段了解MCK眶内投影的确切位置具有若干手术、临床和美学优势。
