Houlihan Lena Mary, Loymak Thanapong, Abramov Irakliy, Jubran Jubran H, Staudinger Knoll Ann J, O'Sullivan Michael G J, Lawton Michael T, Preul Mark C
The Loyal and Edith Davis Neurosurgical Research Laboratory, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, United States.
Department of Neurosurgery, Cork University Hospital, Wilton, Cork, Ireland.
J Neurol Surg B Skull Base. 2024 Apr 30;86(3):313-324. doi: 10.1055/s-0044-1786373. eCollection 2025 Jun.
Our objective was to compare transorbital neuroendoscopic surgery (TONES) with open craniotomy and analyze the effect of visualization technology on surgical freedom. Anatomic dissections included supraorbital craniotomy (SOC), transorbital microscopic surgery (TMS), and TONES. The study was performed in a neurosurgical anatomy laboratory. Neurosurgeons dissecting cadaveric specimens were included in the study. Morphometric analysis of cranial nerve (CN) accessible lengths, frontal lobe base area of exposure, and craniocaudal and mediolateral angle of attack and volume of surgical freedom (VSF) of the paraclinoid internal carotid artery (ICA), terminal ICA, and anterior communicating artery (ACoA). The mean (standard deviation [SD]) frontal lobe base parenchymal exposures for SOC, TMS, and TONES were 955.4 (261.7) mm , 846.2 (249.9) mm , and 944.7 (158.8) mm , respectively. Access to distal vasculature was hindered when using TMS and TONES. Multivariate analysis estimated that accessing the paraclinoid ICA with SOC would provide an 11.2- mm increase in normalized volume (NV) compared with transorbital corridors ( < 0.001). There was no difference between the three approaches for ipsilateral terminal ICA VSF ( = 0.71). Compared with TONES, TMS provided more access to the terminal ICA. For the ACoA, SOC produced the greatest access corridor maneuverability (mean [SD] NV: 15.6 [5.6] mm for SOC, 13.7 [4.4] mm for TMS, and 7.2 [3.5] mm for TONES; = 0.01). SOC provides superior surgical freedom for targets that require more lateral maneuverability, but the transorbital corridor is an option for accessing the frontal lobe base and terminal ICA. Instrument freedom differs quantifiably between the microscope and endoscope. A combined visualization strategy is optimal for the transorbital corridor.
我们的目的是比较经眶神经内镜手术（TONES）与开颅手术，并分析可视化技术对手术操作空间的影响。解剖学研究包括眶上开颅术（SOC）、经眶显微镜手术（TMS）和TONES。该研究在神经外科解剖实验室进行。参与解剖尸体标本的神经外科医生纳入研究。对颅神经（CN）可及长度、额叶基底暴露面积、颅尾侧和内外侧攻击角度以及床突旁颈内动脉（ICA）、颈内动脉终末段和前交通动脉（ACoA）的手术操作空间（VSF）进行形态学分析。SOC、TMS和TONES的额叶基底实质平均暴露面积（标准差[SD]）分别为955.4（261.7）mm²、846.2（249.9）mm²和944.7（158.8）mm²。使用TMS和TONES时，远端血管的显露受到阻碍。多变量分析估计，与经眶入路相比，SOC进入床突旁ICA可使标准化体积（NV）增加11.2 mm²（P＜0.001）。三种入路在同侧颈内动脉终末段VSF方面无差异（P = 0.71）。与TONES相比，TMS对颈内动脉终末段的显露更多。对于ACoA，SOC产生的入路通道可操作性最大（SOC的平均[SD] NV：15.6 [5.6] mm²，TMS为13.7 [4.4] mm²，TONES为7.2 [3.5] mm²；P = 0.01）。对于需要更多外侧可操作性的靶点，SOC提供了更好的手术操作空间，但经眶入路是进入额叶基底和颈内动脉终末段的一种选择。显微镜和内镜在器械操作空间上存在量化差异。经眶入路采用联合可视化策略最为理想。
