Parikh Kara A, Nguyen Vincent N, Motiwala Mustafa, Orr Taylor J, Yagmurlu Kaan, Nichols C Stewart, Arthur Adam S, Sorenson Jeffrey M, Michael Ii L Madison, Khan Nickalus R
Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, United States.
Department of Neurosurgery, University of Rochester Medical Center, Rochester, United States.
Surg Neurol Int. 2025 May 23;16:191. doi: 10.25259/SNI_106_2025. eCollection 2025.
Modified cranial approaches for vascular pathology are sometimes necessary to enhance exposure and can be tailored by the pathology treated and surgical conditions. The authors outline these approaches, comparing the advantages and disadvantages of each.
Surgical footage of the senior author performing cranial-orbital skull base approaches for intracranial aneurysms as part of routine care was reviewed to identify and describe the advantages and disadvantages of these approaches to vascular pathology. The variations of cranial-orbital approaches included supraorbital, lateral supraorbital (LSO), orbito-pterional, cranio-orbital, and transcavernous approaches. Four illustrative cases are included. The literature was also reviewed for a concise compilation and summary of technical considerations and comparisons of cranial-orbital approaches for the microsurgical treatment of vascular pathology.
The supraorbital approach provides a trajectory along the orbital roof, allowing access to anterior circulation aneurysms without drilling the anterior clinoid process. While this approach is suited for inferiorly and anteriorly projecting anterior communicating artery (AcomA) aneurysms, orbito-pterional approaches are better suited for superiorly projecting AcomA aneurysms. The LSO approach allows access to anterior circulation and low-lying basilar apex lesions. The orbito-pterional approach is an "outside-in" approach to access the intracranial space from the orbit; the cranio-orbital approach is considered an "inside-out" approach to access the orbit from the intracranial space.
Modifications of the traditional pterional craniotomy are useful for various anterior and posterior circulation vascular pathologies. Extensions of these surgical corridors with transcavernous approaches can also be useful. Understanding the advantages and disadvantages of each is important in optimal approach selection.
对于血管病变，有时需要采用改良的颅骨入路以增加暴露范围，并且可以根据所治疗的病变和手术情况进行调整。作者概述了这些入路，并比较了每种入路的优缺点。
回顾了资深作者在常规治疗中进行颅眶颅底入路治疗颅内动脉瘤的手术录像，以识别和描述这些血管病变入路的优缺点。颅眶入路的变体包括眶上入路、外侧眶上入路（LSO）、眶翼点入路、颅眶入路和经海绵窦入路。纳入了四个说明性病例。还对文献进行了回顾，以简要汇编和总结颅眶入路显微手术治疗血管病变的技术要点及比较。
眶上入路沿着眶顶提供了一条轨迹，无需磨除前床突即可到达前循环动脉瘤。虽然这种入路适用于向下和向前突出的前交通动脉（AcomA）动脉瘤，但眶翼点入路更适合向上突出的AcomA动脉瘤。LSO入路可用于前循环和低位基底动脉尖病变。眶翼点入路是一种从眼眶进入颅内空间的“由外而内”的入路；颅眶入路被认为是一种从颅内空间进入眼眶的“由内而外”的入路。
传统翼点开颅术的改良对于各种前循环和后循环血管病变是有用的。通过经海绵窦入路扩展这些手术通道也可能有用。了解每种入路的优缺点对于选择最佳入路很重要。
