Wang Peng-Wei, Ju Da-Tong, Liu Wei-Hsiu, Hueng Dueng-Yuan, Chen Yuan-Hao, Ma Hsin-I, Liu Ming-Ying, Lin Bon-Jour
Department of Neurological Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
Division of Neurosurgery, Department of Surgery, Taoyuan Armed Forces General Hospital, National Defense Medical Center, Taoyuan, Taiwan.
Neurosurg Rev. 2025 Jul 10;48(1):557. doi: 10.1007/s10143-025-03710-y.
The endoscopic transorbital approach (ETOA) has been recognized as a pivotal technique within the realm of endoscopic skull base surgery for the management of lesions situated in the skull base with paramedian and lateral positioning. In the execution of the ETOA targeting the anterolateral skull base, the surgical intervention is performed in the coronal plane from superficial to deep with the anatomy becoming progressively more complex. Given that the trajectory of the infraorbital nerve (ION) algins favorably with the surgical corridor of the ETOA to the anterolateral skull base, this investigation evaluates the feasibility of employing the ION as an intraoperative navigational aid during the ETOA, utilizing both cadaveric dissection and relevant clinical applications.
Anatomical dissections were conducted on five adult cadaveric heads bilaterally utilizing two distinct endoscopic transmaxillary techniques aimed at the anterolateral skull base, namely the ETOA and the endoscopic endonasal approach (EEA). For each technique, the anatomical interrelationship between the ION and the adjacent compartments of the anterolateral skull base was meticulously documented. Additionally, the extent of ION exposure was systemically compared between the ETOA and EEA methodologies. The clinical practicality of cadaveric findings was evaluated in two patients presenting with deeply seated neoplasm located in the anterolateral skull base.
In contrast to the EEA, the ETOA demonstrated a markedly greater exposure of the orbitomaxillary segment (ETOA = 32.10 ± 3.32 mm; EEA = 9.98 ± 2.23 mm; P <.001) and the cavernous segment (ETOA = 14.61 ± 1.24 mm; EEA = 8.7 ± 3.72 mm; P <.001) of the ION. Both approaches exhibited a comparable extent of exposure concerning the pterygopalatine segment of the ION (ETOA: 10.66 ± 1.39 mm; EEA: 9.98 ± 2.23 mm). In both cases where patients underwent treatment via the ETOA with the ION utilized as intraoperative navigation, complete tumor resection was achieved without any occurrence of neurological or ophthalmic complications.
According to the findings derived from cadaveric studies and the preliminary clinical implementations, the ION serves as a dependable intraoperative navigational tool throughout the ETOA toward the anterolateral skull base. Each distinct segment of the ION is capable of guiding the operator safely towards the deeper segment and more profound complex anatomy.
内镜经眶入路（ETOA）已被公认为是内镜颅底手术领域中用于处理位于颅底中旁位和外侧位病变的关键技术。在实施针对前外侧颅底的ETOA时，手术操作是在冠状面从浅到深进行，解剖结构逐渐变得更加复杂。鉴于眶下神经（ION）的走行与ETOA至前外侧颅底的手术通道良好对齐，本研究利用尸体解剖和相关临床应用评估在ETOA期间将ION用作术中导航辅助的可行性。
对五个成年尸体头部双侧进行解剖，采用两种不同的针对前外侧颅底的内镜经上颌技术，即ETOA和内镜鼻内入路（EEA）。对于每种技术，ION与前外侧颅底相邻腔隙之间的解剖关系均被详细记录。此外，系统比较了ETOA和EEA方法之间ION暴露的程度。在两名患有位于前外侧颅底的深部肿瘤的患者中评估了尸体研究结果的临床实用性。
与EEA相比，ETOA显示ION的眶上颌段（ETOA = 32.10 ± 3.32 mm；EEA = 9.98 ± 2.23 mm；P <.001）和海绵窦段（ETOA = 14.61 ± 1.24 mm；EEA = 8.7 ± 3.72 mm；P <.001）的暴露明显更多。两种入路在ION的翼腭段暴露程度方面表现相当（ETOA：10.66 ± 1.39 mm；EEA：9.98 ± 2.23 mm）。在两例通过将ION用作术中导航的ETOA进行治疗的患者中，均实现了肿瘤的完全切除，且未发生任何神经或眼科并发症。
根据尸体研究结果和初步临床应用，ION在整个ETOA至前外侧颅底的过程中是一种可靠的术中导航工具。ION的每个不同节段都能够安全地引导术者朝向更深的节段和更复杂的解剖结构。
