Liu J M, Wen Y H, Lai Y Y, Xu Z F, Gao W X, Zheng N Z, Li J, Wen W P
Department of Otolaryngology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou Key Laboratory of Otorhinolaryngology, Otorhinolaryngology Institute of Sun Yat-sen University, Guangzhou 510080, China.
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2025 Sep 7;60(9):1054-1061. doi: 10.3760/cma.j.cn115330-20250407-00210.
To investigate the anatomical feasibility of the endoscopic transorbital approach (ETOA) to the orbital apex and lateral middle cranial fossa, to identify stable and recognizable surgical landmarks under endoscopic visualization, and to provide morphometric data for preoperative planning and intraoperative navigation. Stepwise anatomical dissection was performed on five formalin-fixed cadaveric heads and one fresh arterially injected cadaveric specimen to simulate the ETOA using a 0° endoscope. Key structures and their anatomical relationships were observed and recorded. Additionally, high-resolution CT scans of 50 adults were retrospectively analyzed. Three-dimensional reconstructions and measurements were performed using Mimics 17.0 software. Spatial validation was performed using 17 dry skulls to verify the consistency and reliability of osseous anatomical landmarks. Cadaveric dissection identified the meningo-orbital band, superior orbital fissure, optic canal, foramen rotundum, and foramen ovale as reliable surgical landmarks for the ETOA. A topographic map of the surgical region was established based on the endoscopic view. CT measurements revealed the following distances (Mean±SD): the midpoint of the supraorbital rim to the foramen rotundum (57.31±3.59) mm and foramen ovale (71.46±3.42) mm; the lateral orbital rim to the lateral edge of the superior orbital fissure (37.38±2.52) mm; the distance from the superior orbital fissure to the optic canal (9.98±1.49) mm; and the distance from the anterior ethmoidal artery to the optic canal (19.98±2.05) mm. These measurements were consistent with dry skull data, indicating that these osseous landmarks had stable spatial relationships and were suitable for intraoperative localization. The ETOA provides favorable anatomical accessibility and clinical feasibility for lesions involving the orbital apex and lateral skull base. Key osseous structures demonstrate high identifiability and stable spatial relationships, serving as critical references for intraoperative navigation and preoperative pathway planning. The quantitative anatomical framework established in this study provides critical morphometric support for minimally invasive surgery targeting lesions in this region.
探讨经眶内镜入路（ETOA）至眶尖和颅中窝外侧的解剖可行性，在内镜视野下识别稳定且可识别的手术标志，并为术前规划和术中导航提供形态学数据。对5个福尔马林固定的尸体头部和1个新鲜动脉注射的尸体标本进行逐步解剖，使用0°内镜模拟ETOA。观察并记录关键结构及其解剖关系。此外，对50名成年人的高分辨率CT扫描进行回顾性分析。使用Mimics 17.0软件进行三维重建和测量。使用17个干燥颅骨进行空间验证，以验证骨性解剖标志的一致性和可靠性。尸体解剖确定脑膜眶带、眶上裂、视神经管、圆孔和卵圆孔是ETOA可靠的手术标志。基于内镜视野建立了手术区域的地形图。CT测量显示以下距离（平均值±标准差）：眶上缘中点至圆孔（57.31±3.59）mm和卵圆孔（71.46±3.42）mm；眶外侧缘至眶上裂外侧边缘（37.38±2.52）mm；眶上裂至视神经管的距离（9.98±1.49）mm；以及筛前动脉至视神经管的距离（19.98±2.05）mm。这些测量结果与干燥颅骨数据一致，表明这些骨性标志具有稳定的空间关系，适用于术中定位。ETOA为累及眶尖和颅底外侧的病变提供了良好的解剖可达性和临床可行性。关键骨性结构具有高度可识别性和稳定的空间关系，是术中导航和术前路径规划的关键参考。本研究建立的定量解剖框架为针对该区域病变的微创手术提供了关键的形态学支持。
