Cadaveric Step-by-Step Endoscopic Transorbital Approach to the Cavernous Sinus

Objectives: This study aimed to demonstrate the step-by-step process of performing an endoscopic transorbital approach to the lateral wall of the cavernous sinus, including a critical analysis and discussion of this approach's potential uses. The study objectives are to demonstrate the step-by-step process of performing an endoscopic transorbital approach to the lateral wall of the cavernous sinus, and to perform a critical analysis of the potential neurosurgical utility of this approach.

Background: The endoscopic transorbital approach offers a minimally invasive alternative for accessing the cavernous sinus, potentially improving surgical outcomes and reducing recovery times in skull base surgery.

Methods: The approach was performed on three cadaver heads, totaling five procedures, at the Madison Microneurosurgery Laboratory, University of Wisconsin. We utilized Storz 0- and 30-degree endoscopes with a 4-mm diameter and 275-mm length. All dissections began with a transpalpebral incision, followed by the dissection of the periorbita from the lateral and superior walls of the orbit. We identified key anatomical landmarks for the approach's initiation, including the superior orbital fissure, inferior orbital fissure, optic nerve, and the anterior and posterior ethmoidal arteries. Using a high-speed drill, we performed a craniotomy to open the middle and anterior fossae by removing the sphenoid wing and opening the subtemporal fossa, followed by peeling off the middle fossa. We then measured the distances between the frontozygomatic suture and key skull base structures, including the foramen ovale, foramen rotundum, foramen spinosum, the anterior and posterior ethmoidal arteries, and between the supraorbital notch and these structures.

Results: The lateral wall of the cavernous sinus was successfully exposed in all approaches, providing a good view of the lateral wall, along with the nerves and involved vascular structures. The working distance and angles were easily manageable with endoscopic surgical technique.

Conclusion: The endoscopic transorbital approach is a feasible method for exposing the lateral wall of the cavernous sinus and may be considered for various applications in skull base surgery.

Publication History

Article published online:
07 February 2025