Fully endoscopic supraorbital keyhole approach to the anterior cranial base: A cadaveric study

ABSTRACT

Introduction: The supraorbital keyhole approach for anterior cranial base lesions has been increasingly used in clinical practice. Anatomical studies focusing on the endoscopic anatomy via this approach are few, although the microscopic anatomy has been well studied. The aim of this study is to describe the anatomical features and surgical exposure provided by the endoscopic supraorbital keyhole approach using quantitative measurements. Materials and Methods: Nine formalin-fixed human cadavers from the inventory of the Anatomy department were used. A total of 18 supraorbital keyhole cranitomies were conducted. The distances between the target anatomical structures and the dura mater at the craniotomy site, and the distances between deep anatomical structures were measured with purpose-designed hooks. Results: The distance between the dura mater and optic canal was measured as 69.5 ± 6.7 mm (62-83 mm); optic chiasm as 76.2 ± 5.4 mm (67-86 mm); anterior communicating artery as 82.6 ± 6.1 mm (71-93 mm); internal carotid artery (ICA) bifurcation as 74.7 ± 6.0 mm (66-84 mm) and the basilar tip as 94.9 ± 7.0 mm (87-111 mm). The mean diameter of the optic canal was 7.4 ± 1.3 mm (6-11 mm), whereas the mean diameter of diaphragma sellae was measured as 8.4 ± 1.1 mm (7-10 mm). Conclusions: The results of this study showed that the anterior anda medial aspects of the anterior cranial fossa can be visualized properly. Dissection of the ipsilateral arteries of Circle of Willis can be performed easily using an endoscopic supraorbital keyhole approach.

Key words

Anterior cranial base - full-endoscopic - neuroendoscopy - skull base - supraorbital keyhole approach

• References

• 1 Frazier CH. I. An approach to the hypophysis through the anterior cranial fossa. Ann Surg 1913; 57: 145-50
• 2 Jane JA, Park TS, Pobereskin LH, Winn HR, Buttler AB. The supraorbital approach: Technical note. Neurosurgery 1982; 11: 537-42
• 3 Perneczky A, Müler-Forell W, van Lindert E. Keyhole Concept in Neurosurgery. Stuttgart, Germany: Georg Thieme Verlag; 1999
• 4 Reisch R, Perneczky A. Ten-year experience with the supraorbital subfrontal aprroach through an eyebrow skin incision. Neurosurgery 2005; 57 Suppl 242-55
• 5 van Lindert E, Perneczky A, Fries G, Pierangeli E. The supraorbital keyhole approach to supratentorial aneuryms: Concept and technique. Surg Neurol 1998; 49: 481-90
• 6 Kabil MS, Shahinian HK. Application of the supraorbital endoscopic approach to tumors of the anterior cranial base. J Craniofac Surg 2005; 16: 1070-5
• 7 Wiedemayer H, Sandalcioglu IE, Wiedemayer H, Stolke D. The supraorbital keyhole approach via an eyebrow incision for resection of tumors around the sella and the anterior skull base. Minim Invasive Neurosurg 2004; 47: 221-5
• 8 Benjamin V, Russell SM. The microsurgical nuances of resecting tuberculum sellae meningiomas. Neurosurgery 2005; 56 Suppl 411-7
• 9 Czirják S, Szeifert GT. Surgical experince with frontolateral keyhole craniotomy through a superciliary skin incision. Neurosurgery 2001; 48: 145-50
• 10 Figueiredo EG, Deshmukh V, Nakaji P, Desmukh P, Crusius MU, Crawford N. et al An anatomical evaluation of the mini-supraorbital approach and comprasion with standard craniotomies. Neurosurgery 2006; 59 Suppl (Suppl. 02) ONS212-20
• 11 Ganna A, Dehdashti AR, Karabatsou K, Gentili F. Fronto-basal interhemispheric approach for tuberculum sella meningiomas; long term visual outcome. Br J Neurosurg 2009; 23: 422-30
• 12 Jallo GI, Benjamin V. Tuberculum sellae meningiomas: Microsurgical anatomy and surgical technique. Neurosurgery 2002; 51: 1432-40
• 13 Paladino J, Mrak G, Mikliæ P, Jednacak H, Mihaljeviæ D. The keyhole concept in aneurysm surgery--a comparative study: Keyhole versus standart craniotomy. Minim Invas Neurosurg 2005; 48: 251-8
• 14 Telera S, Carapella CM, Caroli F, Crispo F, Cristalli G, Raus L. et al Supraorbital keyhole approach for removal of midline anterior cranial fossa meningiomas: A series of 20 consecutive cases. Neurosurg Rev 2012; 35: 67-83
• 15 Komatsu F, Komatsu M, Inoue T, Tschabitscher M. Endoscopic supraorbital extradural approach to the cavernous sinus: A cadaver study. J Neurosurg 2011; 114: 1331-7
• 16 van Lindert EJ, Grotenhuis JA. The combined supraorbital keyhole-endoscopic endonasal transsphenoidal approach to sellar, perisellar and frontal skull base tumors: Surgical technique. Minim Invasive Neurosurg 2009; 52: 281-6
• 17 Berhouma M, Jacquesson T, Jouanneau E. The fully endoscopic supraorbital trans-eyebrow keyhole approach to the anterior and middle skull base. Acta Neurochir (Wien) 2011; 153: 1949-54
• 18 Cavalcanti DD, García-González U, Agrawal A, Crawford NR, Tavares PL, Spetzler RF. et al Quantitative anatomic study of the transciliary supraorbital approach: Benefits of additional orbital osteotomy?. Neurosurgery 2010; 66 Suppl Operative 205-10
• 19 Fries G, Perneczky A. Endoscope-assisted brain surgery: Part 2--analysis of 380 procedures. Neurosurgery 1998; 42: 226-32
• 20 Kabil MS, Shahinian HK. The endoscopic supraorbital approach to tumors of the middle cranial base. Surg Neurol 2006; 66: 396-401
• 21 Kabil MS, Shahinian HK. Fully endoscopic supraorbital resection of congenital middle cranial fossa arachnoid cysts: Report of 2 cases. Pediatr Neurosurg 2007; 43: 316-22
• 22 Menovsky T, Grotenhuis JA, de Vries J, Bartels RH. Endoscope-assisted supraorbital craniotomy for lesions of the interpeduncular fossa. Neurosurgery 1999; 44: 106-12
• 23 Otani N, Muroi C, Yano H, Khan N, Pangalu A, Yonekawa Y. Surgical management of tuberculum sellae meningioma: Role of selective extradural anterior clinoidectomy. Br J Neurosurg 2006; 20: 129-38
• 24 Perneczky A, Fries G. Endoscopy-assisted brain surgery: Part 1--evolution, basic concept, and current technique. Neurosurgery 1998; 42: 219-25
• 25 Ciporen JN, Moe KS, Ramanathan D, Lopez S, Ledesma E, Rostomily R. et al Multiportal endoscopic approaches to the central skull base: A cadaveric study. World Neurosurg 2010; 73: 705-12
• 26 Filipce V, Pillai P, Makiese O, Zarzour H, Pigott M, Ammirati M. Quantitative and qualitative analysis of the working area obtained by endoscope and microscope in various approaches to the anterior communicating artery complex using computed tomography based frameless stereotaxy: A cadaver study. Neurosurgery 2009; 65: 1147-53
• 27 Komatsu F, Komatsu M, Inoue T, Tschabitscher M. Endoscopic extradural anterior clinoidectomy via supraorbital keyhole: A cadaveric study. Neurosurgery 2011; 68 Suppl Operative 334-8
• 28 Lang J. Hypophyseal region. In Lang J. editor Skull Base and Related Structures: Atlas of Clinical Anatomy. Stuggart, Germany: Schattauer Verlag; 1995. p 172-6
• 29 Lang J. Incisura tentorii and mesencephalon. In: Lang J. editor Skull Base and Related Structures: Atlas of Clinical Anatomy. Stuggart, Germany: Schattauer Verlag; 1995. p 235-8
• 30 Lang J. Cavernous sinus. In: Lang J. editor Skull Base and Related Structures: Atlas of Clinical Anatomy. Stuggart, Germany: Schattauer Verlag; 1995. p 177-98