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Role of Diffusion MRI Tractography in Endoscopic Endonasal Skull Base Surgery
Published on: July 5, 2021
Multiportal endoscopic approaches to the central skull base: a cadaveric study.
Jeremy N Ciporen1, Kris S Moe, Dinesh Ramanathan
1Department of Neurological Surgery, The University of Washington School of Medicine, Seattle, Washington, USA.
World Neurosurgery
|October 12, 2010
Summary
Combining endoscopic supraorbital and transorbital approaches with transnasal techniques offers improved visualization and access in skull base surgery. These multiportal strategies enhance surgical precision for complex anterior cranial fossa pathologies.
Area of Science:
- Neurosurgery
- Minimally Invasive Surgery
- Skull Base Anatomy
Background:
- Advancements in skull base surgery include endoscopic supraorbital, transnasal, and transorbital techniques.
- These approaches are often used in isolation, but combining them may offer advantages.
- Multiportal approaches could enhance surgical manipulation, reduce working distances, and optimize visualization.
Purpose of the Study:
- To determine if combining endoscopic supraorbital, transnasal, and transorbital approaches improves surgical access and manipulation in the central anterior cranial fossa.
- Evaluate the efficacy of multiportal strategies in skull base surgery.
Main Methods:
- A cadaveric study involving five heads was conducted.
- Procedures included expanded endoscopic binasal, bilateral precaruncular transorbital, and bilateral supraorbital approaches.
- Measurements were taken to assess distances to key anatomical structures like the pituitary gland and optic chiasm.
Main Results:
- Transorbital and supraorbital approaches provided shorter distances to the pituitary gland, optic chiasm, and cavernous carotid artery compared to the transnasal approach.
- Combining approaches created additional working ports, improving visualization and enabling two-handed dissection.
- Significant differences (P=.000) in mean distances were observed between approaches.
Conclusions:
- The precaruncular transorbital and supraorbital approaches offer direct access to central anterior skull base regions.
- Combined endoscopic approaches provide shorter working distances and improved angles for accessing the pituitary gland and surrounding structures.
- Multiportal endoscopic techniques enhance instrument access, visualization, and the ability to perform complex two-handed dissections in skull base surgery.
