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The extended transorbital craniotomy: an anatomic study.

Almaz Kurbanov1, Chris Sanders-Taylor, Jeffrey T Keller

  • 1Department of Neurosurgery, University of Cincinnati (UC) College of Medicine, Comprehensive Stroke Center at UC Neuroscience Institute, Mayfield Clinic, Cincinnati, Ohio.

Neurosurgery
|April 14, 2015
PubMed
Summary
This summary is machine-generated.

This study demonstrates a novel 3-step transorbital approach involving sphenoid wing removal to enhance surgical exposure in the temporal and perisellar regions. This minimally invasive technique offers improved visualization for complex pathologies.

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Area of Science:

  • Neurosurgery
  • Surgical Anatomy
  • Minimally Invasive Techniques

Background:

  • Supra-/transorbital approaches are limited in suprasellar and anterior fossa surgeries.
  • Lateral supraorbital approaches offer restricted retrosellar exposure and operative volume, particularly in the temporal region.

Purpose of the Study:

  • To evaluate the efficacy of removing the lesser and greater wings of the sphenoid bone to expand lateral angles and improve exposure in the temporal lobe and perisellar regions.
  • To enhance the operative volume and visualization capabilities of transorbital approaches.

Main Methods:

  • A 3-step cadaveric study involving 5 specimens.
  • Step 1: Standard transorbital craniotomy via a supra-eyebrow incision.
  • Steps 2 & 3: Extradural removal of the lesser sphenoid wing and partial removal of the greater sphenoid wing, quantifying exposure extension in sylvian, parasellar, and anterolateral temporal regions.

Main Results:

  • Step 2 significantly increased exposure in the sylvian and parasellar regions.
  • Step 3 provided substantial exposure in the lateral temporal region.
  • Progressive increases in lateral view were observed with each step of the sphenoid wing removal.

Conclusions:

  • A 3-step transorbital approach with sphenoid wing removal enhances sylvian, anterior temporal, and parasellar exposures.
  • This minimally invasive technique provides an improved anterolateral view, comparable to subfrontal pterional approaches.
  • Potential applications include treating vascular and neoplastic pathologies, such as sphenoid meningiomas, typically managed with pterional or frontotemporal orbitozygomatic approaches.