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The extradural extended eyebrow approach: A cadaveric feasibility study.

R Martínez-Pérez¹, D A Hardesty², D M Prevedello²

¹Department of Neurological Surgery, The Ohio State University, Wexner Medical Center, 410W. 10th Ave., N-1049 Doan Hall, Columbus, OH 43210, United States.

Neuro-Chirurgie

|December 6, 2020

Summary

The extradural extended eyebrow approach (xEBA+eAC) offers a feasible technique for extradural anterior clinoidectomy (eAC). This modified supraorbital approach successfully exposes the paraclinoid region, crucial for neurosurgical procedures.

Keywords:

Cerebral aneurysms Clinoidectomy Eyebrow Keyhole Meningioma Minimally invasive Ophthalmic artery

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Area of Science:

Neurosurgery
Surgical Anatomy

Background:

Extradural anterior clinoidectomy (eAC) is essential for paraclinoid region exposure.
Limitations exist with standard supraorbital craniotomy for eAC.

Purpose of the Study:

To provide educational material on a modified supraorbital approach.
To discuss technical nuances of the extradural extended eyebrow approach with extradural anterior clinoidectomy (xEBA+eAC).

Main Methods:

Anatomical dissection of four embalmed heads.
Surgical approach demonstration using one additional head for video recording.

Main Results:

Successful removal of the anterior clinoid process and exposure of the paraclinoid region, including the ophthalmic artery.
Key steps involve drilling the sphenoid wing, interdural dissection, and specific osteotomies for clinoid removal.
Sectioning the distal dural ring aids internal carotid artery mobilization and ophthalmic artery exposure.

Conclusions:

The xEBA+eAC is a technically viable surgical approach.
This method provides adequate exposure to the paraclinoid, anterior, and middle cranial fossae.