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Related Concept Videos

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The superior view of the cranium shows the frontal and paired parietal bones.
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Supraorbital Keyhole Versus Pterional Approach: A Morphometric Anatomical Study.

Stefano Signoretti1, Lorenzo Pescatori2, Barbara Nardacci2

  • 1Division of Neurosurgery, Department of Emergency and Urgency, S. Eugenio/CTO Hospital, A.S.L. Roma2, Rome, Italy. stefano.signoretti@aslroma2.it.

Acta Neurochirurgica. Supplement
|December 28, 2023
PubMed
Summary

The supraorbital (SO) keyhole approach provides optimal anatomical exposure for supra- and parasellar regions, serving as a viable alternative to standard Pterional (PT) craniotomy.

Keywords:
Anatomical studyMorphometric analysisPterional craniotomySupraorbital keyhole

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Area of Science:

  • Neurosurgery
  • Minimally Invasive Techniques
  • Surgical Anatomy

Background:

  • The supraorbital (SO) keyhole approach is increasingly recognized for its potential in accessing cranial base regions.
  • Its routine clinical utility, especially with advancements in surgical technology, requires thorough evaluation against established techniques like Pterional (PT) craniotomy.

Purpose of the Study:

  • To conduct a cadaveric morphometric analysis comparing the supraorbital (SO) keyhole approach with the standard Pterional (PT) craniotomy.
  • To evaluate the anatomical exposure and surgical field provided by the SO keyhole approach for supra- and parasellar regions.

Main Methods:

  • A cadaveric study utilizing 8 ETOH-fixed and silicone-injected human heads for each surgical approach (SO and PT).
  • Pre- and post-dissection CT scans and pre-dissection MRI were employed for neuro-navigation and verification of anatomical landmarks.
  • Morphometric analysis was performed to quantify the differences in exposure.

Main Results:

  • Despite a smaller craniotomy size, the SO approach demonstrated superior anatomical exposure compared to the PT approach.
  • A 30° head rotation significantly enhanced the surgical field of the suprasellar region when using the SO keyhole.

Conclusions:

  • The SO keyhole approach is a suitable alternative for accessing the supra- and parasellar regions.
  • Detailed preoperative image-guided surgical planning is crucial for optimizing the effectiveness of the SO keyhole approach.