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Transorbital Approach to the Cavernous Sinus After an Exenteration
Jessica Y Tong1,2,3, Nicholas G Candy4,5, Jeffrey Sung2,3
1South Australian Institute of Ophthalmology, Royal Adelaide Hospital, Adelaide , South Australia , Australia.
Operative Neurosurgery (Hagerstown, Md.)
|May 2, 2025
Summary
This study introduces a new transorbital surgical technique for accessing the cavernous sinus (CS) after orbital exenteration. This method provides a viable alternative pathway, potentially avoiding more invasive transcranial or endonasal approaches.
Area of Science:
- Neurosurgery
- Orbital Surgery
- Anatomy
Background:
- The lateral wall of the cavernous sinus (CS) is a critical surgical region.
- Accessing the CS laterally can be challenging, often requiring transcranial or endonasal routes.
- Orbital exenteration presents unique anatomical considerations for surgical access.
Purpose of the Study:
- To describe and evaluate a novel transorbital surgical technique.
- To assess the feasibility of accessing the lateral wall of the cavernous sinus (CS) after orbital exenteration.
- To establish a new interdural pathway for CS surgery.
Main Methods:
- Cadaveric dissection of seven heads (13 orbits) following total orbital exenteration.
- Creation of an osteotomy in the greater wing of the sphenoid, bordered by the superior and inferior orbital fissures.
- Utilizing the V2 nerve within the foramen rotundum as a guide to the lateral CS wall.
Main Results:
- Precise visualization of the lateral CS wall and cranial nerves III-V2 was achieved.
- The osteotomy created a triangular window with specific dimensions (height 12.7 ± 1.5 mm).
- Measurements of surgical corridors and distances to key neurovascular structures were documented.
Conclusions:
- The transorbital approach is a feasible corridor for lateral CS wall access post-exenteration.
- This technique offers an alternative interdural pathway, potentially avoiding other surgical routes.
- Further clinical studies are needed to validate this technique in practice.
