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Related Experiment Video

Updated: Mar 12, 2026

Role of Diffusion MRI Tractography in Endoscopic Endonasal Skull Base Surgery
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The Supraorbital Keyhole Craniotomy Approach for Olfactory Implantation: A Radiological Feasibility Study.

Lauren J Sterlin1, Arman Saeedi1, William C Broaddus1,2

  • 1Department of Otolaryngology - Head and Neck Surgery, Virginia Commonwealth University Health, Richmond, Virginia, United States.

Journal of Neurological Surgery. Part B, Skull Base
|March 11, 2026
PubMed
Summary

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The supraorbital keyhole craniotomy (SOKC) offers a safe and effective surgical approach for olfactory implants, with 96% of patients showing an unobstructed path to the olfactory bulb (OB). This method may be superior to transnasal techniques.

Area of Science:

  • Neurosurgery
  • Otolaryngology
  • Medical Imaging

Background:

  • Olfactory implants are emerging treatments for anosmia.
  • Current transnasal and transcranial methods for olfactory bulb (OB) access carry risks.
  • The supraorbital keyhole craniotomy (SOKC) is a less invasive surgical technique.

Purpose of the Study:

  • To evaluate the safety and efficacy of the SOKC for accessing the OB.
  • To identify anatomical obstructions and patient-specific factors influencing OB access.
  • To compare SOKC with existing surgical approaches for olfactory implantation.

Main Methods:

  • Retrospective cohort study analyzing 50 computed tomographies of the sinuses.
  • Utilized syngo.via software for image processing and pathway analysis.
Keywords:
anosmia treatmentolfactory bulb accessolfactory implantation

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  • Assessed 1,000 potential pathways from exterior skull points to the OB for obstructions.

    • Main Results:

    • 96% of subjects had at least one unobstructed pathway to the OB.
    • The posterior OB was more accessible than the anterior OB (p=0.00002).
    • Ipsilateral sinuses were the most frequent cause of pathway obstruction.

    Conclusions:

    • SOKC presents a potentially safe and effective surgical option for olfactory implantation.
    • The SOKC approach offers advantages over transnasal routes by potentially avoiding critical anatomical structures.
    • The posterior OB is more readily accessed via SOKC, suggesting improved surgical outcomes.