Quantitative Anatomic Comparison of Microsurgical Transcranial, Endoscopic Endonasal, and Transorbital Approaches to the Spheno-Orbital Region.

Autor:	Agosti E; Division of Neurosurgery, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy.; Division of Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy., Turri-Zanoni M; Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, ASST Sette Laghi, Ospedale di Circolo, University of Insubria, Varese, Italy.; Head and Neck Surgery & Forensic Dissection Research Center, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy., Saraceno G; Division of Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy., Belotti F; Division of Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy., Karligkiotis A; Division of Otorhinolaryngology, Department of Surgical Specialties, ASST Sette Laghi, Ospedale di Circolo, Varese, Italy., Rocca G; Division of Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy., Buffoli B; Section of Anatomy and Physiopathology, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy., Raffetti E; Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden., Hirtler L; Division of Anatomy, Center for Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria., Rezzani R; Section of Anatomy and Physiopathology, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy., Rodella LF; Section of Anatomy and Physiopathology, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy., Ferrari M; Technology for Health (PhD Program), Department of Information Engineering, University of Brescia, Brescia, Italy.; University Health Network (UHN) Guided Therapeutics (GTx) Program International Scholar, UHN, Toronto, Canada.; Section of Otorhinolaryngology-Head and Neck Surgery, University of Padua-'Azienda Ospedaliera di Padova,' Padua, Italy., Nicolai P; Section of Otorhinolaryngology-Head and Neck Surgery, University of Padua-'Azienda Ospedaliera di Padova,' Padua, Italy., Bresson D; Department of Neurosurgery, Hôpital Lariboisière, University of Paris, Paris, France., Herman P; Department of Head and Neck Surgery, Hôpital Lariboisière, University of Paris, Paris, France., Dallan I; Department of Otorhinolaryngology, Azienda Ospedaliera Universitaria, Pisa, Italy., Castelnuovo P; Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, ASST Sette Laghi, Ospedale di Circolo, University of Insubria, Varese, Italy.; Head and Neck Surgery & Forensic Dissection Research Center, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy., Locatelli D; Division of Neurosurgery, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy.; Head and Neck Surgery & Forensic Dissection Research Center, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy., Fontanella MM; Division of Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy., Doglietto F; Division of Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy.
Jazyk:	angličtina
Zdroj:	Operative neurosurgery (Hagerstown, Md.) [Oper Neurosurg (Hagerstown)] 2021 Nov 15; Vol. 21 (6), pp. E494-E505.
DOI:	10.1093/ons/opab310
Abstrakt:	Background: The spheno-orbital region (SOR) is a complex anatomic area that can be accessed with different surgical approaches. Objective: To quantitatively compare, in a preclinical setting, microsurgical transcranial approaches (MTAs), endoscopic endonasal transpterygoid approach (EEA), and endoscopic transorbital approaches (ETOAs) to the SOR. Methods: These approaches were performed in 5 specimens: EEA, ETOAs (superior eyelid and inferolateral), anterolateral MTAs (supraorbital, minipterional, pterional, pterional-transzygomatic, and frontotemporal-orbitozygomatic), and lateral MTAs (subtemporal and subtemporal transzygomatic). All specimens underwent high-resolution computed tomography; an optic neuronavigation system with dedicated software was used to quantify working volume and exposed area for each approach. Mixed linear models with random intercepts were used for statistical analyses. Results: Anterolateral MTAs offer a direct route to the greater wings (GWs) and lesser wings (LWs); only they guarantee exposure of the anterior clinoid. Lateral MTAs provide access to a large area corresponding to the GW, up to the superior orbital fissure (SOF) anteriorly and the foramen rotundum medially. ETOAs also access the GW, close to the lateral portion of SOF, but with a different angle of view as compared to lateral MTAs. Access to deep and medial structures, such as the lamina papyracea and the medial SOF, is offered only by EEA, which exposes the LW and GW only to a limited extent. Conclusion: This is the first study that offers a quantitative comparison of the most used approaches to SOR. A detailed knowledge of their advantages and limitations is paramount to choose the ideal one, or their combination, in the clinical setting. (© Congress of Neurological Surgeons 2021.)
Databáze:	MEDLINE
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