Skip to main content
SpringerLink
Log in

Transcranial Approach to Optic Canal and Orbital Apex

  • Chapter
  • First Online:
Orbital Apex and Periorbital Skull Base Diseases

  • 198 Accesses

Abstract

Neurosurgeons are always often required to approach the optic canal and orbital apex for treatment of various pathologies including neoplastic, vascular, and traumatic in origin. Traditionally and most popularly, this very limited space is approached by transcranial route, of which a wide area of exposure can be achieved. This transcranial route can further be subclassified into extradural approach, intradural approach, and hybrid approach. Development of endoscope-assisted craniotomy with advanced in technology improves the surgical outcome. This chapter is intended to have a comprehensive review of transcranial approach with pros and cons of different subtypes of this surgical approach.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 129.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Regoli M, Bertelli E. The revised anatomy of the canals connecting the orbit with the cranial cavity. Orbit. 2017;36(2):110–7.

    Article  PubMed  Google Scholar 

  2. Acheson JF. Optic nerve disorders: role of canal and nerve sheath decompression surgery. Eye (Lond). 2004;18:1169–74.

    Article  CAS  PubMed  Google Scholar 

  3. Mine S, Yamakami I, Yamaura A, Hanawa K, Ikejiri M, Mizota A, Adachi-Usami E. Outcome of traumatic optic neuropathy. Comparison between surgical and nonsurgical treatment. Acta Neurochir (Wien). 1999;141:27–30.

    Article  CAS  PubMed  Google Scholar 

  4. Wohlrab TM, Maas S, de Carpentier JP. Surgical decompression in traumatic optic neuropathy. Acta Ophthalmol Scand. 2002;80:287–93.

    Article  PubMed  Google Scholar 

  5. He Z, Li Q, Yuan J, Zhang X, Gao R, Han Y, Yang W, Shi X, Lan Z. Evaluation of transcranial surgical decompression of the optic canal as a treatment option for traumatic optic neuropathy. Clin Neurol Neurosurg. 2015;134:130–5.

    Article  PubMed  Google Scholar 

  6. Oh HJ, Yeo DG, Hwang SC. Surgical treatment for traumatic optic neuropathy. Korean J Neurotrauma. 2018;14(2):55–60.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Norris JH, Norris JS, Akinwunmi J, Malhotra R. Optic canal decompression with dural sheath release; a combined orbito-cranial approach to preserving sight from tumours invading the optic canal. Orbit. 2012;31(1):34–43.

    Article  PubMed  Google Scholar 

  8. Natori Y, Rhoton JRAL. Transcranial approach to the orbit: microsurgical anatomy. J Neurosurg. 1994;81:78–86.

    Article  CAS  PubMed  Google Scholar 

  9. Sofferman RA. Sphenoethmoid approach to the optic nerve. Laryngoscope. 1981;91:184–96.

    Article  CAS  PubMed  Google Scholar 

  10. Abou-Al-Shaar H, Krisht KM, Cohen MA, Abunimer AM, Neil JA, Karsy M, Alzhrani G, Couldwell WT. Cranio-orbital and orbitocranial approaches to orbital and intracranial disease: eye-opening approaches for neurosurgeons. Front Surg. 2020;7:1.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Di Somma A, Andaluz N, Gogela SL, Keller JT, Prats-Galino A, Cappabianca P. Surgical freedom evaluation during optic nerve decompression: laboratory investigation. World Neurosurg. 2017;101:227–35.

    Article  PubMed  Google Scholar 

  12. Filho PMMM, Prevedello DM, Prevedello LM, Filho LFD, Fiore ME, Dolci RL, Buohliqah L, Otto BA, Carrau RL. Optic canal decompression: comparison of 2 surgical techniques. World Neurosurg. 2017;104:745–51.

    Article  Google Scholar 

  13. Gogela SL, Zimmer LA, Keller JT, Andaluz N. Refining operative strategies for optic nerve decompression: a morphometric analysis of transcranial and endoscopic endonasal techniques using clinical parameters. Oper Neurosurg (Hagerstown). 2018;14(3):295.

    Article  PubMed  Google Scholar 

  14. Onofrey CB, Tse DT, Johnson TE, Neff AG, Dubovy S, Buck BE, Casiano R. Ophthal Plast Reconstr Surg. 2007;23(4):261–6.

    Article  PubMed  Google Scholar 

  15. Roth J, Fraser J, Singh A, Bernardo A, Anand VK, Schwartz TH. Surgical approaches to the orbital apex: comparison of endoscopic endonasal and transcranial approaches using a novel 3D endoscope. Orbit. 2011;30(1):43–8.

    Article  PubMed  Google Scholar 

  16. Dolenc VV. Direct microsurgical repair of intracavernous vascular lesions. J Neurosurg. 1983;58:824–31.

    Article  CAS  PubMed  Google Scholar 

  17. Dolenc VV. A combined epi- and subdural direct approach to carotid-ophthalmic artery aneurysms. J Neurosurg. 1985;62:667–72.

    Article  CAS  PubMed  Google Scholar 

  18. Yasargil MG, Gasser JC, Hodosh RM, Rankin TV. Carotid-ophthalmic aneurysms: direct microsurgical approach. Surg Neurol. 1977;8(3):155–65.

    CAS  PubMed  Google Scholar 

  19. Froelich SC, Abdel Aziz KM, Levine NB, Theodosopoulos PV, Van Loveren HR, Keller JT. Refinement of the extradural anterior clinoidectomy: surgical anatomy of the orbitotemporal perioteal fold. Neurosurgery. 2007;61(ONS Suppl 2):ons179–86.

    Google Scholar 

  20. Kim JS, Lee SI, Jeon KD, Choi BS. The pterional approach and extradural anterior clinoidectomy to clip paraclinoid aneurysms. J Cerebrovasc Endovasc Neurosurg. 2013;15(3):260–6.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Lehmberg J, Krieg SM, Meyer B. Anterior clinoidectomy. Acta Neurochir (Wien). 2014;156:415–9.

    Article  CAS  PubMed  Google Scholar 

  22. Mishra S, Leao B, Rosio DM. Extradural anterior clinoidectomy: technical nuances from a learner’s perspective. Asian J Neurosurg. 2017;12(2):189–93.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Mikami T, Minamida Y, Koyanagi I, Baba T, Houkin K. Anatomical variations in pneumatization of the anterior clinoid process. J Neurosurg. 2007;106:170–4.

    Article  PubMed  Google Scholar 

  24. Mori K, Yamamoto T, Nakao Y, Esaki T. Surgical simulation of extradural anterior clinoidectomy through the trans-superior orbital fissure approach using a dissectable three-dimensional skull base model with artificial cavernous sinus. Skull Base. 2010;20:229–36.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Otani N, Wada K, Fujii K, Toyooka T, Kumagai K, Ueno H, Tomura S, Tomiyama A, Nakao Y, Yamamoto T, Mori K. Usefulness of extradural optic nerve decompression via trans-superior orbital fissure approach for treatment of traumatic optic nerve injury: surgical procedures and techniques from experience with 8 consecutive patients. World Neurosurg. 2016;90:357–63.

    Article  PubMed  Google Scholar 

  26. Yang Y, Wang H, Shao Y, Wei Z, Zhu S, Wang J. Extradural anterior clinoidectomy as an alternative approach for optic nerve decompression: anatomic study and clinical experience. Neurosurgery. 2006;59(ONS Suppl 4):ons253–62.

    PubMed  Google Scholar 

  27. Meybodi AT, Lawton MT, Yousef S, Guo X, Sanchez JJG, Tabani H, Garcia S, Burkhardt JK, Benet A. Anterior clinoidectomy using an extradural and intradural 2-step hybrid technique. J Neurosurg. 2019;130:238–47.

    Article  Google Scholar 

  28. Kulwin C, Tubbs RS, Cohen-Gadol AA. Anterior clinoidectomy: description of an alternative hybrid method and a review of the current techniques with an emphasis on complication avoidance. Surg Neurol Int. 2011;2:140.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Komatsu F, Komatsu M, Inoue T, Tschabitscher M. Endoscopic extradural anterior clinoidectomy via supraorbital keyhole: a cadaveric study. Neurosurgery. 2011;68(ONS Suppl 2):ons334–8.

    Google Scholar 

  30. Komatsu F, Imai M, Shigematsu H, Aoki R, Oda S, Shimoda M, Matsumae M. Endoscopic extradural supraorbital approach to the temporal pole and adjacent area: technical note. J Neurosurg. 2018;128:1873–9.

    Article  PubMed  Google Scholar 

  31. Cai Q, Guo Q, Zhang W, Ji B, Chen Z, Chen Q. Extradural anterior clinoidectomy and aneurysm clipping using transcranial neuroendoscopic approach. Medicine. 2019;98:17.

    Article  Google Scholar 

  32. Lehmberg J, Krieg SM, Mueller B, Meyer B. Impact of anterior clinoidectomy on visual function after resection of meningiomas in and around the optic canal. Acta Neurochir. 2013;155:1293–9.

    Article  PubMed  Google Scholar 

  33. Romani R, Elsharkawy A, Laakso A, Kangasniemi M, Hernesniemi J. Complications of anterior clinoidectomy through lateral supraorbital approach. World Neurosurg. 2012;77(5/6):699–703.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Queen Elizabeth Hospital, Hong Kong SAR, China

    Tak Lap Poon

Authors
  1. Tak Lap Poon
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Tak Lap Poon .

Editor information

Editors and Affiliations

  1. Department of Neurosurgery, Queen Elizabeth Hospital, Hong Kong, China

    Tak Lap POON

  2. Department of Neurosurgery, Queen Elizabeth Hospital, Hong Kong, China

    Calvin MAK

  3. Ophthalmology and Visual Sciences, Hong Kong Eye Hospital, Hong Kong, China

    Hunter Kwok Lai YUEN

Rights and permissions

Reprints and permissions

Copyright information

© 2023 The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Poon, T.L. (2023). Transcranial Approach to Optic Canal and Orbital Apex. In: POON, T.L., MAK, C., YUEN, H.K.L. (eds) Orbital Apex and Periorbital Skull Base Diseases. Springer, Singapore. https://doi.org/10.1007/978-981-99-2989-4_17

Download citation

  • DOI: https://doi.org/10.1007/978-981-99-2989-4_17

  • Published:

  • Publisher Name: Springer, Singapore

  • Print ISBN: 978-981-99-2988-7

  • Online ISBN: 978-981-99-2989-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation