Endoscopic transorbital transtentorial approach to middle incisural space: preclinical cadaveric study

  • Bon-Jour Lin
  • Kun-Ting Hong
  • Tzu-Tsao Chung
  • Wei-Hsiu Liu
  • Dueng-Yuan Hueng
  • Yuan-Hao Chen
  • Da-Tong Ju
  • Hsin-I Ma
  • Ming-Ying Liu
  • Hung-Chang Hung
  • Chi-Tun TangEmail author
Original Article - Neurosurgical Anatomy
Part of the following topical collections:
  1. Neurosurgical Anatomy



Endoscopic transorbital approach is a novel development of minimally invasive skull base surgery. Recently, anatomical studies have started to discuss the expanded utilization of endoscopic transorbital route for intracranial intradural lesions. The goal of this cadaveric study is to assess the feasibility of endoscopic transorbital transtentorial approach for exposure of middle incisural space.


Anatomical dissections were performed in four human cadaveric heads (8 sides) using 0- and 30-degree endoscopes. A stepwise description of endoscopic transorbital transtentorial approach to middle incisural space and related anatomy was provided.


Orbital manipulation following superior eyelid crease incision with lateral canthotomy and cantholysis established space for bone drilling. Extradural stage consisted of extensive drilling of orbital roof of frontal bone, lessor, and greater wings of sphenoid bone. Intradural stage was composed of dissection of sphenoidal compartment of Sylvian fissure, lateral mobilization of mesial temporal lobe, and penetration of tentorium. A cross-shaped incision of tentorium provided direct visualization of crural cistern with anterolateral aspect of cerebral peduncle and upper pons. Interpeduncular cistern, prepontine cistern, and anterior portions of ambient and cerebellopontine cisterns were exposed by 30-degree endoscope.


The endoscopic transorbital transtentorial approach can be used as a minimally invasive surgery for exposure of middle incisural space. Extensive drilling of sphenoid wing and lateral mobilization of mesial temporal lobe are the main determinants of successful dissection. Further studies are needed to confirm the clinical feasibility of this novel approach.


Endoscopic transorbital Transtentorial Middle incisural space Minimally invasive 


Compliance with ethical standards

Conflicts of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2019

Authors and Affiliations

  • Bon-Jour Lin
    • 1
    • 2
  • Kun-Ting Hong
    • 1
  • Tzu-Tsao Chung
    • 1
  • Wei-Hsiu Liu
    • 1
  • Dueng-Yuan Hueng
    • 1
  • Yuan-Hao Chen
    • 1
  • Da-Tong Ju
    • 1
  • Hsin-I Ma
    • 1
  • Ming-Ying Liu
    • 1
  • Hung-Chang Hung
    • 3
    • 4
  • Chi-Tun Tang
    • 1
    Email author
  1. 1.Department of Neurological Surgery, National Defense Medical CenterTri-Service General HospitalNeihuTaiwan, Republic of China
  2. 2.Department of SurgeryNantou HospitalNantouTaiwan, Republic of China
  3. 3.Department of Internal MedicineNantou HospitalNantouTaiwan, Republic of China
  4. 4.Department of Healthcare AdministrationCentral Taiwan University of Science and TechnologyTaichungTaiwan, Republic of China

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