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Quantifying surgical access in eyebrow craniotomy with and without orbital bar removal: cadaver and surgical phantom studies

  • Experimental Research - Brain Tumors
  • Published:
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Abstract

Background

Eyebrow craniotomy is a recently described minimally invasive approach for tackling primarily pathology of the anterior skull base. The removal of the orbital bar may further expand the surgical corridor of this exposure, but the extent of benefit is poorly quantified. We assessed the effect of orbital bar removal with regards to surgical access in the eyebrow craniotomy using classic morphometric measurements in cadaver heads. Using surgical phantoms and neuronavigation, we also measured the ‘working volume’, a new parameter for characterising the volume of surgical access in these approaches.

Methods

Silicon injected cadaver heads (n = 5) were used for morphometric analysis of the eyebrow craniotomy with and without orbital bar removal. Working depths and ‘working areas’ of surgical access were measured as defined by key anatomical landmarks. The eyebrow craniotomy with or without orbital bar removal was also simulated using surgical phantoms (n = 3, 90–120 points per trial), calibrated against a frameless neuronavigation system. Working volume was derived from reference coordinates recorded along the anatomical borders of the eyebrow craniotomy using the “α-shape algorithm” in R statistics.

Results

In cadaver heads, eyebrow craniotomy with removal of the orbital bar reduced the working depth to the ipsilateral anterior clinoid process (42 ± 2 versus 33 ± 3 mm; p < 0.05), but the working areas as defined by deep neurovascular and bony landmarks was statistically unchanged (total working areas of 418 ± 80 cm2 versus 334 ± 48 cm2; p = 0.4). In surgical phantom studies, however, working-volume for the simulated eyebrow craniotomies was increased with orbital bar removal (16 ± 1 cm3 versus 21 ± 1 cm3; p < 0.01).

Conclusions

In laboratory studies, orbital bar removal in eyebrow craniotomy provides a modest reduction in working depth and increase in the working volume. But this must be weighed up against the added morbidity of the procedure. Working volume, a newly developed parameter may provide a more meaningful endpoint for characterising the surgical access for different surgical approaches and it could be applied to other operative cases undertaken with frameless neuronavigation.

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Acknowledgements

The authors would like to thank Jose Anton-Rodriguez for CT imaging of the skull phantom and Christine Arnold for her work with preparing the cadaver heads.

Conflicts of interest

None.

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Authors and Affiliations

  1. Department of Neurosurgery, Manchester Skull Base Unit, Salford Royal Foundation Trust (SRFT), Stott Lane, Salford, M6 8HD, Manchester, UK

    Zsolt Zador, David J. Coope & Kanna Gnanalingham

  2. Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK

    David J. Coope & Kanna Gnanalingham

  3. Department of Neurosurgery, University of California, San Francisco, CA, USA

    Zsolt Zador & Michael T. Lawton

Authors
  1. Zsolt Zador
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  2. David J. Coope
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  3. Kanna Gnanalingham
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  4. Michael T. Lawton
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Corresponding author

Correspondence to Kanna Gnanalingham.

Additional information

Comment

This cadaver study demonstrated very precisely the advantage and disadvantage of surgical access in eyebrow craniotomy with and without orbital bar removal.

In my opinion the results of this study are important and should be considered before planing surgical approaches.

Daniel Haenggi

Duesseldorf, Germany

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Zador, Z., Coope, D.J., Gnanalingham, K. et al. Quantifying surgical access in eyebrow craniotomy with and without orbital bar removal: cadaver and surgical phantom studies. Acta Neurochir 156, 697–702 (2014). https://doi.org/10.1007/s00701-013-1947-y

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  • DOI: https://doi.org/10.1007/s00701-013-1947-y

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