Abstract
The posterior sino-orbito-cranial interface is a critical area in the skull base since it represents a gateway to deeper vital regions. Quantification of the surgical freedom for any given point/area is an objective method for comparing in a reproducible way different surgical approaches. Three freshly injected cadaver heads (six sides) were dissected under the magnetic navigation control system. The surgical freedom (SF) and the angle of attack of fixed target points were determined from the ipsilateral nasal fossa, from the contralateral nasal fossa (after posterior septectomy), and after an anteromedial maxillotomy (according to the Denker procedure). The mean pre-operative SF value resulted to be 403.07 ± 102.73 mm2 for the ipsilateral nostril, increasing by 126.97 % for the binostril approach, by 118.45 % for the monolateral nostril approach after anteromedial maxillotomy, and by 310.48 % for the binostril approach after bilateral anteromedial maxillotomy. Laterally extended lesions require an anteromedial maxillotomy, while more medially located lesions can be managed by means of a posterior septectomy. When addressing the posterior sino-orbito-cranial interface, the transnasal binostril approach and anteromedial maxillotomy both increase the SF. The choice between them depends on exact position, relationship and clinical behaviour of the lesion to treat.
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Abbreviations
- SF:
-
Surgical freedom
- LOCR:
-
Lateral optic-carotid recess
- MS:
-
Maxillary strut
- IRM:
-
Inferior rectus muscle
- MRM:
-
Medial rectus muscle
- PEA:
-
Posterior ethmoidal artery
References
Khan AM, Varvares MA (2006) Traditional approaches to the orbit. Otolaryngol Clin North Am 39(5):895–909
Murchison AP, Rosen MR, Evans JJ, Bilyk JR (2011) Endoscopic approach to the orbital apex and periorbital skull base. Laryngoscope 121(3):463–467
Filipce V, Pillai P, Makiese O, Zarzour H, Pigott M, Ammirati M. (2009) Quantitative and qualitative analysis of the working area obtained by endoscope and microscope in various approaches to the anterior communicating artery complex using computed tomography-based frameless stereotaxy: a cadaver study. Neurosurgery 65(6):1147–1153
Jittapiromsak P, Wu A, Deshmukh P et al (2009) Comparative analysis of extensions of transbasal approaches: effect on access to midline and paramedian structures. Skull Base 19:387–399
Pillai P, Baig MN, Karas CS, Ammirati M (2009) Endoscopic image-guided transoral approach to the craniovertebral junction: an anatomic study comparing surgical exposure and surgical freedom obtained with the endoscope and the operating microscope. Neurosurgery 64(5):437–444
Hsu FP, Anderson GJ, Dogan A, Finizio J, Noguchi A, Liu KC, McMenomey SO, Delashaw JB Jr (2004) Extended middle fossa approach: quantitative analysis of petroclival exposure and surgical freedom as a function of successive temporal bone removal by using frameless stereotaxy. J Neurosurg 100:695–699
Chang SW, Wu A, Gore P, Beres E, Porter RW, Preul MC, Spetzler RF, Bambakidis NC (2009) Quantitative comparison of Kawase’s approach versus the retrosigmoid approach: implications for tumors involving both middle and posterior fossae. Neurosurgery 64(3 Suppl):44–51
de Notaris M, Prats-Galino A, Cavallo LM et al (2010) Preliminary experience with a new three-dimensional computer-based model for the study and the analysis of skull base approaches. Childs Nerv Syst 26(5):621–626
Cavalcanti DD, García-González U, Agrawal A, et al. (2010) Quantitative anatomic study of the transciliary supraorbital approach: benefits of additional orbital osteotomy? Neurosurgery 66(6):205–210
de Notaris M, Solari D, Cavallo LM et al (2011) The use of a three-dimensional novel computer based model for analysis of the endonasal endoscopic approach to the midline skull base. World Neurosurg 75(1):106–113
Little AS, Nakaji P, Milligan J (2012) Endoscopic endonasal transmaxillary approach and endoscopic sublabial transmaxillary approach: surgical decision making and implication of the nasolacrimal duct. World Neurosurg. doi:10.1016/j.wneu.2012.01.059
Janecka IP, Sen CN, Sekhar LN, Arriaga M (1990) Facial translocation: a new approach to cranial base. Otolaryngol Head Neck Surg 103(3):413–419
Sesenna E, Poli T, Magri AS (2010) Orbital approaches. In: Cappabianca P, Califano L, Iaconetta G (eds) Cranial, cranio-facial and skull base surgery. Springer, Italy, pp 259–280
Leone CR Jr, Wissinger JP (1988) Surgical approaches to diseases of the orbital apex. Ophthalmology 95(3):391–397
Dallan I, Castelnuovo P, de Notaris M et al (2012) Endoscopic endonasal anatomy of superior orbital fissure and orbital apex regions: critical considerations for clinical applications. Eur Arch Otorhinolaryngol. doi:10.1007/s00405-012-2281-3
de Notaris M, Prats-Galino A (2012) Surgical freedom, a challenging topic in endoscopic endonasal approaches. World Neurosurg. doi:10.1016/j.wneu.2012.10.071
Castelnuovo P, Dallan I, Battaglia P, Bignami M (2010) Endoscopic endonasal skull base surgery: past, present and future. Eur Arch Otorhinolaryngol 267(5):649–663
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All the authors certify that they have no conflict of interest or financial relationship with any entity mentioned in the paper. No sponsor is involved in the paper.
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Dallan, I., Lenzi, R., de Notaris, M. et al. Quantitative study on endoscopic endonasal approach to the posterior sino-orbito-cranial interface: implications and clinical considerations. Eur Arch Otorhinolaryngol 271, 2197–2203 (2014). https://doi.org/10.1007/s00405-013-2854-9
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DOI: https://doi.org/10.1007/s00405-013-2854-9