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The endoscopic supraorbital translaminar approach: a technical note

  • Technical Note - Neurosurgical Anatomy
  • Published:
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Abstract

Object

Resection of lesions located within the third ventricle presents a surgical challenge. Several approaches have been developed in an attempt to obtain maximal resection, while minimizing brain retraction. In this work, we assess the surgical exposure and maneuverability of the endoscopic supraorbital translaminar approach (ESTA), a potential alternative to fenestrate the lamina terminalis and approach the third ventricle by using the endoscope through a keyhole supraorbital-eyebrow craniotomy.

Methods

Five cadaveric heads were used to assess the corridor depth, area of exposure, and viewing angles offered by the ESTA. One additional utilized specimen provided a stepwise dissection of the approach.

Results

The ESTA was successfully performed in all specimens. Depth of the surgical corridor from the craniotomy to the ipsilateral internal carotid artery (ICA), lamina terminalis, and contralateral carotid were 70.7 ± 2.9 mm, 73.2 ± 2.9 mm, and 78.9 ± 4.1 mm, respectively. Viewing angle referenced to the ipsilateral ICA was 6.5 ± 4.2°, while the viewing angle for the lamina terminalis was 25.8 ± 4.3°. The surgical exposure provided by the ESTA was 1655 ± 255 mm2.

Conclusions

The ESTA provides a wide surgical view of the lamina terminalis and may be potentially used to approach lesions located in the anterior third of the third ventricle. As a pure endoscopic approach, the ESTA requires minimal brain retraction, while affords good visualization of targeted lesions around the lamina terminalis. The ESTA uses an anterolateral approach and so provides a short and straightforward approach to these structures.

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Abbreviations

ICA:

Internal carotid artery

mFLT

Microsurgical fenestration of the lamina terminalis

minLTBC

Minimally invasive fenestration of the lamina terminalis and basal cisterns

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Authors and Affiliations

  1. Department of Neurological Surgery, Wexner Medical Center, The Ohio State University, 410 W. 10th Ave., N-1049 Doan Hall, Columbus, OH, 43210, USA

    Rafael Martinez-Perez, Thiago Albonette-Felicio, Douglas A. Hardesty, Mostafa Shahein, Ricardo L. Carrau & Daniel M. Prevedello

  2. Department of Head and Neck Surgery, Wexner Medical Center, The Ohio State University, Columbus, OH, USA

    Douglas A. Hardesty, Ricardo L. Carrau & Daniel M. Prevedello

Authors
  1. Rafael Martinez-Perez
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  2. Thiago Albonette-Felicio
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  3. Douglas A. Hardesty
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  4. Mostafa Shahein
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  5. Ricardo L. Carrau
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  6. Daniel M. Prevedello
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Corresponding authors

Correspondence to Rafael Martinez-Perez or Daniel M. Prevedello.

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Conflict of interest

Daniel M. Prevedello is a consultant for Stryker Corporation and Medtronic Corp. Daniel Prevedello has equity on 3 rivers LLC, eLUM Technologies, LLC and Soliton LLC. Daniel Prevedello receives royalties from KLS-Martin and Mizuho. Ricardo L. Carrau is a consultant for Medtronic Corp.

Ethical approval and informed consent (to participate and for publication)

Informed consent and ethical approval were not deemed necessary by the local ethics in view of the design of the study (anatomy laboratory study). All anatomical dissections were performed at the Anatomical Laboratory for VisuoSpatial Innovations in Otolaryngology and Neurosurgery (ALT-VISION) at The Ohio State University, using standard institutionally approved practices for cadaveric specimens.

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This article is part of the Topical Collection on Neurosurgical Anatomy

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Martinez-Perez, R., Albonette-Felicio, T., Hardesty, D.A. et al. The endoscopic supraorbital translaminar approach: a technical note. Acta Neurochir 163, 635–641 (2021). https://doi.org/10.1007/s00701-020-04498-0

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  • DOI: https://doi.org/10.1007/s00701-020-04498-0

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