Quantitative Anatomic Study of the Transciliary Supraorbital Approach: Benefits of Additional Orbital Osteotomy?

The transciliary supraorbital approach (TCSO) provides an anterior view for visualizing sellar, parasellar, and suprasellar structures. Whether an orbital osteotomy adds to this exposure has not been quantified. We quantitatively evaluated the TCSO and benefits of an additional orbital osteotomy for...

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Bibliographic Details
Published in:	Neurosurgery Vol. 66; no. 6; pp. 205 - 210
Main Authors:	CAVALCANTI, Daniel D, GARCIA-GONZALEZ, Ulises, AGRAWAL, Abhishek, CRAWFORD, Neil R, TAVARES, Paulo Leonardo M. S, SPETZLER, Robert F, PREUL, Mark C
Format:	Journal Article
Language:	English
Published:	Hagerstown, MD Lippincott Williams & Wilkins 01-06-2010
Subjects:	Aged Aged, 80 and over Anterior Cerebral Artery - anatomy & histology Anterior Cerebral Artery - pathology Anterior Cerebral Artery - surgery Biological and medical sciences Cadaver Carotid Artery, Internal - anatomy & histology Carotid Artery, Internal - physiology Carotid Artery, Internal - surgery Circle of Willis - anatomy & histology Circle of Willis - pathology Circle of Willis - surgery Cranial Fossa, Anterior - anatomy & histology Cranial Fossa, Anterior - surgery Cranial Fossa, Middle - anatomy & histology Cranial Fossa, Middle - surgery Craniotomy - methods Craniotomy - standards Dissection - methods Female Frontal Bone - anatomy & histology Frontal Bone - surgery Humans Intracranial Aneurysm - pathology Intracranial Aneurysm - surgery Male Medical sciences Middle Cerebral Artery - anatomy & histology Middle Cerebral Artery - pathology Middle Cerebral Artery - surgery Neurosurgery Neurosurgical Procedures - methods Neurosurgical Procedures - standards Orbit - anatomy & histology Orbit - surgery Osteotomy - methods Osteotomy - standards Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Nervous system diseases Skull base Osteotomy Cardiovascular disease Minimally invasive neurosurgery Orbit (eye) Cerebral disorder Vascular disease Anatomic study intracranial aneurysm Surgery Central nervous system disease Orbital osteotomy Supraorbital craniotomy Skull Craniotomy Surgical approach Cerebrovascular disease
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Summary:	The transciliary supraorbital approach (TCSO) provides an anterior view for visualizing sellar, parasellar, and suprasellar structures. Whether an orbital osteotomy adds to this exposure has not been quantified. We quantitatively evaluated the TCSO and benefits of an additional orbital osteotomy for exposing common sites of anterior circulation aneurysms. Under image guidance, TCSO and orbital osteotomy were performed on 10 sides of 5 cadaver heads to quantify exposures of 4 surgical targets: (1) the junction of the anterior cerebral and anterior communicating arteries (ACoA); (2) the internal carotid artery (ICA) at the level of the posterior communicating artery (PCoA); (3) the bifurcation of the ICA; and (4) the middle cerebral artery (MCA) bifurcation. Horizontal and vertical angles of attack and surgical freedom for instrument manipulation were measured before and after the orbital rim and roof were removed. An orbital osteotomy significantly increased surgical freedom to the ACoA (from 471.15 +/- 182.14 mm2 to 683.35 +/- 283.78 mm2, P = .021); PCoA (from 746.58 +/- 242.78 mm2 to 966.23 +/- 360.22 mm2, P = .007); ICA bifurcation (from 616.08 +/- 310.95 mm2 to 922.38 +/- 374.88 mm2, P = .002); and MCA bifurcation (from 1160.77 +/- 412.03 mm2 to 1597.71 +/- 733.18 mm2, P = .004). There were no significant differences in horizontal angles of attack. The vertical angles of attack were significantly greater after orbital osteotomy, principally with the ACoA and ICA bifurcation as targets. TCSO combined with orbital osteotomy improves exposure. Removing the orbital rim and roof increases the area for instrument use and improves the vertical angle of attack to common sites in the anterior circulation involving aneurysms.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0148-396X 1524-4040
DOI:	10.1227/01.NEU.0000369948.37233.70