Quantitative Analysis of the Supraorbital, Transorbital Microscopic, and Transorbital Neuroendoscopic Approaches to the Anterior Skull Base and Paramedian Vasculature

Lena Mary Houlihan, The Loyal and Edith Davis Neurosurgical Research Laboratory, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, United States.
Thanapong Loymak, The Loyal and Edith Davis Neurosurgical Research Laboratory, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, United States.
Irakliy Abramov, The Loyal and Edith Davis Neurosurgical Research Laboratory, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, United States.
Jubran H. Jubran, The Loyal and Edith Davis Neurosurgical Research Laboratory, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, United States.
Ann J. Staudinger Knoll, The Loyal and Edith Davis Neurosurgical Research Laboratory, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, United States.
Michael G. O'Sullivan, Department of Neurosurgery, Cork University Hospital, Wilton, Cork, Ireland.
Michael T. Lawton, The Loyal and Edith Davis Neurosurgical Research Laboratory, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, United States.
Mark C. Preul, The Loyal and Edith Davis Neurosurgical Research Laboratory, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, United States.

Document Type

Article

Abstract

Our objective was to compare transorbital neuroendoscopic surgery (TONES) with open craniotomy and analyze the effect of visualization technology on surgical freedom.  Anatomic dissections included supraorbital craniotomy (SOC), transorbital microscopic surgery (TMS), and TONES.  The study was performed in a neurosurgical anatomy laboratory.  Neurosurgeons dissecting cadaveric specimens were included in the study.  Morphometric analysis of cranial nerve (CN) accessible lengths, frontal lobe base area of exposure, and craniocaudal and mediolateral angle of attack and volume of surgical freedom (VSF) of the paraclinoid internal carotid artery (ICA), terminal ICA, and anterior communicating artery (ACoA).  The mean (standard deviation [SD]) frontal lobe base parenchymal exposures for SOC, TMS, and TONES were 955.4 (261.7) mm , 846.2 (249.9) mm , and 944.7 (158.8) mm , respectively. Access to distal vasculature was hindered when using TMS and TONES. Multivariate analysis estimated that accessing the paraclinoid ICA with SOC would provide an 11.2- mm increase in normalized volume (NV) compared with transorbital corridors ( p  < 0.001). There was no difference between the three approaches for ipsilateral terminal ICA VSF ( p  = 0.71). Compared with TONES, TMS provided more access to the terminal ICA. For the ACoA, SOC produced the greatest access corridor maneuverability (mean [SD] NV: 15.6 [5.6] mm for SOC, 13.7 [4.4] mm for TMS, and 7.2 [3.5] mm for TONES; p  = 0.01).  SOC provides superior surgical freedom for targets that require more lateral maneuverability, but the transorbital corridor is an option for accessing the frontal lobe base and terminal ICA. Instrument freedom differs quantifiably between the microscope and endoscope. A combined visualization strategy is optimal for the transorbital corridor.

Publication Date

6-1-2025

Publication Title

Journal of neurological surgery. Part B, Skull base

ISSN

2193-6331

Volume

86

Issue

3

First Page

313

Last Page

324

PubMed ID

40351872

Digital Object Identifier (DOI)

10.1055/s-0044-1786373

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