Document Detail

Quantitative anatomic study of the transciliary supraorbital approach: benefits of additional orbital osteotomy?
MedLine Citation:
PMID:  20489507     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: 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.
OBJECTIVE: We quantitatively evaluated the TCSO and benefits of an additional orbital osteotomy for exposing common sites of anterior circulation aneurysms.
METHODS: 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.
RESULTS: 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.
CONCLUSION: 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.
Daniel D Cavalcanti; Ulises García-González; Abhishek Agrawal; Neil R Crawford; Paulo Leonardo M S Tavares; Robert F Spetzler; Mark C Preul
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Neurosurgery     Volume:  66     ISSN:  1524-4040     ISO Abbreviation:  Neurosurgery     Publication Date:  2010 Jun 
Date Detail:
Created Date:  2010-05-21     Completed Date:  2010-12-16     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7802914     Medline TA:  Neurosurgery     Country:  United States    
Other Details:
Languages:  eng     Pagination:  205-10     Citation Subset:  IM    
Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
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MeSH Terms
Aged, 80 and over
Anterior Cerebral Artery / anatomy & histology,  pathology,  surgery
Carotid Artery, Internal / anatomy & histology,  physiology,  surgery
Circle of Willis / anatomy & histology,  pathology,  surgery
Cranial Fossa, Anterior / anatomy & histology,  surgery
Cranial Fossa, Middle / anatomy & histology,  surgery*
Craniotomy / methods*,  standards
Dissection / methods
Frontal Bone / anatomy & histology,  surgery*
Intracranial Aneurysm / pathology,  surgery*
Middle Cerebral Artery / anatomy & histology,  pathology,  surgery
Neurosurgical Procedures / methods,  standards
Orbit / anatomy & histology,  surgery*
Osteotomy / methods*,  standards
Comment In:
Neurosurgery. 2010 Dec;67(6):E1864-5   [PMID:  21107159 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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