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Quantitative analysis of the surgical exposure and surgical freedom between transcranial and transorbital endoscopic anterior petrosectomies to the posterior fossa.
Noiphithak, Raywat; Yanez-Siller, Juan C; Revuelta Barbero, Juan Manuel; Otto, Bradley A; Carrau, Ricardo L; Prevedello, Daniel M.
Afiliación
  • Noiphithak R; 1Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Thammasat University, Pathumthani, Thailand; and.
  • Yanez-Siller JC; Departments of2Neurosurgery and.
  • Revuelta Barbero JM; 3Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio.
  • Otto BA; Departments of2Neurosurgery and.
  • Carrau RL; Departments of2Neurosurgery and.
  • Prevedello DM; 3Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio.
J Neurosurg ; 131(2): 569-577, 2018 08 03.
Article en En | MEDLINE | ID: mdl-30074460
OBJECT: This study proposes a variation of the transorbital endoscopic approach (TOEA) that uses the lateral orbit as the primary surgical corridor, in a minimally invasive fashion, for the posterior fossa (PF) access. The versatility of this technique was quantitatively analyzed in comparison with the anterior transpetrosal approach (ATPA), which is commonly used for managing lesions in the PF. METHODS: Anatomical dissections were carried out in 5 latex-injected human cadaveric heads (10 sides). During dissection, the PF was first accessed by TOEAs through the anterior petrosectomy, both with and without lateral orbital rim osteotomies (herein referred as the lateral transorbital approach [LTOA] and the lateral orbital wall approach [LOWA], respectively). ATPAs were performed following the orbital approaches. The stereotactic measurements of the area of exposure, surgical freedom, and angles of attack to 5 anatomical targets were obtained for statistical comparison by the neuronavigator. RESULTS: The LTOA provided the smallest area of exposure (1.51 ± 0.5 cm2, p = 0.07), while areas of exposure were similar between LOWA and ATPA (1.99 ± 0.7 cm2 and 2.01 ± 1.0 cm2, respectively; p = 0.99). ATPA had the largest surgical freedom, whereas that of LTOA was the most restricted. Similarly, for all targets, the vertical and horizontal angles of attack achieved with ATPA were significantly broader than those achieved with LTOA. However, in LOWA, the removal of the lateral orbital rim allowed a broader range of movement in the horizontal plane, thus granting a similar horizontal angle for 3 of the 5 targets in comparison with ATPA. CONCLUSIONS: The TOEAs using the lateral orbital corridor for PF access are feasible techniques that may provide a comparable surgical exposure to the ATPA. Furthermore, the removal of the orbital rim showed an additional benefit in an enhancement of the surgical maneuverability in the PF.
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Texto completo: 1 Base de datos: MEDLINE Asunto principal: Órbita / Hueso Petroso / Fosa Craneal Posterior / Neuroendoscopía Tipo de estudio: Evaluation_studies Límite: Humans Idioma: En Revista: J Neurosurg Año: 2018 Tipo del documento: Article

Texto completo: 1 Base de datos: MEDLINE Asunto principal: Órbita / Hueso Petroso / Fosa Craneal Posterior / Neuroendoscopía Tipo de estudio: Evaluation_studies Límite: Humans Idioma: En Revista: J Neurosurg Año: 2018 Tipo del documento: Article