The classical supraorbital minicraniotomy to approach the areas of origin of anterior skull base meningiomas: Anatomical nuances influencing accessibility, operability, and frontal lobe retraction.
Surg Neurol Int
; 15: 168, 2024.
Article
en En
| MEDLINE
| ID: mdl-38840607
ABSTRACT
Background:
The classical supraorbital minicraniotomy (cSOM) constitutes a minimally invasive alternative for the resection of anterior skull base meningiomas (ASBM). Surgical success depends strongly on optimal patient selection and surgery planning, for which a careful assessment of tumor characteristics, approach trajectory, and bony anterior skull base anatomy is required. Still, morphometrical studies searching for relevant anatomical factors with surgical relevance when intending a cSOM for ASBM resection are lacking.Methods:
Bilateral cSOM was done in five formaldehyde-fixed heads toward the areas of origin of ASBM. Morphometrical data with potential relevant surgical implications were analyzed.Results:
The more tangential position of the cSOM with respect to the olfactory groove (OG) led to a reduction in surgical freedom (SF) in this area compared to others (P < 0.0001). Frontal lobe retraction (FLR) was also higher when approaching the OG (P < 0.05). Olfactory nerve mobilization was higher when accessing the planum sphenoidale (PS), tuberculum sellae (TS), and anterior clinoid process (ACP) (P < 0.0001). OG depth and the slope of the sphenoid bone between the PS and TS predicted lower SF and higher frontal retraction requirements along the OG and TS, respectively (P < 0.05). In contrast, longer distances to the ACP tip predicted lower SF over this structure (P < 0.01).Conclusion:
Although clinical validation is still needed, the present anatomical data suggest that assessing minicraniotomy's position/extension, OG depth, the sphenoid's slope, and distance to ACP-tip might be of particular relevance to predict FLR, maneuverability, and accessibility when considering the cSOM for ASBM resection, thus helping surgeons optimize patient selection and surgical strategy.
Texto completo:
1
Banco de datos:
MEDLINE
Idioma:
En
Año:
2024
Tipo del documento:
Article