Minimally Invasive Approaches for Anterior Skull Base Meningiomas: Supraorbital Eyebrow, Endoscopic Endonasal, or a Combination of Both? - Anatomical Study, Limitations and Surgical Application.

Minimally Invasive Approaches for Anterior Skull Base Meningiomas: Supraorbital Eyebrow, Endoscopic Endonasal, or a Combination of Both? - Anatomical Study, Limitations and Surgical Application.

World Neurosurg. 2018 Jan 25;:

Authors: Borghei-Razavi H, Truong HQ, Fernandes-Cabral DT, Celtikci E, Chabot JD, Stefko ST, Wang EW, Snyderman CH, Cohen-Gadol A, Gardner PA, Fernández-Miranda JC

Abstract
BACKGROUND: Minimally invasive accesses to the anterior skull base include endoscopic endonasal approach (EEA) and supraorbital eyebrow approach. The two are often seen as competing and not alternative or combinatory approaches. In this study, we evaluated the anatomical limitations of each approach and the combined approach for accessing the anterior skull base.
METHODS: Ten neurovascular injected cadaver heads were used for the study. Supraorbital approach to the anterior skull base was performed on five heads, and EEA was done on the other five. Then, supraorbital approach was added to the five heads receiving EEA. Visualization and surgical limitations were recorded by the ability to perform resection of crista galli, anterior clinoid, cribriform plate, and planum sellae.
RESULT: The maximal lateral extension of EEA for anterior skull base was the mid-orbit line anteriorly but narrowing down toward the orbital apex. The limitation of supraorbital approach was found mostly medial and anterior. Drilling of anterior skull base was impossible medially between the sphenoethmoidal suture and the posterior aspect of the crista galli. The combined approach showed complementary area of visualization and surgical maneuverability. Three clinical cases were presented to illustrate the indications for standalone supraorbital approach, EEA, and combined approach.
CONCLUSION: The limitations of EEA when dealing with lateral extension of anterior skull base meningiomas, and the limitations of supraorbital eyebrow approach for medial skull base drilling and reconstruction, can be overcome by a judicious, anatomically-based combination of both approaches.

PMID: 29378344 [PubMed - as supplied by publisher]

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