Abstract：
Skull base lesions within the middle cranial fossa (MCF) remain challenging. Recent reports suggest that transorbital endoscopic approaches (TOEAs) might be particularly suitable to access the MCF and expose the lateral wall of the cavernous sinus and the Meckel\'s cave.
The present study was developed to compare the nuances of the subtemporal approach (STA) with those of the lateral TOEA (LTOEA) to the MCF and posterior cranial fossa (PCF) in cadaveric specimens. After orbital craniectomy, interdural opening of the cavernous sinus lateral wall (CSlw), exposure of the Gasserian ganglion, and extradural elevation of the temporal lobe was performed. Next, anterior endoscopic petrosectomy was performed and the PCF was accessed. We quantitatively analyzed and compared the angles of attack and distances between LTOEA and STA to different structures at the CSlw, petrous apex (PA), and PCF.
Cadaveric dissection through the LTOEA completely exposed the CSlw and PA. LTOA exhibited larger distances than the STA to all targets. Importantly, these differences were greater at the PA and its surrounding key anatomic landmarks. The horizontal and vertical angles of attack allowed by the LTOA were smaller both for the CSlw and PA. However, these differences were not significant for the vertical angle of attack at the CSlw.
LTOEA provides a direct ventral route to the medial aspect of MCF, PA, and PCF. Although TOEAs are versatile approaches, the unfamiliar surgical anatomy and limited instrument maneuverability demand extensive cadaveric dissection before moving to the clinical setting.
The present study was developed to compare the nuances of the subtemporal approach (STA) with those of the lateral TOEA (LTOEA) to the MCF and posterior cranial fossa (PCF) in cadaveric specimens. After orbital craniectomy, interdural opening of the cavernous sinus lateral wall (CSlw), exposure of the Gasserian ganglion, and extradural elevation of the temporal lobe was performed. Next, anterior endoscopic petrosectomy was performed and the PCF was accessed. We quantitatively analyzed and compared the angles of attack and distances between LTOEA and STA to different structures at the CSlw, petrous apex (PA), and PCF.
Cadaveric dissection through the LTOEA completely exposed the CSlw and PA. LTOA exhibited larger distances than the STA to all targets. Importantly, these differences were greater at the PA and its surrounding key anatomic landmarks. The horizontal and vertical angles of attack allowed by the LTOA were smaller both for the CSlw and PA. However, these differences were not significant for the vertical angle of attack at the CSlw.
LTOEA provides a direct ventral route to the medial aspect of MCF, PA, and PCF. Although TOEAs are versatile approaches, the unfamiliar surgical anatomy and limited instrument maneuverability demand extensive cadaveric dissection before moving to the clinical setting.
摘要：
背景：中颅窝（MCF）内的颅底病变仍然具有挑战性。最近的报道表明，经眶内窥镜入路（TOEA）可能特别适合进入MCF并暴露海绵窦和Meckel洞穴的侧壁。
方法：本研究旨在比较尸体标本中颞下入路（STA）与外侧TOEA（LTOEA）与MCF和后颅窝（PCF）的细微差别。眼眶骨瓣切除术后,海绵窦侧壁（CSlw）的硬膜间开口，Gasserian神经节的暴露,并进行颞叶硬膜外抬高。接下来,进行了前路内窥镜岩石切除术，并进入了PCF。我们定量分析并比较了LTOEA和STA对CSlw处不同结构的攻角和距离，岩尖（PA），和PCF。
结果：通过LTOEA进行的尸体解剖完全暴露了CSlw和PA。LTOA显示比STA到所有目标的距离更大。重要的是,这些差异在PA及其周围关键解剖标志处更大。对于CSlw和PA，LTOA允许的水平和垂直攻角均较小。然而,这些差异对于CSlw的垂直攻角并不显著。
结论：LTOEA为MCF的内侧提供了直接的腹侧途径，PA,和PCF。虽然TOEA是通用的方法，不熟悉的手术解剖结构和有限的器械可操作性需要在转移到临床环境之前进行广泛的尸体解剖。
方法：本研究旨在比较尸体标本中颞下入路（STA）与外侧TOEA（LTOEA）与MCF和后颅窝（PCF）的细微差别。
结果：通过LTOEA进行的尸体解剖完全暴露了CSlw和PA。
结论：LTOEA为MCF的内侧提供了直接的腹侧途径，
