Abstract：
The superior eyelid endoscopic transorbital approach (SETOA) provides a direct and short minimally invasive route to the anterior and middle skull base. Nevertheless, it uses a narrow corridor that limits its angles of attack. The aim of this study was to evaluate the feasibility and potential benefits of an \"extended\" conservative variant of the \"standard\" endoscopic transorbital approach-termed \"open-door\"-to enhance the exposure of lesions affecting the paramedian aspect of the anterior and middle cranial fossae.
First, the authors described the technical nuances of the open-door extended transorbital approach (ODETA). Next, they documented its morphometric advantages over standard SETOA. Finally, they provided a clinical-anatomical application to demonstrate enhanced exposure and better angles of attack to treat lesions occupying the paramedian anterior and middle cranial fossae. Five adult cadaveric specimens (10 sides) initially underwent standard SETOA and then extended open-door SETOA (ODETA to the paramedian anterior and middle fossae). The adjunct of hinge-orbitotomy, through three surgical steps and straddling the frontozygomatic suture, converted conventional SETOA to its extended open-door variant. CT scans were performed before dissection and uploaded to the neuronavigation system for quantitative analysis. The angles of attack on the axial plane that addressed four key landmarks, namely the tip of the anterior clinoid process (ACP), foramen rotundum (FR), foramen ovale (FO), and trigeminal impression (TI), were calculated for both operative techniques and compared.
Hinge-orbitotomy of the extended open-door SETOA resulted in several surgical, functional, and esthetic advantages: it provided wider axial angles of attack for each of the target points, with a gain angle of 26.68° ± 1.31° for addressing the ACP (p < 0.001), 29.50° ± 2.46° for addressing the FR (p < 0.001), 19.86° ± 1.98° for addressing the FO (p < 0.001), and 17.44° ± 2.21° for addressing the lateral aspect of the TI (p < 0.001), while hiding the skin scar, avoiding temporalis muscle dissection, preserving flap vascularization, and decreasing the rate of bone infection and degree of orbital content retraction.
The extended open-door technique may be specifically suited for selected patients affected by paramedian anterior and middle fossae lesions, with prevalent anteromedial extension toward the anterior clinoid, the foremost compartment of the cavernous sinus and FR and not completely controlled with the pure endoscopic transorbital approach.
First, the authors described the technical nuances of the open-door extended transorbital approach (ODETA). Next, they documented its morphometric advantages over standard SETOA. Finally, they provided a clinical-anatomical application to demonstrate enhanced exposure and better angles of attack to treat lesions occupying the paramedian anterior and middle cranial fossae. Five adult cadaveric specimens (10 sides) initially underwent standard SETOA and then extended open-door SETOA (ODETA to the paramedian anterior and middle fossae). The adjunct of hinge-orbitotomy, through three surgical steps and straddling the frontozygomatic suture, converted conventional SETOA to its extended open-door variant. CT scans were performed before dissection and uploaded to the neuronavigation system for quantitative analysis. The angles of attack on the axial plane that addressed four key landmarks, namely the tip of the anterior clinoid process (ACP), foramen rotundum (FR), foramen ovale (FO), and trigeminal impression (TI), were calculated for both operative techniques and compared.
Hinge-orbitotomy of the extended open-door SETOA resulted in several surgical, functional, and esthetic advantages: it provided wider axial angles of attack for each of the target points, with a gain angle of 26.68° ± 1.31° for addressing the ACP (p < 0.001), 29.50° ± 2.46° for addressing the FR (p < 0.001), 19.86° ± 1.98° for addressing the FO (p < 0.001), and 17.44° ± 2.21° for addressing the lateral aspect of the TI (p < 0.001), while hiding the skin scar, avoiding temporalis muscle dissection, preserving flap vascularization, and decreasing the rate of bone infection and degree of orbital content retraction.
The extended open-door technique may be specifically suited for selected patients affected by paramedian anterior and middle fossae lesions, with prevalent anteromedial extension toward the anterior clinoid, the foremost compartment of the cavernous sinus and FR and not completely controlled with the pure endoscopic transorbital approach.
摘要：
目的：上眼睑内窥镜经眶入路（SETOA）提供了通往前颅底和中颅底的直接且短的微创途径。然而，它使用狭窄的走廊来限制其攻角。这项研究的目的是评估“标准”内窥镜经眶入路的“扩展”保守变体的可行性和潜在益处，该方法称为“开门”，以增强影响前颅窝和中颅窝的旁正中方面的病变的暴露。
方法：首先，作者描述了开放式扩展经眶入路(ODETA)的技术细微差别.接下来,他们记录了其形态计量学优于标准SETOA。最后,他们提供了一种临床解剖学应用，以证明暴露增强和攻角更好，可以治疗占据副正中前颅窝和中颅窝的病变。五个成年尸体标本（10面）最初接受了标准SETOA，然后延长了开门SETOA（ODETA到旁正中前窝和中窝）。铰链-眼眶切开术的辅助手段，通过三个手术步骤和跨前颧骨缝合，将传统的SETOA转换为其扩展的开放式变体。解剖前进行CT扫描，并上传到神经导航系统进行定量分析。指向四个关键地标的轴向平面的迎角，即前斜突（ACP）的尖端，圆孔（FR），卵圆孔（FO），和三叉神经印象（TI），对两种手术技术进行了计算并进行了比较。
结果：延长的开放式SETOA的铰链眼眶切开术导致了几次手术，功能，和美学优势：它为每个目标点提供了更宽的轴向攻角，增益角为26.68°±1.31°，用于寻址ACP（p<0.001），29.50°±2.46°，用于寻址FR(p<0.001)，19.86°±1.98°，用于寻址FO(p<0.001)，和17.44°±2.21°，用于寻址TI的横向（p<0.001），在隐藏皮肤疤痕的同时，避免颞肌解剖，保留皮瓣血管化，降低骨感染率和眼眶内容物回缩程度。
结论：扩展的开门技术可能特别适用于患有旁正中前窝和中窝病变的选定患者，普遍的前内侧向前斜关节延伸，海绵窦和FR的最前室，不能完全用内窥镜经眶入路控制。
方法：首先，作者描述了开放式扩展经眶入路(ODETA)的技术细微差别.接下来,他们记录了其形态计量学优于标准SETOA。最后,他们提供了一种临床解剖学应用，以证明暴露增强和攻角更好，可以治疗占据副正中前颅窝和中颅窝的病变。五个成年尸体标本（10面）最初接受了标准SETOA，然后延长了开门SETOA（ODETA到旁正中前窝和中窝）。铰链-眼眶切开术的辅助手段，通过三个手术步骤和跨前颧骨缝合，将传统的SETOA转换为其扩展的开放式变体。解剖前进行CT扫描，并上传到神经导航系统进行定量分析。指向四个关键地标的轴向平面的迎角，即前斜突（ACP）的尖端，圆孔（FR），卵圆孔（FO），和三叉神经印象（TI），对两种手术技术进行了计算并进行了比较。
结果：延长的开放式SETOA的铰链眼眶切开术导致了几次手术，功能，和美学优势：它为每个目标点提供了更宽的轴向攻角，增益角为26.68°±1.31°，用于寻址ACP（p<0.001），29.50°±2.46°，用于寻址FR(p<0.001)，19.86°±1.98°，用于寻址FO(p<0.001)，和17.44°±2.21°，用于寻址TI的横向（p<0.001），在隐藏皮肤疤痕的同时，避免颞肌解剖，保留皮瓣血管化，降低骨感染率和眼眶内容物回缩程度。
结论：扩展的开门技术可能特别适用于患有旁正中前窝和中窝病变的选定患者，普遍的前内侧向前斜关节延伸，海绵窦和FR的最前室，不能完全用内窥镜经眶入路控制。
