目的:内镜经眶入路(ETOA)已被证明是通往岩尖的可行腹侧途径。然而,它被认为是前岩石切除术的深而狭窄的走廊;特别是,当瞄准岩流区域时,仪器的中介化可能会成为一个问题。为了克服这个限制,已建议使用带有眼眶边缘去除的ETOA(ETOA-OR),但不是事实上的比较,在不移除轮缘的情况下经眶入路。这种添加可以增加进入岩尖区域时的手术暴露和运动自由。
方法:解剖五个人尸体头部(10侧)。首先,通过常规的ETOA(不切除眶缘)进行前路岩石切除术.第二,整块去除眼眶边缘,随着眼眶骨瓣切除术的扩大,随后,内岩尖的进一步钻孔。提供定性和定量比较。还示出了说明性的外科手术情况。
结果:经眶途径允许作者对所有标本进行前岩性切除术。骨去除的标志叠加在经颅路径上。ETOA-OR增加了颅骨切除术的体积(从4.0mL增加到5.5mL),外侧内侧角度,和岩区内仪器的超下角度。因此,这种方法改善了内侧岩壁区域的暴露,允许进行扩大的岩石切除术(从1.4毫升到2.0毫升,增加39.5%),并提高机动性,岩区(从44.1cm2到76.5cm2,增加73.3%)和后颅窝(从20.2cm2到52.0cm2,增加158%)。ETOA-OR也被实用地用于治疗复发性岩壁脑膜瘤。实现了完全移除,外展神经麻痹得到改善,三叉神经痛的严重程度有所减轻,仍然需要药物治疗。
结论:作者提供了保留眼缘的经眶入路与去除眼缘以进入岩尖的经眶入路之间的首次正式解剖学比较。此外,一个说明性的案例被用作概念和可行性的证明。根据作者的数据,ETOA-OR显著改善了手术暴露和外科医生在这一深部区域的舒适度.骨缺损可以重建,以避免美容畸形,维持经眶手术的最小破坏性概念。
OBJECTIVE: The endoscopic transorbital approach (ETOA) has been demonstrated to be a feasible ventral route to the petrous apex. Yet, it has been pointed to as a deep and narrow corridor for anterior petrosectomy; particularly, medialization of the instruments can become an issue when targeting the petroclival area. To overcome this limitation, an ETOA with orbital rim removal (ETOA-OR) has been suggested, but not de facto compared, with a transorbital approach without removal of the rim. This addition could augment the surgical exposure and freedom of movement when accessing the petrous apex area.
METHODS: Five human cadaveric heads (10 sides) were dissected. First, anterior petrosectomy was performed via a conventional ETOA (without orbital rim removal). Second, en bloc removal of the orbital rim was performed, with enlargement of the orbital craniectomy and, subsequently, further drilling of the medial petrous apex. Qualitative and quantitative comparisons are provided. An illustrative surgical case is also shown.
RESULTS: The transorbital route allowed the authors to perform an anterior petrosectomy in all specimens. The landmarks of bone removal are superposed onto those in the transcranial route. The ETOA-OR increased the volume of craniectomy (from 4.0 mL to 5.5 mL), the lateromedial angulation, and superoinferior angulation of the instruments within the petrous area. Thus, this approach improved the exposure of the medial petroclival area, allowing for an augmented petrosectomy (from 1.4 mL to 2.0 mL, 39.5% increase) and for increased maneuverability, both in the petrous area (from 44.1 cm2 to 76.5 cm2, 73.3% increase) and in the posterior fossa (from 20.2 cm2 to 52.0 cm2, 158% increase). The ETOA-OR was also pragmatically applied to treat a recurrent petroclival meningioma. Complete removal was achieved, the abducens nerve palsy improved, and the trigeminal neuralgia decreased in severity, yet still required medication.
CONCLUSIONS: The authors provide the first formal anatomical comparison between the transorbital approach with preservation of the orbital rim and a transorbital approach with removal of the rim to access the petrous apex. In addition, an illustrative case is used as a proof of concept and feasibility. According to the authors\' data, the ETOA-OR significantly improves surgical exposure and the surgeon\'s comfort in this deep region. The bony defect can be reconstructed to avoid cosmetic deformities, maintaining the minimally disruptive concept of transorbital surgery.