目标:尽管锁孔经眶入路越来越受欢迎,它们的适应症还没有得到充分的比较研究。在这项研究中,作者将它们定义为平移入路-这意味着他们使用蝶骨翼的不同相进行颅骨入路-并试图比较四个主要的入路:1)通过外侧can骨切口(LatOrb)进行的外侧眼眶切开术;2)通过眼睑切口(ModOzPalp)改良的眼眶入路;加上其扩展版本(SupraTransOrb)。
方法:在神经解剖学实验室进行尸体解剖。为了描绘颅底暴露,使用四个福尔马林固定头,双方致力于每种方法。通过图像指导评估外部界限,并相应地绘制和说明。第五个头是纯粹用内窥镜解剖的,只是为了便于概述转机的概念。还严格检查了定性特征。
结果:LatOrb在中颅窝(MCF)中被证明更通用,而前颅窝(ACF)的暴露仅限于蝶骨脊上方的一小部分。前路临床切除术是可能的;然而,视神经管顶部的暴露是次优的。ModOzPalp充分暴露了ACF和MCF。它的横向轨迹允许从下到上的视野,然而,限制进入内侧前颅底(嗅沟)。ModOzEyB还提供ACF和MCF的广泛曝光,但与ModOzPalp相比,轨迹更优越,使其更适合于到达内侧前颅底甚至对侧的病理。前路临床切除术可改善视神经管的可视化。SupraOrb主要提供前颅底暴露,有最小的中间窝。可以进行前路临床切除术,但没有直接观察上眶裂缝.如果外侧蝶骨机翼向下钻孔,则可以完成一些MCF访问,导致其高度通用的变体,SupraTransOrb.
结论:所有上述方法都使用蝶骨翼作为特定方向点的颅底走廊;因此这些方法被称为平移方法。它们的特殊性要求仔细选择病例,以有效和安全地完成手术目标。
Although keyhole transorbital approaches are gaining traction, their indications have not been adequately studied comparatively. In this study the authors have defined them also as transwing approaches-meaning that they use the different facies of the sphenoid wing for cranial entry-and sought to compare the four major ones: 1) lateral orbitocraniotomy through a lateral canthal incision (LatOrb); 2) modified orbitozygomatic approach through a palpebral incision (ModOzPalp); 3) modified orbitozygomatic approach through an eyebrow incision (ModOzEyB); and 4) supraorbital craniotomy through an eyebrow incision (SupraOrb), coupled with its expanded version (SupraTransOrb).
Cadaveric dissections were performed at the neuroanatomy lab. To delineate the skull base exposure, four formalin-fixed heads were used, with two sides dedicated to each approach. The outer limits were assessed via image guidance and were mapped and illustrated accordingly. A fifth head was dissected purely endoscopically, just to facilitate an overview of the transwing concept. Qualitative features were also rigorously examined.
The LatOrb proves to be more versatile in the middle cranial fossa (MCF), whereas the anterior cranial fossa (ACF) exposure is limited to a small area above the sphenoid ridge. An anterior clinoidectomy is possible; however, the exposure of the roof of the optic canal is suboptimal. The ModOzPalp adequately exposes both the ACF and MCF. Its lateral trajectory allows the inferior to superior view, yet there is restricted access to the medial anterior skull base (olfactory groove). The ModOzEyB also provides extensive exposure of the ACF and MCF, but has a more superior to inferior trajectory compared to the ModOzPalp, making it more appropriate for pathology reaching the medial anterior skull base or even the contralateral side. The anterior clinoidectomy is performed with improved visualization of the optic canal. The SupraOrb provides mainly anterior cranial base exposure, with minimal middle fossa. An anterior clinoidectomy can be performed, but without any direct observation of the superior orbital fissure. Some MCF access can be accomplished if the lateral sphenoid wing is drilled inferiorly, leading to its highly versatile variant, the SupraTransOrb.
All the aforementioned approaches use the sphenoid wing as skull base corridor from a specific orientation point; hence these are designated as transwing approaches. Their peculiarities mandate careful case selection for the effective and safe completion of the surgical goals.