The Extended Lateral Supraorbital Approach and Extradural Anterior Clinoidectomy Through a Frontopterio-Orbital Window : Technical Note and Pilot Surgical Series

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Andrade-Barazarte , H , Jagersberg , M , Belkhair , S , Tymianski , R , Turel , M K , Schaller , K , Hernesniemi , J A , Tymianski , M & Radovanovic , I 2017 , ' The Extended Lateral Supraorbital Approach and Extradural Anterior Clinoidectomy Through a Frontopterio-Orbital Window : Technical Note and Pilot Surgical Series ' , World Neurosurgery , vol. 100 , pp. 159-166 . https://doi.org/10.1016/j.wneu.2016.12.087

Title: The Extended Lateral Supraorbital Approach and Extradural Anterior Clinoidectomy Through a Frontopterio-Orbital Window : Technical Note and Pilot Surgical Series
Author: Andrade-Barazarte, Hugo; Jagersberg, Max; Belkhair, Sirajeddin; Tymianski, Rachel; Turel, Mazda K.; Schaller, Karl; Hernesniemi, Juha A.; Tymianski, Michael; Radovanovic, Ivan
Contributor organization: Department of Neurosciences
Clinicum
Neurokirurgian yksikkö
HUS Neurocenter
Date: 2017-04
Language: eng
Number of pages: 8
Belongs to series: World Neurosurgery
ISSN: 1878-8750
DOI: https://doi.org/10.1016/j.wneu.2016.12.087
URI: http://hdl.handle.net/10138/236980
Abstract: BACKGROUND: Lateral approaches to treat anterior cranial fossa lesions have evolved since the first frontotemporal approach described by Dandy in 1918. We describe a less invasive approach to perform extradural anterior clinoidectomy through a lateral supraorbital (LSO) approach for anterior circulation aneurysms and anterolateral skull base lesions. METHODS: The extended LSO approach involves performing a standard lateral supraorbital craniotomy followed by drilling of the sphenoid wing and lateral wall of the orbit through the frontal bony opening of the LSO approach, without any temporal extension of the craniotomy. This creates a frontopterio-orbital window exposing the periorbita; superior, medial, and anterior aspect of the temporal dura mater; and superior orbital fissure. After unroofing the superior orbital fissure, the meningo- orbital fold is cut, and the temporal dura mater is peeled from the lateral wall of the cavernous sinus to expose the anterior clinoid process allowing a standard opening of the optic canal and anterior clinoidectomy. RESULTS: The extended LSO approach and extradural anterior clinoidectomy allowed access to 4 sphenoid wing/anterior clinoidal meningiomas, 5 anterior circulation aneurysms, 2 temporomesial lesions, and 1 orbital/cavernous sinus abscess. Postoperatively, 2 patients had transient hemiparesis, 2 patients had transient third nerve palsy, and 1 patient had minimal visual field deterioration. All patients had a modified Rankin Scale score CONCLUSION: The extended LSO approach opens a new route (frontopterio-orbital window) to perform extradural anterior clinoidectomy safely and increases surgical exposure, angles, and operability of a less invasive keyhole craniotomy (LSO approach) to treat anterior cranial fossa lesions.
Subject: Anterior cranial fossa
Extradural anterior clinoidectomy
Intracranial aneurysm
Lateral supraorbital approach
Tumor
CONSECUTIVE PATIENTS
EXPERIENCE
ANEURYSMS
ANATOMY
3112 Neurosciences
3124 Neurology and psychiatry
3126 Surgery, anesthesiology, intensive care, radiology
Peer reviewed: Yes
Rights: unspecified
Usage restriction: openAccess
Self-archived version: publishedVersion


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