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Surgical anatomy of the cavernous sinus, superior orbital fissure, and orbital apex via a lateral orbitotomy approach: a cadaveric anatomical study.
Acta Neurochir (Wien). 2016 11; 158(11):2135-2148.AN

Abstract

BACKGROUND

Tumors of the middle fossa or cavernous sinus (CS), or intraorbital tumors, can penetrate each other through the superior orbital fissure (SOF) or neighboring tissue. These complicated pathologies are often treated with highly invasive surgical procedures. In this article, we demonstrate surgical anatomic dissections of the CS, SOF, orbital apex (OA), and dura mater extending to the periorbita from the middle fossa, by performing an epidural dissection via a lateral orbitotomy approach, and discuss findings that may provide guidance during surgery in these regions.

METHODS

Lateral orbitotomy was performed on latex-injected cadaver heads by making a 2-cm skin incision lateral to the lateral canthus, drilling the lesser and greater sphenoid wings that form the SOF borders, and removing the bone section between the middle fossa and orbit. Dura mater from the middle fossa to the periorbita was exposed to perform anterior clinoidectomy. Meningeal dura was dissected from the endosteal dura, which forms the lateral wall of the CS, to expose the CS, SOF, and OA for dissections.

RESULTS

Changing the orientation of the microscope from posterior to anterior enabled regional control for dissection from the Gasserian ganglion to the OA. Cranial nerves that pass through the CS, SOF, and OA were dissected and exposed. The annular tendon was opened, revealing the oculomotor nerves and its branches, as well as the abducens and nasociliary nerves, which pass through the oculomotor foramen and course within the OA and orbit.

CONCLUSIONS

This approach causes less tissue damage; provides control of the surgical area in spheno-orbital tumors invading the fissure and foramen by changing the orientation of the microscope toward the orbit, OA, SOF, CS, and middle fossa; and expands the indication criteria for lateral orbitotomy surgery. This approach, therefore, represents an alternative surgical method for excising complicated tumors in these regions.

Authors+Show Affiliations

Department of Neurosurgery, Sanko University School of Medicine, Gaziantep, Sehitkamil, Turkey. nrsrgn@yahoo.com. Emek mah, İbrahimli yolu cad, ayışıgı apt No:25, kat 2, daire 3, Gaziantep, Sehitkamil, Turkey. nrsrgn@yahoo.com.Department of Neurosurgery, Acıbadem Hospital, Bursa, Turkey.Department of Neurosurgery, Bahcesehir University School of Medicine, Istanbul, Goztepe, Turkey.Department of Neurosurgery, Bahcesehir University School of Medicine, Istanbul, Goztepe, Turkey.Professor of Neurosurgery, Private Clinic, Bursa, Turkey.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27614437

Citation

Ulutas, Murat, et al. "Surgical Anatomy of the Cavernous Sinus, Superior Orbital Fissure, and Orbital Apex Via a Lateral Orbitotomy Approach: a Cadaveric Anatomical Study." Acta Neurochirurgica, vol. 158, no. 11, 2016, pp. 2135-2148.
Ulutas M, Boyacı S, Akakın A, et al. Surgical anatomy of the cavernous sinus, superior orbital fissure, and orbital apex via a lateral orbitotomy approach: a cadaveric anatomical study. Acta Neurochir (Wien). 2016;158(11):2135-2148.
Ulutas, M., Boyacı, S., Akakın, A., Kılıç, T., & Aksoy, K. (2016). Surgical anatomy of the cavernous sinus, superior orbital fissure, and orbital apex via a lateral orbitotomy approach: a cadaveric anatomical study. Acta Neurochirurgica, 158(11), 2135-2148.
Ulutas M, et al. Surgical Anatomy of the Cavernous Sinus, Superior Orbital Fissure, and Orbital Apex Via a Lateral Orbitotomy Approach: a Cadaveric Anatomical Study. Acta Neurochir (Wien). 2016;158(11):2135-2148. PubMed PMID: 27614437.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Surgical anatomy of the cavernous sinus, superior orbital fissure, and orbital apex via a lateral orbitotomy approach: a cadaveric anatomical study. AU - Ulutas,Murat, AU - Boyacı,Suat, AU - Akakın,Akın, AU - Kılıç,Türker, AU - Aksoy,Kaya, Y1 - 2016/09/10/ PY - 2016/05/04/received PY - 2016/08/17/accepted PY - 2016/9/12/pubmed PY - 2017/7/25/medline PY - 2016/9/12/entrez KW - Anterior clinoid KW - Cavernous sinus KW - Lateral orbitotomy KW - Oculomotor foramen KW - Orbital apex KW - Superior orbital fissure SP - 2135 EP - 2148 JF - Acta neurochirurgica JO - Acta Neurochir (Wien) VL - 158 IS - 11 N2 - BACKGROUND: Tumors of the middle fossa or cavernous sinus (CS), or intraorbital tumors, can penetrate each other through the superior orbital fissure (SOF) or neighboring tissue. These complicated pathologies are often treated with highly invasive surgical procedures. In this article, we demonstrate surgical anatomic dissections of the CS, SOF, orbital apex (OA), and dura mater extending to the periorbita from the middle fossa, by performing an epidural dissection via a lateral orbitotomy approach, and discuss findings that may provide guidance during surgery in these regions. METHODS: Lateral orbitotomy was performed on latex-injected cadaver heads by making a 2-cm skin incision lateral to the lateral canthus, drilling the lesser and greater sphenoid wings that form the SOF borders, and removing the bone section between the middle fossa and orbit. Dura mater from the middle fossa to the periorbita was exposed to perform anterior clinoidectomy. Meningeal dura was dissected from the endosteal dura, which forms the lateral wall of the CS, to expose the CS, SOF, and OA for dissections. RESULTS: Changing the orientation of the microscope from posterior to anterior enabled regional control for dissection from the Gasserian ganglion to the OA. Cranial nerves that pass through the CS, SOF, and OA were dissected and exposed. The annular tendon was opened, revealing the oculomotor nerves and its branches, as well as the abducens and nasociliary nerves, which pass through the oculomotor foramen and course within the OA and orbit. CONCLUSIONS: This approach causes less tissue damage; provides control of the surgical area in spheno-orbital tumors invading the fissure and foramen by changing the orientation of the microscope toward the orbit, OA, SOF, CS, and middle fossa; and expands the indication criteria for lateral orbitotomy surgery. This approach, therefore, represents an alternative surgical method for excising complicated tumors in these regions. SN - 0942-0940 UR - https://www.unboundmedicine.com/medline/citation/27614437/Surgical_anatomy_of_the_cavernous_sinus_superior_orbital_fissure_and_orbital_apex_via_a_lateral_orbitotomy_approach:_a_cadaveric_anatomical_study_ L2 - https://dx.doi.org/10.1007/s00701-016-2940-z DB - PRIME DP - Unbound Medicine ER -