The supraorbital approach for resection of meningiomas of the anterior skull base: a large retrospective surgical and anatomical study

To the authors' knowledge, this is the first report of the use of anterior orbitotomy via the supraorbital eyelid crease to repair a dural tear caused by an orbital roof fracture. When transorbital penetrating injuries occur in children, they are commonly caused by accidental falls onto pointed objects. The authors report on their experience with a 7-year-old girl who fell onto a blunt metal rod hanger that penetrated her left eyelid, traversed superior to the eye globe, and penetrated the orbital roof at a depth of 3–4 cm, lacerating the dura mater and entering the cerebrum. An anterior transpalpebral transorbital approach was used to perform the microsurgical anterior skull base and dural repair. The authors advocate the application of this approach to orbital roof fractures because it provides excellent access to the orbital roof, eliminates the need for more invasive craniotomy, results in a small and well-hidden scar in the eye crease, and overall offers a shorter recovery time with less psychological stress to the patient.

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The lateral supraorbital approach, doable and cosmetic access to anterior skull base

Egyptian Journal of Neurosurgery ◽

10.1186/s41984-020-00086-7 ◽

2020 ◽

Vol 35 (1) ◽

Author(s):

Ahmed Abdelaziz Elsharkawy ◽

Essam Ahmed Abdelhameed

Keyword(s):

Skull Base ◽

Anterior Skull Base ◽

Supraorbital Approach ◽

Lateral Supraorbital Approach

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Anterior Skull Base Analysis from Coronal and Reconstructed Computed Tomography: Radio-Anatomical Study

Nepal Medical College Journal ◽

10.3126/nmcj.v23i4.42216 ◽

2021 ◽

Vol 23 (4) ◽

pp. 302-307

Author(s):

Bhima Neupane ◽

Phanindra Prasad Poudel ◽

Prakash Sharma ◽

Krishna Koirala ◽

Brihaspati Sigdel

Keyword(s):

Ct Scan ◽

Skull Base ◽

Computerized Tomography ◽

Skull Base Surgery ◽

Anatomical Study ◽

Anterior Skull Base ◽

Cribriform Plate ◽

Bony Landmarks ◽

Nasal Floor ◽

Base Analysis

Endoscopic sinus and skull base Surgery has gained significant improvement widely all over the world. A computerized tomography (CT) scan provides a detailed anatomy of the skull base especially the bone framework. This study aims to analyze the fixed anatomical bony landmarks of the anterior skull base through coronal and reconstructed CT in the context of the Nepalese population and guide the surgeon to perform endoscopic sinus and skull base surgery safely. This Prospective study includes 70 Computerized Tomography scans of Paranasal sinuses. The different measurement from nasal floor to skull base was taken in coronal and reformatted sagittal CT scan. Mean, standard deviation, minimum and maximum values were analyzed using descriptive statistics. Student T-test was applied to compare between right and left side. This study includes 75 patients between 18 to 77 years. The measurement from nasal floor to the cribriform plate and ethmoidal roof in right and left side were, mean± SD (47± 4.1, 45.3±4.3, 47.9±5.1, and 49±8.5 mm) respectively. Mean Take off angle at the cribriform plate was 43.9 ±10.9°on right side and 43 ± 9.4° on the left side. The distance from the nasal spine to the skull base (mean ± SD) at nasofrontal recess, bulla ethmoidalis, and the junction of sphenoethmoid levels at right sides were 51.5 ± 4.7, 52.9 ± 4.1, and 61.2 ±4.7 little higher at left side. This study provides a detailed analysis of the anterior skull base in coronal and sagittal CT scans which helps to reduces complications.

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Keyhole Supraorbital Approach for Anterior Skull Base Meningiomas: Analysis of 13 Years of Experience

Skull Base ◽

10.1055/s-2009-1242363 ◽

2009 ◽

Vol 19 (03) ◽

Cited By ~ 1

Author(s):

Ali Ayyad

Keyword(s):

Skull Base ◽

Anterior Skull Base ◽

Years Of Experience ◽

Supraorbital Approach ◽

Skull Base Meningiomas

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The 1-piece transbasal approach: operative technique and anatomical study

Journal of Neurosurgery ◽

10.3171/2014.8.jns132609 ◽

2014 ◽

Vol 121 (6) ◽

pp. 1446-1452 ◽

Cited By ~ 8

Author(s):

Sabih T. Effendi ◽

Vikas Y. Rao ◽

Eric N. Momin ◽

Jovany Cruz-Navarro ◽

Edward A. M. Duckworth

Keyword(s):

Skull Base ◽

Surface Area ◽

Nasal Bone ◽

Anatomical Study ◽

Anterior Skull Base ◽

Illustrative Case ◽

Vertical Angle ◽

Bone Removal ◽

Orbital Roof ◽

Suprasellar Region

Object The transbasal approach (TBA) is an anterior skull base approach, which provides access to the anterior skull base, sellar-suprasellar region, and clivus. The TBA typically involves a bifrontal craniotomy with orbital bar and/or nasal bone osteotomies performed in 2 separate steps. The authors explored the feasibility of routinely performing this approach in 1 piece with a quantitative cadaveric anatomical study, and present an operative case example of their approach. Methods Seven latex-injected cadaveric heads underwent a 1-piece TBA, followed by additional bone removal typical for a traditional 2-piece approach. Six surgical angles relative to the pituitary stalk, as well as the surface area of the orbital roof osteotomy, were measured before and after additional bone removal. The vertical angle from the frontonasal suture to the foramen cecum was measured in all specimens. In addition to an anatomical study, the authors have used this technique in the operating room, and present an illustrative case of resection of an anterior skull base meningioma. Results Morphometric results were as follows: the vertical angle from the frontonasal suture to the foramen cecum ranged from 17.4° to 29.7° (mean 23.8° ± 4.8°) superiorly. Of the 6 surgical angle measures, only the middle horizontal angle was increased in the 2-piece versus the 1-piece approach (mean 43.4° ± 4.6° vs 43.0° ± 4.3°, respectively; p = 0.049), with a mean increase of 0.4°. The surface area of the orbital osteotomy was increased in the 2-piece versus the 1-piece approach (mean 2467 mm2 ± 360 mm2 vs 2045 mm2 ± 352 mm2, respectively; p < 0.001). The patient in the illustrative clinical case had a good outcome, both clinically and cosmetically. Conclusions The 1-piece TBA provides an alternative to the traditional 2-piece approach. It allows easier reconstruction, potentially decreased operative time, and improved cosmesis. While more of the orbital roof can be removed with the 2-piece approach, this additional bone removal offers only a small increase in 1 of 6 surgical angles that were measured.

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