Endoscopic Endonasal Anatomy of the Optic Canal

2013 ◽  
Vol 74 (S 01) ◽  
Author(s):  
Francisco A. Filho ◽  
Omar Ramirez ◽  
Yancy Acosta ◽  
Luis Bonilla ◽  
Milton Rastelli ◽  
...  
Keyword(s):  
Optic Canal ◽  
Endoscopic Endonasal

Endoscopic Endonasal Transmaxillary Transsphenoidal Approach for Excision of a Superior Orbital Fissure-Cavernous Sinus Meningioma: 2-Dimensional Operative Video

2018 ◽  
Vol 15 (5) ◽  
pp. E61-E62
Author(s):  
Ehab El Refaee ◽  
Steffen Fleck ◽  
Marc Matthes ◽  
Henry W S Schroeder
Keyword(s):  
Mr Imaging ◽  
Cavernous Sinus ◽  
Tumor Resection ◽  
Middle Turbinate ◽  
Lateral Wall ◽  
Optic Canal ◽  
Superior Orbital Fissure ◽  
Endoscopic Endonasal ◽  
Cavernous Sinus Meningioma ◽  
Left Middle

Abstract We present a 43-old-male who suffered from a slowly progressive loss of vision in the left eye. Magnetic resonance (MR) imaging revealed a well-circumscribed contrast-enhancing lesion in the region of the anterior cavernous sinus and superior orbital fissure that extended into the optic canal. A schwannoma or meningioma was suspected. A transcranial surgery performed at another institution was not successful in removing the tumor and further deterioration of vision occurred. After resection of the left middle turbinate, the sphenoid and maxillary sinus were opened. The bulging of the tumor was seen at the lateral wall of the sphenoid sinus. After bony decompression of the optic canal, the dura was opened. A meningioma was exposed that arose in between the dural layers of the cavernous sinus. A nice dissection plane was found and the tumor was circumferentially dissected and finally totally removed. There were no complications such as double vision or visual field deficit. MR imaging confirmed a total tumor resection. The visual acuity normalized within a few days. MR imaging obtained 3 yr after surgery shows no recurrence.

Endoscopic Endonasal Approach to the Optic Canal: Anatomical Considerations and Surgical Relevance

2015 ◽  
Vol 76 (S 01) ◽  
Author(s):  
Kumar Abhinav ◽  
Yancy Acosta ◽  
Luis Bonilla ◽  
Wei Wang ◽  
Maria Koutourousiou ◽  
...  
Keyword(s):  
Optic Canal ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Endoscopic Endonasal

Endoscopic Endonasal Approach to the Optic Canal: Anatomic Considerations and Surgical Relevance

2015 ◽  
Vol 11 (3) ◽  
pp. 431-446 ◽  
Author(s):  
Kumar Abhinav ◽  
Yancy Acosta ◽  
Wei-Hsin Wang ◽  
Luis R Bonilla ◽  
Maria Koutourousiou ◽  
...  
Keyword(s):  
Ophthalmic Artery ◽  
Human Head ◽  
Optic Canal ◽  
Falciform Ligament ◽  
Endoscopic Endonasal Approach ◽  
Endoscopic Endonasal Surgery ◽  
Endonasal Surgery ◽  
Endoscopic Endonasal ◽  
Dural Opening ◽  
Anatomic Relationship

Abstract BACKGROUND Increasing use of endoscopic endonasal surgery for suprasellar lesions with extension into the optic canal (OC) has necessitated a better endonasal description of the OC. OBJECTIVE To identify the osseous OC transcranially and then investigate its anatomic relationship to the key endonasal intrasphenoidal landmarks. We also aimed to determine and describe the technical nuances for safely opening the falciform ligament and intracanalicular dura (surrounding the optic nerve [ON]) endonasally. METHODS Ten fresh human head silicon-injected specimens underwent an endoscopic transtuberculum/transplanum approach followed by 2-piece orbitozygomatic craniotomy to allow identification of 20 OCs. After completing up to 270° of endonasal bony decompression of the OC, a dural incision started at the sella and continued superiorly across the superior intercavernous sinus. Subsequently the dural opening was extended anterolaterally across the dura of the prechiasmatic sulcus, limbus sphenoidale, and planum. RESULTS Endonasally, the length of the osseous OC was approximately 6 mm and equivalent to the length of the lateral opticocarotid recess, as measured anteroposteriorly. The ophthalmic artery arose from the supraclinoidal carotid artery at approximately 2.5 mm from the medial osseous OC entrance. Transcranial correlation of the endonasal dural incision confirmed medial detachment of the falciform ligament and exposure of the preforaminal ON. CONCLUSION The lateral opticocarotid recess allows distinction of the preforaminal ON, roofed by the falciform ligament from the intracanalicular segment in the osseous OC. This facilitates the preoperative surgical strategy regarding the extent of OC decompression and dural opening. Extensive endonasal decompression of the OC and division of the falciform ligament is feasible.

scholarly journals Effectiveness of Optic Decompression by Endoscopic Endonasal Approach on Patients with Traumatic Fracture of Optic Canal

OALib ◽  
2017 ◽  
Vol 04 (06) ◽  
pp. 1-8
Author(s):  
Rongjiang Luo ◽  
Zhichao Yan ◽  
Wentong Xia ◽  
Xianping Zeng ◽  
Rui Xu ◽  
...  
Keyword(s):  
Optic Canal ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Endoscopic Endonasal ◽  
Traumatic Fracture

Endoscopic Endonasal versus Transcranial Optic Canal Decompression: A Morphometric, Cadaveric Study

2021 ◽  
Author(s):  
Jun Kim ◽  
Aaron R Plitt ◽  
Awais Vance ◽  
Scott Connors ◽  
James Caruso ◽  
...  
Keyword(s):  
Anatomical Study ◽  
Contralateral Side ◽  
Lateral Approach ◽  
Ct Scans ◽  
Optic Canal ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Endoscopic Endonasal ◽  
Transcranial Approach ◽  
The Mean

Abstract Introduction Decompression of the optic nerve within the optic canal is indicated for compressive visual decline. The two most common approaches utilized for optic canal decompression are a medial approach with an endoscopic endonasal approach and a lateral approach with a craniotomy. Our study is a cadaveric anatomical study comparing the length and circumference of the orbit decompressed via an endoscopic endonasal approach versus a frontotemporal craniotomy. Methods Five cadaveric specimens were utilized. Predissection computed tomography (CT) scans were performed on each specimen. On each specimen, a standard frontotemporal craniotomy with anterior clinoidectomy and superolateral orbital decompression was performed on one side and an endoscopic endonasal approach with medial wall decompression was performed on the contralateral side. Post-dissection CT scans were performed. An independent radiologist provided measurements of the length (mm) and circumference (degrees) of optic canal decompression bilaterally. Results The mean length of optic canal decompression for open and endoscopic approach was 13 mm (range 12–15 mm) and 12.4 mm (range 10–16 mm), respectively. The mean circumference of decompression for open and endoscopic approaches was 252.8 degrees (range 205–280 degrees) and 124.6 degrees (range 100–163 degrees), respectively. Conclusion The endoscopic endonasal and the transcranial approaches provide a similar length of optic canal decompression, but the transcranial approach leads to greater circumferential decompression. The endoscopic endonasal approach has the benefit of being minimally invasive, though. Ultimately, the surgical approach decision should be based on the location of the pathology and the surgeon's comfort.

Interdural course of the ophthalmic artery in the optic canal

2020 ◽  
Vol 132 (1) ◽  
pp. 277-283
Author(s):  
Ali Tayebi Meybodi ◽  
Leandro Borba Moreira ◽  
Michael T. Lawton ◽  
Jennifer M. Eschbacher ◽  
Evgenii G. Belykh ◽  
...  
Keyword(s):  
Optic Nerve ◽  
Histological Examination ◽  
Direct Contact ◽  
Ophthalmic Artery ◽  
Optic Canal ◽  
Endoscopic Endonasal ◽  
Orbital Fat ◽  
The Relationship ◽  
Exact Relationship

OBJECTIVEIn the current neurosurgical and anatomical literature, the intracanalicular segment of the ophthalmic artery (OphA) is usually described to be within the optic nerve dural sheath (ONDS), implying direct contact between the nerve and the artery inside the optic canal. In the present study, the authors sought to clarify the exact relationship between the OphA and ONDS.METHODSTen cadaveric heads were subjected to endoscopic endonasal and transcranial exposures of the OphA in the optic canal (5 for each approach). The relationship between the OphA and ONDS was assessed. Histological examination of one specimen of the optic nerve and the accompanying OphA was also performed to confirm the relationship with the ONDS.RESULTSIn all specimens, the OphA coursed between the two layers of the dura (endosteal and meningeal) and was not in direct contact with the optic nerve, except for the first few millimeters of the proximal optic canal before it pierced the ONDS. Upon reaching the orbit, the two layers of the dura separated and allowed the OphA to literally float within the orbital fat. The meningeal dura continued as the ONDS, whereas the endosteal dura became the periorbita.CONCLUSIONSThis study clarifies the interdural course of the OphA within the optic canal. This anatomical nuance has important neurosurgical implications regarding safe exposure and manipulation of the OphA.

scholarly journals Selection of endoscopic or transcranial surgery for tuberculum sellae meningiomas according to specific anatomical features: a retrospective multicenter analysis (KOSEN-002)

2019 ◽  
Vol 130 (3) ◽  
pp. 838-847 ◽  
Author(s):  
Doo-Sik Kong ◽  
Chang-Ki Hong ◽  
Sang Duk Hong ◽  
Do-Hyun Nam ◽  
Jung-Il Lee ◽  
...  
Keyword(s):  
Visual Outcome ◽  
Visual Disturbance ◽  
Optic Canal ◽  
Surgical Approaches ◽  
Anterior Clinoid Process ◽  
Endoscopic Endonasal ◽  
Anatomical Features ◽  
Significant Difference ◽  
Stable Vision ◽  
Tuberculum Sellae

OBJECTIVEThe endoscopic endonasal approach (EEA) and the transcranial approach (TCA) are good options for the treatment of tuberculum sellae (TS) meningiomas. The objective of this study was to identify the key anatomical features in TS meningiomas and compare the two surgical approaches.METHODSThe authors retrospectively reviewed clinical data in 178 patients with TS meningiomas treated at 3 institutions between January 2010 and July 2016. Patients with tumors encasing the internal carotid artery or anterior cerebral artery or involving the anterior clinoid process or cavernous sinus were excluded. Tumors were classified as high-lying or low-lying based on their location, and involvement of the optic canal was evaluated. The surgical outcomes of EEA and TCA were analyzed according to the relevant anatomical features.RESULTSDuring the study period, 84 patients underwent EEA and 94 patients underwent TCA. Based on preoperative MR images, 43 (24.2%) meningiomas were classified as high-lying tumors, 126 (70.8%) as low-lying, and 9 (5.0%) as nonspecific. Gross-total resection (GTR) was performed in 145 patients (81.5%); the GTR rate did not differ significantly between the EEA and TCA groups. Of 157 patients with preoperative visual disturbance, 140 had improved or stable vision postoperatively. However, 17 patients (9.6%) experienced some visual deterioration after surgery. The TCA group had a worse visual outcome than the EEA group in patients with preoperative optic canal involvement (77.6% vs 93.2%, p = 0.019), whereas there was no significant difference in visual outcome based on whether tumors were high-lying or low-lying.CONCLUSIONSThe results of this study support EEA over TCA, at least with respect to visual improvement with acceptable complications, although TCA is still an effective approach for TS meningioma.

Endoscopic Endonasal Optic Nerve Decompression for Benign Pathology of the Optic Canal

2014 ◽  
Vol 75 (S 02) ◽  
Author(s):  
T. Deklotz ◽  
S. Stefko ◽  
J. Fernandez-Miranda ◽  
P. Gardner ◽  
C. Snyderman ◽  
...  
Keyword(s):  
Optic Nerve ◽  
Optic Canal ◽  
Endoscopic Endonasal ◽  
Nerve Decompression ◽  
Optic Nerve Decompression ◽  
Benign Pathology

Endoscopic Endonasal Removal of Primary/Recurrent Meningiomas in the Medial Optic Canal: Surgical Technique and Long-Term Visual Outcome

2019 ◽  
Vol 17 (5) ◽  
pp. 470-480 ◽  
Author(s):  
Kiyohiko Sakata ◽  
Nobuyuki Takeshige ◽  
Yui Nagata ◽  
Hidenobu Yoshitake ◽  
Satoru Komaki ◽  
...  
Keyword(s):  
Visual Loss ◽  
Visual Disturbance ◽  
Optic Canal ◽  
Maximum Diameter ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Tumor Removal ◽  
Endoscopic Endonasal ◽  
Average Maximum ◽  
Tuberculum Sellae

Abstract BACKGROUND Tuberculum sellae meningiomas frequently extend into the optic canals, which leads to a progressive longitudinal visual loss. Therefore, in addition to tumor removal, unroofing and exploration inside the optic canal are important procedures. OBJECTIVE To perform endoscopic endonasal tumor removal with optic canal decompression for small primary or recurrent meningiomas associated with a progressive visual loss at the inferior-medial optic canal, which corresponded to a blind corner in the ipsilateral pterional/subfrontal approach. METHODS We retrospectively reviewed 2 cases of primary meningiomas that arose in the inferior-medial optic canal and 4 recurrent cases from the remnant inside the medial optic canal that had previously undergone craniotomy for tuberculum sellae meningiomas, and were treated by the endoscopic endonasal approach. RESULTS All tumors were detectable and could be removed without manipulation of the affected optic nerve. The average maximum diameter of the tumor was 8.4 mm (range: 5-12 mm). Two patients who had a long history of progressive visual disturbance and papillary atrophy did not recover from severe visual disturbances postoperatively. However, others showed considerable improvement, maintaining postoperative visual function during follow-up. There were no postoperative complications. CONCLUSION Endoscopic endonasal approach has several advantages for meningiomas in the medial optic canal and associated with progressive visual disturbance. In surgery of tuberculum sellae meningiomas, optic canal decompression and exploration inside the optic canal are important procedures to avoid symptomatic recurrence, which may be facilitated by the endoscopic endonasal approach. Papillary atrophy and duration of visual deterioration are predictive factors for postoperative visual outcomes.

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