scholarly journals Orbital Anatomy: Anatomical Relationships of Surrounding Structures

2020 ◽  
Vol 81 (04) ◽  
pp. 333-347
Author(s):  
Laura Salgado-López ◽  
Luciano C.P. Campos-Leonel ◽  
Carlos D. Pinheiro-Neto ◽  
María Peris-Celda
Keyword(s):  
Connective Tissue ◽  
Orbitofrontal Cortex ◽  
Point Of View ◽  
Medial Canthus ◽  
Superior Orbital Fissure ◽  
Ethmoid Bone ◽  
Orbital Surgery ◽  
Endoscopic Endonasal ◽  
Neurovascular Anatomy ◽  
Inferior Orbital Fissure

AbstractAdvances in skull base and orbital surgery have led to an increased need to understand the anatomy of the orbit and surrounding structures to safely perform surgeries in this area. The purpose of this article is to review the surrounding anatomy of the orbit from a practical and operative point of view. We describe the orbit from an inferomedial endoscopic endonasal perspective (focusing on its inferior relationship with the maxillary sinus and related structures and its medial relationship with the ethmoid bone), from a posterior and superolateral intracranial perspective (describing the anatomy of the superior orbital fissure, optic canal, inferior orbital fissure, cavernous sinus, orbitofrontal cortex, and surrounding dura) and from an anterior perspective (focusing on the muscles, connective tissue, lateral and medial canthus, and relevant neurovascular anatomy). A deep knowledge of the critical neurovascular and osseous structures surrounding the orbit is necessary for adequately choosing and performing the most favorable orbital approach in every case.

Endoscopic Endonasal Approaches to the Cavernous Sinus: Surgical Approaches

Neurosurgery ◽  
2001 ◽  
Vol 49 (2) ◽  
pp. 354-362 ◽  
Author(s):  
Alessandra Alfieri ◽  
Hae-Dong Jho
Keyword(s):  
Cavernous Sinus ◽  
Middle Turbinate ◽  
Lateral Wall ◽  
Surgical Instruments ◽  
Surgical Approaches ◽  
Lateral Nasal Wall ◽  
Orbital Apex ◽  
Superior Orbital Fissure ◽  
Endoscopic Endonasal ◽  
Surgical Access

Abstract OBJECTIVE After completion of an earlier endoscopic transsphenoidal anatomic study, we studied various endoscopic transsphenoidal approaches using cadaveric specimens to develop endoscopic endonasal surgical approaches to the cavernous sinus. METHODS Ten cavernous sinuses in five artery-injected adult cadaveric heads were studied with 0-, 30-, and 70-degree angled 4-mm rod-lens endoscopes. The extent of the surgical exposure, the skewed endoscopic anatomic view, and the maneuverability of surgical instruments through their relative operating spaces were studied after various endoscopic endonasal approaches via one nostril. RESULTS The paraseptal approach was used between the nasal septum and the middle turbinate and provided exposure at the anteromedial portion of the cavernous sinus. The contralateral paraseptal approach rendered a slightly more medial view at the cavernous sinus than did the ipsilateral approach. This approach offered limited surgical access to the lateral vertical compartment. The middle turbinectomy approach allowed surgical access to the lateral wall of the cavernous sinus, except for the superior orbital fissure and the orbital apex. The middle meatal approach, which was made between the middle turbinate and the lateral nasal wall, revealed the entire lateral vertical compartment of the cavernous sinus, including the orbital apex and the superior orbital fissure. However, its lateral tangential surgical trajectory and the absence of dedicated surgical tools limited the surgeon's surgical maneuverability. A combination of the middle turbinectomy and middle meatal approaches increased the operating space. CONCLUSION Various endoscopic endonasal surgical approaches to the cavernous sinus were studied using adult cadaveric head specimens.

Anatomic Nuances of the Ophthalmic Artery Origin from a Ventral Viewpoint: Considerations and Implications for Endoscopic Endonasal Surgery

2018 ◽  
Vol 16 (4) ◽  
pp. 478-485
Author(s):  
Cristian A Naudy ◽  
Juan C Yanez-Siller ◽  
Paulo M Mesquita Filho ◽  
Matias Gomez G. ◽  
Bradley A Otto ◽  
...  
Keyword(s):  
Ophthalmic Artery ◽  
Internal Carotid ◽  
Point Of View ◽  
Endoscopic Endonasal Surgery ◽  
Endonasal Surgery ◽  
Endoscopic Endonasal ◽  
Nerve Segment ◽  
Surgical Field ◽  
The Right ◽  
Ophthalmic Arteries

Abstract BACKGROUND The origin of the ophthalmic artery is within the surgical field of endoscopic endonasal approaches (EEAs) to the suprasellar and parasellar regions. However, its anatomy from the endoscopic point-of-view has not been adequately elucidated. OBJECTIVE To highlight the anatomy of the ophthalmic artery origin from an endoscopic endonasal perspective. METHODS The origin of the ophthalmic artery was studied bilaterally under endoscopic visualization, after performing transplanum/transtubercular EEAs in 17 cadaveric specimens (34 arteries). Anatomic relationships relevant to surgery were evaluated. To complement the cadaveric findings, the ophthalmic artery origin was reviewed in 200 “normal” angiographic studies. RESULTS On the right side, 70.6% of ophthalmic arteries emerged from the superior aspect, while 17.6% and 11.8% emerged from the superomedial and superolateral aspects of the intradural internal carotid artery, respectively. On the left, 76.5%, 17.6%, and 5.9% of ophthalmic arteries emerged from the superior, superomedial, and superolateral aspects of the internal carotid, respectively. Similar findings were observed on angiography. All ophthalmic arteries emerged at the level of the medial opticocarotid recess. Overall, 47%, 26.5%, and 26.5% of ophthalmic arteries (right and left) were inferolateral, inferior, and inferomedial to the intracranial optic nerve segment, respectively. On both sides, the intracranial length of the ophthalmic artery ranged from 1.5 to 4.5 mm (mean: 2.90 ± standard deviation of 0.74 mm). CONCLUSION Awareness of the endoscopic nuances of the ophthalmic artery origin is paramount to minimize the risk of sight-threatening neurovascular injury during EEAs to the suprasellar and parasellar regions.

scholarly journals The Pathology of Tumours of the Urinary Tract

1939 ◽  
Vol 32 (11) ◽  
pp. 1455-1467
Author(s):  
W. D. Newcomb
Keyword(s):  
Urinary Tract ◽  
Connective Tissue ◽  
Renal Pelvis ◽  
Clinical Importance ◽  
Point Of View ◽  
Renal Tubules ◽  
Clear Cut ◽  
Renal Tumours ◽  
The Difference

Attention is called to the difference between the pathologist's and the radiologist's point of view. The reasons for this difference are discussed with special emphasis on renal tumours. Classification of renal tumours. The first main groups are innocent and malignant. Are these really clear-cut or do they blend into one another? The commoner innocent renal tumours are adenoma, fibroma, myoma, lipoma, and angioma. These are rarely of any clinical importance but adenoma is a possible source of hypernephroma. Many elaborate classifications of cancer of the kidney have been proposed but the following four groups are sufficient for most puposes: Carcinoma, hypernephroma, sarcoma, and teratoid tumours. Much the commonest malignant renal tumour in adults is the hypernephroma, thought by Grawitz and others to be derived from ectopic adrenal rests. There is still no agreement concerning their origin but three views are held at the present time: ( a) All are carcinoma of renal tubules. ( b) Some are derived from renal tubules and some from ectopic adrenal. ( c) All are formed from adrenal tissue. These views are discussed with special reference to material in St. Mary's Hospital Museum, and it is suggested that the first view is the most probable although the second cannot be excluded. The teratoid tumours are the commonest in infants and swine. The differences between them and hypernephromata are described. The renal Pelvis, ureter, and bladder all have tumours of the same type and can conveniently be considered together. Connective tissue tumours, both innocent and malignant, are very rare. Papilloma and carcinoma are rare in the pelvis and ureter, but commoner in the bladder. The relation between these two tumours is discussed.

Transection of Inferior Orbital Fissure Contents for Improved Access and Visibility in Orbital Surgery

2014 ◽  
Vol 25 (2) ◽  
pp. 557-562 ◽  
Author(s):  
Sophie Ricketts ◽  
Hall F. Chew ◽  
Ian R. P. Sunderland ◽  
Alex Kiss ◽  
Jeffrey A. Fialkov
Keyword(s):  
Orbital Surgery ◽  
Inferior Orbital Fissure

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.

scholarly journals The Tough Fibrous Tissue of The Supracondylar Groove As A Useful Landmark Via The Endoscopic Endonasal Approach To The Lower Clivus

2021 ◽  
Author(s):  
Changchen Hu ◽  
Liyuan Zhou ◽  
Hongming Ji ◽  
Gangli Zhang ◽  
Shengli Chen ◽  
...  
Keyword(s):  
Connective Tissue ◽  
Fibrous Tissue ◽  
Craniovertebral Junction ◽  
Fibrous Connective Tissue ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Endoscopic Endonasal ◽  
External Orifice ◽  
Surgical Corridor ◽  
Lower Clivus

Abstract Background: The hypoglossal canal (HGC) is the most important structural landmark for the endoscopic endonasal approach to access the lower clivus (LC). We explored the feasibility of using the tough fibrous tissue covering the supracondylar groove (SCG) as a useful landmark to identify the location of the HGC. Methods: Four cadaveric specimens were dissected and analyzed. The craniovertebral junction (CVJ) region was accessed utilizing 4-mm endoscope with either 0° or 30° lenses. CVJ exposure and the surgical corridor areas were measured. The relationship between the tough fibrous tissue covering the SCG and the HGC was analyzed.Results: Tough fibrous connective tissue was tightly attached the SCG and ran superomedially to inferolaterally. The angle between the horizontal plane and the long axis of the SCG was 30°. Separating the tough tissue inferolaterally, we could locate the external orifice (EO) of the HGC to further accurately isolate the hypoglossal nerve. Conclusion: The tough fibrous connective tissue covered the SCG to the upper part of the HGC EO. The course of the tough fibrous connective tissue was superomedial to inferolateral. Using the tough fibrous connective tissue covering the SCG as a landmark, it was possible to accurately locate the HGC EO via the endoscopic endonasal approach to access the LC.

Endoscopic Endonasal Orbital Surgery

2020 ◽  
Author(s):  
Jeffrey Glicksman ◽  
Maria Peris-Celda ◽  
Tyler Kenning ◽  
Edward Wladis ◽  
Carlos Pinheiro-Neto
Keyword(s):  
Orbital Surgery ◽  
Endoscopic Endonasal

Mixed Connective Tissue Disease in Childhood

1986 ◽  
Vol 7 (10) ◽  
pp. 309-314
Author(s):  
Bernhard H. Singsen
Keyword(s):  
Connective Tissue ◽  
Connective Tissue Disease ◽  
Rheumatic Diseases ◽  
Mixed Connective Tissue Disease ◽  
Overlap Syndrome ◽  
Point Of View ◽  
Nuclear Antigen ◽  
Extractable Nuclear Antigen ◽  
First Child ◽  
One Year

Rheumatic diseases with overlapping clinical features have been known since at least 1900 under such descriptive designations as "sclerodermatomyositis," "lupoderma," "rupus," and others. These hybrid descriptors recognize the occasional mixing of features of the classic rheumatic disorders, rheumatoid arthritis, scleroderma, dermatomyositis, and systemic lupus erythematous (SLE), in the same patient. However, because of the absence of precise pathogenetic and etiologic information, even the traditional rheumatic diseases have been largely classified on the basis of aggregations of clinical, histologic, and immunologic findings. In 1972, Sharp and colleagues first described 26 adults with a new syndrome, which they defined as mixed connective tissue disease (MCTD). A major contribution of Sharp and his colleagues was to name and attempt to classify an overlap syndrome in explicit clinical terms and to associate it with specific autoantibodies directed against "extractable nuclear antigen" (ENA). One year later, the first child with MCTD was reported, and in 1977 a series of 14 children with MCTD was first investigated. Where does mixed connective tissue disease, in both children and adults, stand now after more than a decade of study? Directly, the concept of MCTD has focused our attention upon the description of overlapping features of the rheumatic diseases, and it has forced us to confront whether "lumping" or "splitting" descriptors serves the patient from a therapeutic or prognostic point of view.

Sign in / Sign up

Export Citation Format

Share Document