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. 2015 Jul-Sep;6(3):361-8.
doi: 10.4103/0976-3147.154568.

Fully endoscopic supraorbital keyhole approach to the anterior cranial base: A cadaveric study

Mehmet Osman Akçakaya  1 , Yavuz Aras  1 , Nail İzgi  1 , Özcan Gayretli  2 , Pulat Akın Sabancı  1 , Aydın Aydoseli  1 , İlke Ali Gürses  2 , Altay Sencer  1 , Adnan Öztürk  2 , Kemal Hepgül  1
Affiliations

Fully endoscopic supraorbital keyhole approach to the anterior cranial base: A cadaveric study

Mehmet Osman Akçakaya et al. J Neurosci Rural Pract. 2015 Jul-Sep.

Abstract

Introduction: The supraorbital keyhole approach for anterior cranial base lesions has been increasingly used in clinical practice. Anatomical studies focusing on the endoscopic anatomy via this approach are few, although the microscopic anatomy has been well studied. The aim of this study is to describe the anatomical features and surgical exposure provided by the endoscopic supraorbital keyhole approach using quantitative measurements.

Materials and methods: Nine formalin-fixed human cadavers from the inventory of the Anatomy department were used. A total of 18 supraorbital keyhole cranitomies were conducted. The distances between the target anatomical structures and the dura mater at the craniotomy site, and the distances between deep anatomical structures were measured with purpose-designed hooks.

Results: The distance between the dura mater and optic canal was measured as 69.5 ± 6.7 mm (62-83 mm); optic chiasm as 76.2 ± 5.4 mm (67-86 mm); anterior communicating artery as 82.6 ± 6.1 mm (71-93 mm); internal carotid artery (ICA) bifurcation as 74.7 ± 6.0 mm (66-84 mm) and the basilar tip as 94.9 ± 7.0 mm (87-111 mm). The mean diameter of the optic canal was 7.4 ± 1.3 mm (6-11 mm), whereas the mean diameter of diaphragma sellae was measured as 8.4 ± 1.1 mm (7-10 mm).

Conclusions: The results of this study showed that the anterior and medial aspects of the anterior cranial fossa can be visualized properly. Dissection of the ipsilateral arteries of Circle of Willis can be performed easily using an endoscopic supraorbital keyhole approach.

Keywords: Anterior cranial base; full-endoscopic; neuroendoscopy; skull base; supraorbital keyhole approach.

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Conflict of interest statement

Conflict of Interest: None declared.

Figures

Figure 1
Figure 1
Two special hooks 22 cm in length were designed for the measurements between deep-seated anatomical structures. (MEG medikal, Istanbul,Turkey) One hook has a 2cm, 45-degree end on one side with a (15 mm) milimetric scale and a 2 cm, 90-degree end on the other side with a (10 mm) millimetric scale. The other hook has a 2 cm, 30-degree end on one side with a (8 mm) milimetric scale and a 2 cm, 90-degree end on the other side with a (8 mm) milimetric scale. Both of the hooks were made from a bendable material in order to adopt to different surfaces
Figure 2
Figure 2
Skin incision and frontal nerve within the supraorbital notch
Figure 3
Figure 3
Supraorbital keyhole craniotomy
Figure 4
Figure 4
C-shaped dural opening with its base on the orbital roof
Figure 5
Figure 5
View of the internal carotid artery (ICA), M1 segment of the middle cerebral artery (MCA), A1 segment of the anterior cerebral artery (ACA) and the liliequist membrane (LM) after the opening of the carotid cistern
Figure 6
Figure 6
Following the opening of the chiasmatic cistern, diaphragma sellae and infundibulum were exposed with the use 30 degree lense endoscope
See this image and copyright information in PMC

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