• Viola Bartoletti, Jorge Rios-Zermeno, Ivan El-Sayed, Adib A Abla, and Rodriguez RubioRobertoRSkull Base and Cerebrovascular Laboratory, University of California, San Francisco, California, USA; Department of Neurological Surgery, University of California, San Francisco, California, USA; Department of Otolaryngology-Head and.
• Neurosurgery, Department of Neuroscience, University of Padua, Padua, Italy; Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, California, USA.
• World Neurosurg. 2023 Jul 1; 175: e1133e1143e1133-e1143.

BackgroundThe endoscopic endonasal approach (EEA) offers a minimally invasive route to treat medial intraconal space (MIS) lesions. Understanding the configuration of the ophthalmic artery (OphA) and the central retinal artery (CRA) is crucial.MethodsAn EEA to the MIS was performed on 30 orbits. The description of the intraorbital part of the OphA was divided into 3 segments and classified as type 1 and type 2 and the MIS was divided into three surgical zones (A, B, C). The CRA's origin, course, and point of penetration (PP) were analyzed. The relationship between the position of the CRA in the MIS and the OphA type was analyzed.ResultsThe OphA type 2 was present in 20% of specimens. The site of origin of the CRA from the OphA was found on the medial surface in type 1 and on the lateral surface of type 2. The point of penetrationof the central retinal arterywas found in 87% of the specimens on the inferomedial surface, just anterior to the inferior muscular trunk, at an average distance of 9.5 mm ± 1 from the globe and 17 mm ± 1.5 from the AZ. The presence of the CRA in Zone C was associated only with OphA type 1.ConclusionsOphA type 2 is a common finding and can compromise the feasibility of an EEA to the MIS. A detailed preoperative analysis of the OphA and CRA should be conducted prior to approaching the MIS due to the implications of the anatomical variations that can compromise safe intraconal maneuverability during an EEA.Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.

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