• Qinwei Wang, Xide Xu, Siguang Ouyang, Jian Chen, Zhuhuan Song, Juhui Lou, Shichen Jiang, and Wei Shi.
• Department of Neurosurgery, Jiangsu Clinical Medicine Center of Tissue Engineering and Nerve Injury Repair and the Training Base of Neuroendoscopic Physician under Chinese Medical Doctor Association, Affiliated Hospital of Nantong University, Nantong, Jiangsu Province, China.
• World Neurosurg. 2024 Jan 1; 181: e1047e1058e1047-e1058.

ObjectiveTo compare the endoscopic transorbital approach (ETOA) and endoscopic endonasal approach (EEA) in terms of cavernous sinus (CS) exposure.MethodsFour cadaveric heads (8 sides) were dissected. The CS was accessed using the EEA and ETOA. Stereotactic measurements of the length of the main structures exposed, angles of attack, depths of surgical corridor, and areas of exposure were obtained and compared between the approaches. An illustrative case is also presented.ResultsThe endoscopic transorbital approach (ETOA) exposed the lateral and superior compartments of the CS without obstruction by the internal carotid artery (ICA). The EEA exposed all compartments after mobilizing the ICA. Both approaches enabled similar exposure of the cranial nerves. The depth of surgical corridor was significantly shorter with the ETOA (P < 0.01). The areas of lateral compartment exposure were similar. As the number of instruments placed into the surgical channel increased, the available angles of attack with the ETOA became smaller and were smaller than those of the EEA. In the clinical case presented, the tumor was successfully removed without complications.ConclusionsThe ETOA has the advantages of a sterile surgical channel, short operation time, little patient trauma, short surgical corridor, large exposure area, and interdural pathway; moreover, it allows dissection through the interdural space without entering the neurovascular compartment of the CS. Although the space for manipulation of instruments is limited, the ETOA is suitable for treating selected tumors in the superior and lateral compartments of the CS.Copyright © 2023 Elsevier Inc. All rights reserved.

11 keywords...

hide…