• World Neurosurg · Feb 2020

    Proposal of an Anatomically-Based Endoscopic Endonasal Model to Navigate the Anterior Skull Base Using the Orbitosellar Line (OSL), Critical Oblique Foramen Line (COFL), and Paramedian Anterior Line (PAL) as Coordinates.

    • Laila Perez de San Roman-Mena, Alejandro Monroy-Sosa, Srikant S Chakravarthi, Lior Gonen, Austin Epping, Sammy Khalili, William Smithee, Mikaeel Kassam, Juanita M Celix, Bhavani Kura, Jonathan Jennings, Richard A Rovin, Melanie B Fukui, and Amin B Kassam.
    • Aurora Neuroscience Innovation Institute, Aurora St. Luke's Medical Center, Milwaukee, Wisconsin, USA.
    • World Neurosurg. 2020 Feb 1; 134: e422-e431.

    BackgroundEndoscopic endonasal approaches to access the sellar and parasellar regions are challenging in the face of anatomical variations or pathologic conditions. We propose an anatomically-based model including the orbitosellar line (OSL), critical oblique foramen line (COFL), and paramedial anterior line (PAL) facilitating safe, superficial-to-deep dissection triangulating upon the medial opticocarotid recess.MethodsFive cadaveric heads were dissected to systematically expose the OSL, COFL, and PAL, illustrated with image guidance. Application of the coordinate system and a 6-step dissection sequence is described.ResultsThe coordinate system consists of 1) the OSL, connecting a) the anterior orbital point, junction of the anterior buttress of the middle turbinate with the agger nasi region, located 34.3 ± 0.9 mm above the intersection of the vertical plane of the lacrimal crest, and the orthogonal plane of the maxillo-ethmoidal suture; b) the posterior orbital point, junction of the optic canal with the lamina papyracea, located 4 ± 0.7 mm below the posterior ethmoidal artery; and c) the medial opticocarotid recess; 2) COFL (15 ± 2.8 mm), connecting the palatovaginal canal, vidian canal, and foramen rotundum; and 3) PAL (39 ± 0.06 mm), connecting the vidian canal with the posterior ethmoidal artery.ConclusionsOSL, COFL, and PAL form an anatomically-based model for the systematic exposure when accessing the parasellar and sellar regions. Preliminary anatomical data suggest that this model may be of value when normal anatomy is distorted by pathology or anatomic variations.Copyright © 2019 Elsevier Inc. All rights reserved.

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