• Lucas Ramos Lima, Andre Beer-Furlan, Daniel M Prevedello, Ricardo L Carrau, Diego Armando Servián-Duarte, Matias Gomez Galarce, Alaa S Montaser, Leal de Vasconcelos Victor V Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA., and Alexandre Varella Giannetti.
• Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA; Department of Surgery, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
• World Neurosurg. 2020 Sep 1; 141: e86-e96.

BackgroundTransorbital and subtemporal keyhole approaches have recently been proposed to approach lesions in the lateral wall of the cavernous sinus (CS) and Meckel's cave (MC). Our goal was to compare these approaches and suggest indications for each of them.MethodsFive cadaver heads (10 sides, 40 procedures) were used. The lateral transorbital approaches were carried out without and with the removal of the lateral orbital rim, herein referred to as the lateral transorbital approach (LTOA) and the lateral orbital wall approach (LOWA). The subtemporal approaches were performed without and with the removal of the zygomatic arch, referred to as the subtemporal approach (STA) and the subtemporozygomatic approach (STZA). Five targets were chosen and 2 triangles were created representing the lateral wall of the CS and MC. Stereotactic measurements were quantified to calculate angles of attack, surgical freedom, and temporal lobe retraction for each approach.ResultsLTOA presented the smaller horizontal angles of attack. LOWA increased the angles to the same level of STA and STZA. STA and STZA presented larger vertical angles of attack. The surgical freedom presented gradual increase from LTOA to LOWA, STA, and STZA. STA and STZA needed greater temporal lobe retraction for most targets.ConclusionsLTOA is a good option to biopsy a lesion in the lateral wall of the CS and LOWA increased the surgical corridor to work with microsurgical techniques. STA and STZA could be better options when wide exposure is necessary, but temporal lobe retraction should be taken into consideration.Copyright © 2020 Elsevier Inc. All rights reserved.

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