Transorbital endoscopic approach for exposure of the sylvian fissure, middle cerebral artery and crural cistern: an anatomical study

摘要: The availability of minimal access instrumentation and endoscopic visualization has revolutionized the field minimally invasive skull base surgery. transorbital approach using an eyelid incision been proposed as a new technique for treatment pathology, mostly extradural tumors. Our study aims to evaluate anatomical aspects potential role exposure sylvian fissure, middle cerebral artery crural cistern. An dissection was performed in four freshly injected cadaver heads (8 orbits) 0- 30-degree endoscopes. First, endonasal medial orbital decompression done facilitate retraction orbit. through incision, with drilling posterior wall orbit lesser sphenoidal wing, then expose fissure cisterns. A stepwise description visualized anatomy is detailed. superior followed by provided surgical window approximately 1.2 cm (range 1.0–1.5 cm) dissection. (SOF) inferior (IOF) fissures represent limits are identified initial part procedure. Drilling roof (lateral SOF), greater wing SOF IOF) exposed anterior fossa dura. square-shaped dural opening gyri, temporal pole. Intradural allowed portion M1, MCA bifurcation M2 branches lenticulostriate perforators. Dissection aspect carotid cisterns endoscope mesial lobe allows successful M1 segments artery. Angled endoscopes may provide Although our demonstrates feasibility intradural closure via approach, further studies necessary its clinical scenario.