Lena Mary Houlihan, Thanapong Loymak, Irakliy Abramov, Jubran H. Jubran, Ann J. Staudinger Knoll, Michael G. J. O'Sullivan, Michael T. Lawton, Mark C. Preul
{"title":"眶上、经眶显微镜和经眶神经内窥镜进入前颅底和颅旁血管的定量分析","authors":"Lena Mary Houlihan, Thanapong Loymak, Irakliy Abramov, Jubran H. Jubran, Ann J. Staudinger Knoll, Michael G. J. O'Sullivan, Michael T. Lawton, Mark C. Preul","doi":"10.1055/s-0044-1786373","DOIUrl":null,"url":null,"abstract":"<p>\n<b>Objectives</b> Our objective was to compare transorbital neuroendoscopic surgery (TONES) with open craniotomy and analyze the effect of visualization technology on surgical freedom.</p> <p>\n<b>Design</b> Anatomic dissections included supraorbital craniotomy (SOC), transorbital microscopic surgery (TMS), and TONES.</p> <p>\n<b>Setting</b> The study was performed in a neurosurgical anatomy laboratory.</p> <p>\n<b>Participants</b> Neurosurgeons dissecting cadaveric specimens were included in the study.</p> <p>\n<b>Main Outcome Measures</b> Morphometric analysis of cranial nerve (CN) accessible lengths, frontal lobe base area of exposure, and craniocaudal and mediolateral angle of attack and volume of surgical freedom (VSF) of the paraclinoid internal carotid artery (ICA), terminal ICA, and anterior communicating artery (ACoA).</p> <p>\n<b>Results</b> The mean (standard deviation [SD]) frontal lobe base parenchymal exposures for SOC, TMS, and TONES were 955.4 (261.7) mm<sup>2</sup>, 846.2 (249.9) mm<sup>2</sup>, and 944.7 (158.8) mm<sup>2</sup>, respectively. Access to distal vasculature was hindered when using TMS and TONES. Multivariate analysis estimated that accessing the paraclinoid ICA with SOC would provide an 11.2- mm<sup>3</sup> increase in normalized volume (NV) compared with transorbital corridors (<i>p</i> < 0.001). There was no difference between the three approaches for ipsilateral terminal ICA VSF (<i>p</i> = 0.71). Compared with TONES, TMS provided more access to the terminal ICA. For the ACoA, SOC produced the greatest access corridor maneuverability (mean [SD] NV: 15.6 [5.6] mm<sup>3</sup> for SOC, 13.7 [4.4] mm<sup>3</sup> for TMS, and 7.2 [3.5] mm<sup>3</sup> for TONES; <i>p</i> = 0.01).</p> <p>\n<b>Conclusion</b> SOC provides superior surgical freedom for targets that require more lateral maneuverability, but the transorbital corridor is an option for accessing the frontal lobe base and terminal ICA. Instrument freedom differs quantifiably between the microscope and endoscope. A combined visualization strategy is optimal for the transorbital corridor.</p> ","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":"87 1","pages":""},"PeriodicalIF":0.9000,"publicationDate":"2024-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Quantitative Analysis of the Supraorbital, Transorbital Microscopic, and Transorbital Neuroendoscopic Approaches to the Anterior Skull Base and Paramedian Vasculature\",\"authors\":\"Lena Mary Houlihan, Thanapong Loymak, Irakliy Abramov, Jubran H. Jubran, Ann J. Staudinger Knoll, Michael G. J. O'Sullivan, Michael T. Lawton, Mark C. Preul\",\"doi\":\"10.1055/s-0044-1786373\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p>\\n<b>Objectives</b> Our objective was to compare transorbital neuroendoscopic surgery (TONES) with open craniotomy and analyze the effect of visualization technology on surgical freedom.</p> <p>\\n<b>Design</b> Anatomic dissections included supraorbital craniotomy (SOC), transorbital microscopic surgery (TMS), and TONES.</p> <p>\\n<b>Setting</b> The study was performed in a neurosurgical anatomy laboratory.</p> <p>\\n<b>Participants</b> Neurosurgeons dissecting cadaveric specimens were included in the study.</p> <p>\\n<b>Main Outcome Measures</b> Morphometric analysis of cranial nerve (CN) accessible lengths, frontal lobe base area of exposure, and craniocaudal and mediolateral angle of attack and volume of surgical freedom (VSF) of the paraclinoid internal carotid artery (ICA), terminal ICA, and anterior communicating artery (ACoA).</p> <p>\\n<b>Results</b> The mean (standard deviation [SD]) frontal lobe base parenchymal exposures for SOC, TMS, and TONES were 955.4 (261.7) mm<sup>2</sup>, 846.2 (249.9) mm<sup>2</sup>, and 944.7 (158.8) mm<sup>2</sup>, respectively. Access to distal vasculature was hindered when using TMS and TONES. Multivariate analysis estimated that accessing the paraclinoid ICA with SOC would provide an 11.2- mm<sup>3</sup> increase in normalized volume (NV) compared with transorbital corridors (<i>p</i> < 0.001). There was no difference between the three approaches for ipsilateral terminal ICA VSF (<i>p</i> = 0.71). Compared with TONES, TMS provided more access to the terminal ICA. For the ACoA, SOC produced the greatest access corridor maneuverability (mean [SD] NV: 15.6 [5.6] mm<sup>3</sup> for SOC, 13.7 [4.4] mm<sup>3</sup> for TMS, and 7.2 [3.5] mm<sup>3</sup> for TONES; <i>p</i> = 0.01).</p> <p>\\n<b>Conclusion</b> SOC provides superior surgical freedom for targets that require more lateral maneuverability, but the transorbital corridor is an option for accessing the frontal lobe base and terminal ICA. Instrument freedom differs quantifiably between the microscope and endoscope. A combined visualization strategy is optimal for the transorbital corridor.</p> \",\"PeriodicalId\":16513,\"journal\":{\"name\":\"Journal of Neurological Surgery Part B: Skull Base\",\"volume\":\"87 1\",\"pages\":\"\"},\"PeriodicalIF\":0.9000,\"publicationDate\":\"2024-04-30\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Neurological Surgery Part B: Skull Base\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1055/s-0044-1786373\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"Medicine\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Neurological Surgery Part B: Skull Base","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1055/s-0044-1786373","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"Medicine","Score":null,"Total":0}
Quantitative Analysis of the Supraorbital, Transorbital Microscopic, and Transorbital Neuroendoscopic Approaches to the Anterior Skull Base and Paramedian Vasculature
Objectives Our objective was to compare transorbital neuroendoscopic surgery (TONES) with open craniotomy and analyze the effect of visualization technology on surgical freedom.
Design Anatomic dissections included supraorbital craniotomy (SOC), transorbital microscopic surgery (TMS), and TONES.
Setting The study was performed in a neurosurgical anatomy laboratory.
Participants Neurosurgeons dissecting cadaveric specimens were included in the study.
Main Outcome Measures Morphometric analysis of cranial nerve (CN) accessible lengths, frontal lobe base area of exposure, and craniocaudal and mediolateral angle of attack and volume of surgical freedom (VSF) of the paraclinoid internal carotid artery (ICA), terminal ICA, and anterior communicating artery (ACoA).
Results The mean (standard deviation [SD]) frontal lobe base parenchymal exposures for SOC, TMS, and TONES were 955.4 (261.7) mm2, 846.2 (249.9) mm2, and 944.7 (158.8) mm2, respectively. Access to distal vasculature was hindered when using TMS and TONES. Multivariate analysis estimated that accessing the paraclinoid ICA with SOC would provide an 11.2- mm3 increase in normalized volume (NV) compared with transorbital corridors (p < 0.001). There was no difference between the three approaches for ipsilateral terminal ICA VSF (p = 0.71). Compared with TONES, TMS provided more access to the terminal ICA. For the ACoA, SOC produced the greatest access corridor maneuverability (mean [SD] NV: 15.6 [5.6] mm3 for SOC, 13.7 [4.4] mm3 for TMS, and 7.2 [3.5] mm3 for TONES; p = 0.01).
Conclusion SOC provides superior surgical freedom for targets that require more lateral maneuverability, but the transorbital corridor is an option for accessing the frontal lobe base and terminal ICA. Instrument freedom differs quantifiably between the microscope and endoscope. A combined visualization strategy is optimal for the transorbital corridor.
期刊介绍：
The Journal of Neurological Surgery Part B: Skull Base (JNLS B) is a major publication from the world''s leading publisher in neurosurgery. JNLS B currently serves as the official organ of several national and international neurosurgery and skull base societies.
JNLS B is a peer-reviewed journal publishing original research, review articles, and technical notes covering all aspects of neurological surgery. The focus of JNLS B includes microsurgery as well as the latest minimally invasive techniques, such as stereotactic-guided surgery, endoscopy, and endovascular procedures. JNLS B is devoted to the techniques and procedures of skull base surgery.
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