The Eyelid Trans-orbital Trans-cavernous Approach to the Basilar Apex: A Cadaveric Proof-of-Concept Study

Objective The pretemporal transcavernous approach is an elegant technique that provides exposure to the basilar apex, which is conventionally completed with a frontotemporal incision. This can also be performed via a minimally invasive eyelid transorbital approach, which has unique attributes. This is a proof-of-concept cadaveric study to demonstrate details of the combination of these two approaches. Design This study is a proof-of-concept study using cadaveric heads. Setting This study is a proof-of-concept study in a cadaveric laboratory. Participants A latex-injected cadaveric head. Main Outcome Measures Detailed dissection was performed and demonstrated in a step-by-step fashion. Results The eyelid transorbital approach provides the exact exposure required to complete the pretemporal osteotomy including an anterior clinoidectomy and dissection, so that a transcavernous approach can be completed. The basilar apex and its branches can also be accessed via the eyelid transorbital approach, with comparable exposure to the traditional approach; however, the access trajectory is much narrower. It takes advantages of the inferior corridor with a more medial access angle and provides a complementary perspective to the cavernous sinus contents and basilar apex complex. Conclusion The combination of an eyelid transorbital and pretemporal transcavernous approaches can achieve a deep exposure via a minimally invasive incision, which may add an additional approach to the cavernous sinus and basilar apex regions.