Supraorbital, Transorbital, and Endonasal Approaches to the Supraoptic Recess: A Comparative, Qualitative, and Quantitative Anatomic Study.

Background And Objectives: The supraoptic recess is a bony pyramid-shape area with a base that abuts the sphenoid sinus and an apex that corresponds intracranially to the anterior clinoid process and the body of the lesser sphenoid wing. During an extended endoscopic endonasal approach, the recess needs to be identified and delineated to achieve further lateral extension over the planum sphenoidale. By drilling the supraoptic recess in a medial-to-lateral direction toward the body of the lesser sphenoid wing, the most medial portion of the lesser wing overlying the orbit could be exposed and progressively drilled out.

Clinical impact following the establishment of a specialized brain metastases tumor board.

Purpose: To evaluate the impact of brain metastasis tumor board (BMTB) on treatment patterns and survival.

Methods: 365 patients with brain metastases (BM) were analyzed at the Hospital Clínic de Barcelona from October 2019 to October 2022. This included those treated in the department of neurosurgery and radiation oncology during the first 18 months following its establishment.

Endoscopic 360° vision of the orbit: A comparative anatomical study of endonasal and transorbital approaches.

Background And Objective: Treatment of lesions located within and surrounding the orbit pose considerable surgical challenges, due to the presence of critical neurovascular structures in such deep, confined spaces. Historically, transcranial and craniofacial approaches have been widely used to deal with orbital pathologies. However, in recent decades we have witnessed the emergence of minimally invasive techniques to reduce morbidity and hospitalization times.

The meningo-orbital band from an endoscopic transorbital approach: an anatomical study.

Introduction: The meningo-orbital band (MOB) is an intricate dural structure extending between the periorbita, the frontal dura, and the temporal dura. The endoscopic transorbital approach (ETOA) provides a more thorough understanding of its anatomy.

Materials And Methods: Anatomical dissections were performed on 15 human head specimens (30 orbits) at the Laboratory of Surgical Neuroanatomy (LSNA) at the University of Barcelona.

Transorbital approach for a Meckel's cave hybrid benign tumor: operative video and technical nuances.

This video presents the transorbital endoscopic resection of a Meckel's cave lesion, initially suspected as a trigeminal schwannoma. A 35-year-old woman with trigeminal hypoesthesia, pain, and gait instability underwent near-total tumor removal, with a transient cranial nerve III deficit that resolved completely. Histopathology identified the tumor as a hybrid benign lesion (trigeminal schwannoma/neurofibroma, WHO grade I).

How we do it: Ultrasound-guided scuba technique for evacuation of intracerebral hematoma.

Background: Minimally invasive treatment of intracerebral hematomas is gaining importance following recent trials. Clot evacuation must minimise collateral damage while assuring optimal blood-volume reduction. Technical refinements call for systematic yet dynamic procedures, where ultrasound is an asset.

Transorbital Transsylvian Selective Amygdalohippocampectomy: A Feasibility Anatomic Investigation.

Background And Objectives: Several surgical techniques have been developed to treat mesial temporal lobe epilepsy, the most common form of drug-resistant epilepsy. Although surgical treatment for mesial temporal lobe epilepsy has proven to be highly effective in controlling seizures and improving patients' quality of life, it carries potential risk to critical neurovascular structures, which can result in significant complications. With the advent of endoscopic techniques, the transorbital route has emerged as a potential alternative for mesial temporal lobe surgery.

Influence of spine biomechanics and sagittal balance on the outcome of lumbar discectomy.

Purpose: Spine biomechanics, particularly sagittal balance and spino-pelvic angulation are determinant factors in the understanding of lumbar degenerative disease. These concepts translated into objective measurements are progressively being integrated into clinical practice. The present study explores them as prognostic factors in patients undergoing lumbar microdiscectomy, which could help identify those at higher risk of surgical failure.

Transorbital laser surgery for epilepsy: Anatomic-radiological feasibility of transorbital magnetic resonance imaging-guided laser interstitial thermal therapy (MRIgLITT) for amygdalohippocampectomy in refractory epilepsy.

Objective: to study the anatomical feasibility of laser fiber insertion for interstitial thermal therapy via transorbital approach to the temporo-mesial structures (amygdala-hippocampus-parahippocampus complex).

Methods: Anatomical dissections were performed bilaterally on two human cadaveric heads via a transorbital approach, in which screws and laser fibers were used for magnetic resonance imaging-guided laser interstitial thermal therapy (MRIgLITT) assisted by neuronavigation. In addition, eight transorbital trajectories were simulated using the transorbital entry points obtained from a cadaveric radiological study of four patients previously operated on for mesial temporal lobe epilepsy.

Identifying the best treatment choice for relapsing/refractory glioblastoma: a systematic review with multiple Bayesian network meta-analyses.

Background: Glioblastoma is a highly aggressive primary central nervous system tumor characterized by poor outcomes. In case of relapse or progression to adjuvant chemotherapy, there is no univocal preferred regimen for relapsing glioblastoma.

Methods: We conducted a systematic review and Bayesian trial-level network meta-analyses (NMA) to identify the regimens associated with the best outcomes.

Transorbital Route to Intracranial Space.

The endoscopic superior eyelid transorbital approach has emerged as a notable and increasingly utilized surgical technique in recent years. This chapter presents an overview of the approach, tracing its historical development and highlighting its growing acceptance within the skull base community.Beginning with an introduction and historical perspective, the chapter outlines the evolution of the transorbital approach, shedding light on its origins and the factors driving its adoption.

The Endoscopic Transorbital Approach for Vascular Surgery: An Anterior Circulation Anatomic Study, 2-Dimensional Operative Video.

Background And Objectives: Minimally invasive endoscopic approaches in cranial base surgery have been developing in the past decades. The transorbital (TO) route is one promising alternative, yet its adequacy for intracranial vascular lesions remains unclear. The present anatomic work aimed to test the feasibility and to provide a qualitative description of the endoscopic TO approach for the anterior circulation, namely the internal carotid artery and the middle cerebral artery.

Endoscopic transorbital approach to the petrous apex: is orbital rim removal worthwhile for the exposure? An anatomical study with illustrative case.

Objective: The endoscopic transorbital approach (ETOA) has been demonstrated to be a feasible ventral route to the petrous apex. Yet, it has been pointed to as a deep and narrow corridor for anterior petrosectomy; particularly, medialization of the instruments can become an issue when targeting the petroclival area. To overcome this limitation, an ETOA with orbital rim removal (ETOA-OR) has been suggested, but not de facto compared, with a transorbital approach without removal of the rim.

Effects of the Use of Neuronavigation in Patients with Supratentorial Brain Gliomas: A Cohort Study.

Objective: Despite the growing acceptance of neuronavigation in the field of neurosurgery, there is limited comparative research with contradictory results. This study aimed to compare the effectiveness (tumor resection rate and survival) and safety (frequency of neurological complications) of surgery for brain gliomas with or without neuronavigation.

Methods: This retrospective cohort study evaluated data obtained from electronic records of patients who underwent surgery for gliomas at Dr.

Transorbital approach to the cavernous sinus: an anatomical study of the related cranial nerves.

Background: The cavernous sinus (CS) is a demanding surgical territory, given its deep location and the involvement of multiple neurovascular structures. Subjected to recurrent discussion on the optimal surgical access, the endoscopic transorbital approach has been recently proposed as a feasible route for selected lesions in the lateral CS. Still, for this technique to safely evolve and consolidate, a comprehensive anatomical description of involved cranial nerves, dural ligaments, and arterial relations is needed.

Neurophysiologic Monitoring of Oculomotor Nerves During Transorbital Surgery: Proof of Concept and Anatomic Demonstration.

Background And Objectives: Transorbital neuroendoscopic surgery (TONES) is continuously evolving and gaining terrain in approaching different skull base pathologies. The objective of this study was to present our methodology for introducing recording electrodes, which includes a new transconjunctival pathway, to monitor the extraocular muscle function during TONES.

Methods: A translational observational study was performed from an anatomic demonstration focused on the transconjunctival electrode placement technique to a descriptive analysis in our series of 6 patients operated using TONES in association with intraoperative neurophysiologic monitoring of the oculomotor nerves from 2017 to 2023.

Endoscopic transorbital approach bone pillars: a comprehensive stepwise anatomical appraisal.

Objective: The endoscopic superior eyelid transorbital approach has garnered significant consideration and gained popularity in recent years. Detailed anatomical knowledge along with clinical experience has allowed refinement of the technique as well as expansion of its indications. Using bone as a consistent reference, the authors identified five main bone pillars that offer access to the different intracranial targeted areas for different pathologies of the skull base, with the aim of enhancing the understanding of the intracranial areas accessible through this corridor.

Optimizing the Endoscopic Transorbital Approach: MacCarty Keyhole for Enhanced Surgical Exposure in the Opticocarotid Region.

Background: In recent years, the endoscopic transorbital (TO) approach has gained increasing interest for the treatment of middle cranial fossa lesions. We propose a technical refinement to the conventional superior eyelid TO approach, which improves the surgical exposure and augments the working angles when targeting the opticocarotid region.

Methods: Four embalmed adult cadaveric specimens (8 sides) were dissected at the Laboratory of Surgical Neuroanatomy of our institution.

The Sellar Region as Seen from Transcranial and Endonasal Perspectives: Exploring Bony Landmarks Through New Surface Photorealistic Three-Dimensional Model Reconstruction for Neurosurgical Anatomy Training.

Background: Virtual reality-based learning of neuroanatomy is a new feasible method to explore, visualize, and dissect interactively complex anatomic regions. We provide a new interactive photorealistic three-dimensional (3D) model of sellar region microsurgical anatomy that allows side-by-side views of exocranial and endocranial surfaces to be explored, with the aim of assisting young neurosurgery residents in learning microsurgical anatomy of this complex region.

Methods: Four head specimens underwent an endoscopic endonasal approach extended to the anterior and posterior skull base to expose the main bony anatomic landmarks of the sellar region.

Endoscopic transorbital resection of the temporal lobe: anatomic qualitative and quantitative study.

Objective: Starting from an anatomic study describing the possibility of reaching the temporal region through an endoscopic transorbital approach, many clinical reports have now demonstrated the applicability of this strategy when dealing with intra-axial lesions. The study aimed to provide both a qualitative anatomic description of the temporal region, as seen through a transorbital perspective, and a quantitative analysis of the amount of temporal lobe resection achievable via this route.

Material And Methods: A total of four cadaveric heads (eight sides) were dissected at the Laboratory of Surgical Neuroanatomy (LSNA) of the University of Barcelona, Spain.