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. Through cadaveric dissections, we compare the supraorbital, endoscopic transorbital, and endonasal approaches to the supraoptic recess of working area exposure and surgical freedom.

Methods: For this purpose, 4 cadaveric specimens, separately, underwent endoscopic endonasal, endoscopic transorbital, and supraorbital microsurgical approaches to the supraoptic recess.

Results: All the approaches taken in consideration can expose the supraoptic area with different degrees of anatomical limitations. The endoscopic endonasal approach is limited inferiorly by the optic nerve, and the surgical view is subjected to the use of angled endoscope. The endoscopic transorbital approach is confined laterally by the orbital process of the frontal bone. The supraorbital approach permits a fine view of the projection of the supraoptic recess but does not guarantee safe view of the anatomic structures in the inferomedial portion of the anterior cranial fossa.

Conclusion: For midline bilateral pathologies not extending beyond the optic nerve, the endoscopic approach offers sufficient exposure and maneuverability by a binostril technique. The supraorbital approach provides better control for lesions superoanterior to the optic canal, whereas the transorbital approach is preferable for pathologies extending laterally to the optic canal and greater wing of the sphenoid.