Minimally Invasive Approaches for Anterior Skull Base Meningiomas: Supraorbital Eyebrow, Endoscopic Endonasal, or a Combination of Both? Anatomic Study, Limitations, and Surgical Application

Hamid Borghei-Razavi, Huy Q. Truong, David T. Fernandes-Cabral, Emrah Celtikci, Joseph D. Chabot, S. Tonya Stefko, Eric W. Wang, Carl H. Snyderman, Aaron Cohen-Gadol, Paul A. Gardner, Juan C. Fernández-Miranda

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background: Minimally invasive accesses to the anterior skull base include the endoscopic endonasal approach (EEA) and the supraorbital eyebrow approach. These 2 are often seen as competing approaches, not alternative or combinatory approaches. In this study, we evaluated the anatomic limitations of each approach and the combined approach for accessing the anterior skull base. Methods: Ten neurovascular injected cadaver heads were used for the study. The supraorbital approach to the anterior skull base was performed on 5 heads, and EEA was done on the other 5 heads. Then, the supraorbital approach was added to the 5 heads receiving EEA. Visualization and surgical limitations were recorded by the ability to perform resection of the crista galli, anterior clinoid, cribriform plate, and planum sellae. Results: The maximal lateral extension of EEA for anterior skull base was the midorbit line anteriorly but narrowing down toward the orbital apex. The limitation of the supraorbital approach was found mostly medial and anterior. Drilling of anterior skull base was impossible medially between the sphenoethmoidal suture and the posterior aspect of the crista galli. The combined approach showed complementary areas of visualization and surgical maneuverability. Three clinical cases were presented to illustrate the indications for the stand-alone supraorbital approach, EEA, and combined approach. Conclusion: The limitations of the EEA when dealing with lateral extension of anterior skull base meningiomas, and the limitations of the supraorbital eyebrow approach for medial skull base drilling and reconstruction, can be overcome by a judicious, anatomically based combination of both approaches.

Original languageEnglish (US)
JournalWorld Neurosurgery
DOIs
StateAccepted/In press - Jan 1 2018

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Eyebrows
Skull Base
Meningioma
Head
Ethmoid Bone
Temazepam
Cadaver
Sutures

Keywords

  • Anterior skull base
  • Endoscopic endonasal approach
  • Meningioma
  • Minimally invasive
  • Supraorbital approach

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Minimally Invasive Approaches for Anterior Skull Base Meningiomas : Supraorbital Eyebrow, Endoscopic Endonasal, or a Combination of Both? Anatomic Study, Limitations, and Surgical Application. / Borghei-Razavi, Hamid; Truong, Huy Q.; Fernandes-Cabral, David T.; Celtikci, Emrah; Chabot, Joseph D.; Stefko, S. Tonya; Wang, Eric W.; Snyderman, Carl H.; Cohen-Gadol, Aaron; Gardner, Paul A.; Fernández-Miranda, Juan C.

In: World Neurosurgery, 01.01.2018.

Research output: Contribution to journalArticle

Borghei-Razavi, Hamid ; Truong, Huy Q. ; Fernandes-Cabral, David T. ; Celtikci, Emrah ; Chabot, Joseph D. ; Stefko, S. Tonya ; Wang, Eric W. ; Snyderman, Carl H. ; Cohen-Gadol, Aaron ; Gardner, Paul A. ; Fernández-Miranda, Juan C. / Minimally Invasive Approaches for Anterior Skull Base Meningiomas : Supraorbital Eyebrow, Endoscopic Endonasal, or a Combination of Both? Anatomic Study, Limitations, and Surgical Application. In: World Neurosurgery. 2018.
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abstract = "Background: Minimally invasive accesses to the anterior skull base include the endoscopic endonasal approach (EEA) and the supraorbital eyebrow approach. These 2 are often seen as competing approaches, not alternative or combinatory approaches. In this study, we evaluated the anatomic limitations of each approach and the combined approach for accessing the anterior skull base. Methods: Ten neurovascular injected cadaver heads were used for the study. The supraorbital approach to the anterior skull base was performed on 5 heads, and EEA was done on the other 5 heads. Then, the supraorbital approach was added to the 5 heads receiving EEA. Visualization and surgical limitations were recorded by the ability to perform resection of the crista galli, anterior clinoid, cribriform plate, and planum sellae. Results: The maximal lateral extension of EEA for anterior skull base was the midorbit line anteriorly but narrowing down toward the orbital apex. The limitation of the supraorbital approach was found mostly medial and anterior. Drilling of anterior skull base was impossible medially between the sphenoethmoidal suture and the posterior aspect of the crista galli. The combined approach showed complementary areas of visualization and surgical maneuverability. Three clinical cases were presented to illustrate the indications for the stand-alone supraorbital approach, EEA, and combined approach. Conclusion: The limitations of the EEA when dealing with lateral extension of anterior skull base meningiomas, and the limitations of the supraorbital eyebrow approach for medial skull base drilling and reconstruction, can be overcome by a judicious, anatomically based combination of both approaches.",
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author = "Hamid Borghei-Razavi and Truong, {Huy Q.} and Fernandes-Cabral, {David T.} and Emrah Celtikci and Chabot, {Joseph D.} and Stefko, {S. Tonya} and Wang, {Eric W.} and Snyderman, {Carl H.} and Aaron Cohen-Gadol and Gardner, {Paul A.} and Fern{\'a}ndez-Miranda, {Juan C.}",
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T1 - Minimally Invasive Approaches for Anterior Skull Base Meningiomas

T2 - Supraorbital Eyebrow, Endoscopic Endonasal, or a Combination of Both? Anatomic Study, Limitations, and Surgical Application

AU - Borghei-Razavi, Hamid

AU - Truong, Huy Q.

AU - Fernandes-Cabral, David T.

AU - Celtikci, Emrah

AU - Chabot, Joseph D.

AU - Stefko, S. Tonya

AU - Wang, Eric W.

AU - Snyderman, Carl H.

AU - Cohen-Gadol, Aaron

AU - Gardner, Paul A.

AU - Fernández-Miranda, Juan C.

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Background: Minimally invasive accesses to the anterior skull base include the endoscopic endonasal approach (EEA) and the supraorbital eyebrow approach. These 2 are often seen as competing approaches, not alternative or combinatory approaches. In this study, we evaluated the anatomic limitations of each approach and the combined approach for accessing the anterior skull base. Methods: Ten neurovascular injected cadaver heads were used for the study. The supraorbital approach to the anterior skull base was performed on 5 heads, and EEA was done on the other 5 heads. Then, the supraorbital approach was added to the 5 heads receiving EEA. Visualization and surgical limitations were recorded by the ability to perform resection of the crista galli, anterior clinoid, cribriform plate, and planum sellae. Results: The maximal lateral extension of EEA for anterior skull base was the midorbit line anteriorly but narrowing down toward the orbital apex. The limitation of the supraorbital approach was found mostly medial and anterior. Drilling of anterior skull base was impossible medially between the sphenoethmoidal suture and the posterior aspect of the crista galli. The combined approach showed complementary areas of visualization and surgical maneuverability. Three clinical cases were presented to illustrate the indications for the stand-alone supraorbital approach, EEA, and combined approach. Conclusion: The limitations of the EEA when dealing with lateral extension of anterior skull base meningiomas, and the limitations of the supraorbital eyebrow approach for medial skull base drilling and reconstruction, can be overcome by a judicious, anatomically based combination of both approaches.

AB - Background: Minimally invasive accesses to the anterior skull base include the endoscopic endonasal approach (EEA) and the supraorbital eyebrow approach. These 2 are often seen as competing approaches, not alternative or combinatory approaches. In this study, we evaluated the anatomic limitations of each approach and the combined approach for accessing the anterior skull base. Methods: Ten neurovascular injected cadaver heads were used for the study. The supraorbital approach to the anterior skull base was performed on 5 heads, and EEA was done on the other 5 heads. Then, the supraorbital approach was added to the 5 heads receiving EEA. Visualization and surgical limitations were recorded by the ability to perform resection of the crista galli, anterior clinoid, cribriform plate, and planum sellae. Results: The maximal lateral extension of EEA for anterior skull base was the midorbit line anteriorly but narrowing down toward the orbital apex. The limitation of the supraorbital approach was found mostly medial and anterior. Drilling of anterior skull base was impossible medially between the sphenoethmoidal suture and the posterior aspect of the crista galli. The combined approach showed complementary areas of visualization and surgical maneuverability. Three clinical cases were presented to illustrate the indications for the stand-alone supraorbital approach, EEA, and combined approach. Conclusion: The limitations of the EEA when dealing with lateral extension of anterior skull base meningiomas, and the limitations of the supraorbital eyebrow approach for medial skull base drilling and reconstruction, can be overcome by a judicious, anatomically based combination of both approaches.

KW - Anterior skull base

KW - Endoscopic endonasal approach

KW - Meningioma

KW - Minimally invasive

KW - Supraorbital approach

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