Abstract
OBJECTIVE: Dolenc has pioneered the extradural approach to the anterior clinoid process (ACP) in approaching the cavernous sinus, clinoidal space, and orbital apex. A key step is the division of the frontotemporal dural fold (FTDF). Less experienced surgeons may not be as versatile in their three-dimensional understanding of the superior orbital fissure and thus may risk injury to its contents. Through our cadaveric and subsequent clinical experience, we have devised a modification of the approach that permits safer handling of the contents of the superior orbital fissure. METHODS: In five consecutive injected cadaveric heads (10 sides), we performed on one side a traditional extradural exposure of the ACP. On the other side, we performed our alternative dissection. Instead of exposing the ACP from medial to lateral and dividing the frontotemporal dural fold along the assumed path of safety, we followed the edge of the lesser wing from lateral to medial, uncovered the superior orbital fissure, and peeled the outer layer of the cavernous sinus medial to the foramen rotundum along the greater wing, thus uncovering the inferolateral surface of the ACP. This allowed dural division under full visualization. RESULTS: The alternative method proved easier and more reliable in every case. We applied this technical modification in seven patients with no complications. Specifically, there was no injury to the oculomotor, lacrimal, frontal, or trigeminal nerves or branches. We present detailed anatomic expositions of the injected specimens. CONCLUSION: This technical modification of the extradural approach of Dolenc is a simple, safe, and valuable adjunct to the exposure of the ACP. We recommend its use particularly by relatively inexperienced surgeons.
| Original language | English |
|---|---|
| Pages (from-to) | 162-167 |
| Number of pages | 6 |
| Journal | Neurosurgery |
| Volume | 53 |
| Issue number | 1 |
| State | Published - Jul 1 2003 |
Fingerprint
Keywords
- Anterior clinoid process
- Cranial base surgery
- Dolenc approach
- Superior orbital fissure
ASJC Scopus subject areas
- Clinical Neurology
- Surgery
Cite this
An alternative extradural exposure to the anterior clinoid process : The superior orbital fissure as a surgical corridor. / Coscarella, Ernesto; Ba̧kaya, Mustafa K.; Morcos, Jacques; Rosenblatt, Sami; Ciric, Ivan S.; Sekhar, Laligam N.; Day, John Diaz; Zubay, Geoffrey; Spetzler, Robert F.; George, Bernard.
In: Neurosurgery, Vol. 53, No. 1, 01.07.2003, p. 162-167.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - An alternative extradural exposure to the anterior clinoid process
T2 - The superior orbital fissure as a surgical corridor
AU - Coscarella, Ernesto
AU - Ba̧kaya, Mustafa K.
AU - Morcos, Jacques
AU - Rosenblatt, Sami
AU - Ciric, Ivan S.
AU - Sekhar, Laligam N.
AU - Day, John Diaz
AU - Zubay, Geoffrey
AU - Spetzler, Robert F.
AU - George, Bernard
PY - 2003/7/1
Y1 - 2003/7/1
N2 - OBJECTIVE: Dolenc has pioneered the extradural approach to the anterior clinoid process (ACP) in approaching the cavernous sinus, clinoidal space, and orbital apex. A key step is the division of the frontotemporal dural fold (FTDF). Less experienced surgeons may not be as versatile in their three-dimensional understanding of the superior orbital fissure and thus may risk injury to its contents. Through our cadaveric and subsequent clinical experience, we have devised a modification of the approach that permits safer handling of the contents of the superior orbital fissure. METHODS: In five consecutive injected cadaveric heads (10 sides), we performed on one side a traditional extradural exposure of the ACP. On the other side, we performed our alternative dissection. Instead of exposing the ACP from medial to lateral and dividing the frontotemporal dural fold along the assumed path of safety, we followed the edge of the lesser wing from lateral to medial, uncovered the superior orbital fissure, and peeled the outer layer of the cavernous sinus medial to the foramen rotundum along the greater wing, thus uncovering the inferolateral surface of the ACP. This allowed dural division under full visualization. RESULTS: The alternative method proved easier and more reliable in every case. We applied this technical modification in seven patients with no complications. Specifically, there was no injury to the oculomotor, lacrimal, frontal, or trigeminal nerves or branches. We present detailed anatomic expositions of the injected specimens. CONCLUSION: This technical modification of the extradural approach of Dolenc is a simple, safe, and valuable adjunct to the exposure of the ACP. We recommend its use particularly by relatively inexperienced surgeons.
AB - OBJECTIVE: Dolenc has pioneered the extradural approach to the anterior clinoid process (ACP) in approaching the cavernous sinus, clinoidal space, and orbital apex. A key step is the division of the frontotemporal dural fold (FTDF). Less experienced surgeons may not be as versatile in their three-dimensional understanding of the superior orbital fissure and thus may risk injury to its contents. Through our cadaveric and subsequent clinical experience, we have devised a modification of the approach that permits safer handling of the contents of the superior orbital fissure. METHODS: In five consecutive injected cadaveric heads (10 sides), we performed on one side a traditional extradural exposure of the ACP. On the other side, we performed our alternative dissection. Instead of exposing the ACP from medial to lateral and dividing the frontotemporal dural fold along the assumed path of safety, we followed the edge of the lesser wing from lateral to medial, uncovered the superior orbital fissure, and peeled the outer layer of the cavernous sinus medial to the foramen rotundum along the greater wing, thus uncovering the inferolateral surface of the ACP. This allowed dural division under full visualization. RESULTS: The alternative method proved easier and more reliable in every case. We applied this technical modification in seven patients with no complications. Specifically, there was no injury to the oculomotor, lacrimal, frontal, or trigeminal nerves or branches. We present detailed anatomic expositions of the injected specimens. CONCLUSION: This technical modification of the extradural approach of Dolenc is a simple, safe, and valuable adjunct to the exposure of the ACP. We recommend its use particularly by relatively inexperienced surgeons.
KW - Anterior clinoid process
KW - Cranial base surgery
KW - Dolenc approach
KW - Superior orbital fissure
UR - http://www.scopus.com/inward/record.url?scp=0038048461&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0038048461&partnerID=8YFLogxK
M3 - Article
C2 - 12823885
AN - SCOPUS:0038048461
VL - 53
SP - 162
EP - 167
JO - Neurosurgery
JF - Neurosurgery
SN - 0148-396X
IS - 1
ER -