Endonazal Endoskopik Optik Sinir Dekompresyon Cerrahisindeki Anatomik Belirteçler: Anatomi Çalışması

Abstract

Amaç Canalis opticus’u ve nervus opticus’u etkileyen pek çok patoloji için nervus opticus dekompresyonu yapılmaktadır. Endonazal endoskopik yol ile yapılan nervus opticus dekompresyonu, endoskopik cerrahideki gelişmeler ile de günümüzde oldukça revaçtadır. Gereç ve Yöntemler Bu çalışmada opticocarotid bölgeye transsfenoidal yaklaşım sırasında kullanılan ve önemli anatomik belirteçler olan materal optikorarotid recess (LOCR) ve medial opticocarotid recess (MOCR) incelendi. Bu anatomik belirteçlerin birbiri ile olan ve nervus opticus gibi önemli çevre anatomik yapılar ile olan ilişkileri değerlendirildi. Bulgular MOCR sağ tarafta tüm kadavralarda ve sol tarafta 5 kadavranın 4 tanesinde belirgin olarak izlendi. LOCR superior kenarı sağ tarafta ortalama 4,85±1,94 mm ve sol tarafta ortalama 3,93±1,11 mm aralığında ölçüldü. LOCR inferior kenarı sağ tarafta ortalama 4,72±2,11 mm ve sol tarafta ortalama 3,98±1,67 mm aralığında ölçüldü. LOCR ile MOCR arasındaki lineer mesafe sağ tarafta ortalama 3,11±1,41 mm ve sol tarafta ortalama 2,46±1,36 mm aralığında ölçüldü. Sonuçlar Nervus opticus dekompresyonu sırasında anatomik belirteçlerin ortaya konulabilmesi ve bölgenin detaylı anatomisinin bilinmesi güvenli bir cerrahi için gereklidir.

Keywords

• optik sinir
• optik kanal
• dekompresyon
• belirteç
• endoskopik

The Anatomical Landmarks in Endonasal Endoscopic Optic Nerve Decompression Surgery: An Anatomical Study

Abstract

Aim Optic nerve decompression can be applied for many pathologies that affect the optic canal and the optic nerve. Optic nerve decompression via endonasal endoscopic method is very popular in nowadays with the developments in endoscopic surgery. Material and Methods In this study, the lateral opticocarotid recess (LOCR) and the medial opticocarotid recess (MOCR) which are important anatomical landmarks used during transsphenoidal approach to the opticocarotid region were evaluated. The relations of these anatomical landmarks with each other and with important surrounding landmarks such as optic nerve were examined. Results MOCR were observed in all cadavers on the right side and in 4 of 5 cadavers on the left side. The superior border of the LOCR was measured as 4.85±1.94 mm in average on the right side and 3.93±1.11 mm in average on the left side. The inferior border of the LOCR was measured as 4.72±2.11 mm in average on the right side and 3.98±1.67 mm in average on the left side. The linear distance between the LOCR and the MOCR was measured as 3.11±1.41 mm in average on the right side and 2.46±1.36 mm in average on the left side. Conclusion It is necessary for a safe surgery to reveal the anatomical landmarks and to know the detailed anatomy of this region during optic nerve decompression.

Keywords

• optic nerve
• optic canal
• decompression
• landmarks
• endoscopic

References

1. 1. Güler TM, Yılmazlar S, Özgün G. Anatomical aspects of optic nerve decompression in transcranial and transsphenoidal approach. J Craniomaxillofac Surg. 2019; 47(4): 561-9.
2. 2. Dandy WE. Prechiasmal intracranial tumors of the optic nerves. Am J Ophthalmol. 1922; 5(3): 169-88.
3. 3. Sewall EC. External operation on the ethmosphenoidfrontal group of sinuses under local anesthesia: technic for removal of part of optic foramen wall for relief of pressure on optic nerve. Arch Otolaryngol. 1926; 4(5): 377-411.
4. 4. Yılmazlar S, Saraydaroğlu Ö, Korfalı E. Anatomical aspects in the transsphenoidal-transethmoidal approach to the optic canal: An anatomic-cadaveric study. J Craniomaxillofac Surg. 2012; 40(7): 198-205.
5. 5. Zoli M, Manzoli L, Bonfatti R, Ruggeri A, Mariani GA, Bacci A et al. Endoscopic endonasal anatomy of the ophthalmic artery in the optic canal. Acta Neurochir (Wien). 2016; 158(7): 1343-50.
6. 6. Liu Y, Yu H, Zhen H. Navigation-assisted, endonasal, endoscopic optic nerve decompression for the treatment of nontraumatic optic neuropathy. J Craniomaxillofac Surg. 2019; 47(2): 328-33.
7. 7. Li J, Wang J, Jing X, Zhang W, Zhang X, Qiu Y. Transsphenoidal optic nerve decompression: an endoscopic anatomic study. J Craniofac Surg. 2008; 19(6): 1670-4.
8. 8. Abhinav K, Acosta Y, Wang WH, Bonilla LR, Koutourousiou M, Wang E et al. Endoscopic endonasal approach to the optic canal: anatomic considerations and surgical relevance. Neurosurgery. 2015; 11(3): 431-45.

9. 9. Kilinc MC, Basak H, Çoruh AG, Mutlu M, Guler TM, Beton S et al. Endoscopic anatomy and a safe surgical corridor to the anterior skull base. World Neurosurg. 2021; 145: e83-9.
10. 10. Locatelli M, Caroli M, Pluderi M, Motta F, Gaini SM, Tschabitscher M et al. Endoscopic transsphenoidal optic nerve decompression: an anatomical study. Surgical and radiologic anatomy 2011; 33(3): 257-62.
11. 11. Rhoton Jr AL. The orbit. Neurosurgery. 2002; 51(suppl 4): S1-303.
12. 12. Ozcan T, Yilmazlar S, Aker S, Korfali E. Surgical limits in transnasal approach to opticocarotid region and planum sphenoidale: an anatomic cadaveric study. World Neurosurg. 2010; 73(4): 326-33.
13. 13. Sun J, Cai X, Zou W, Zhang J. Outcome of Endoscopic Optic Nerve Decompression for Traumatic Optic Neuropathy. Ann Otol Rhinol Laryngol. 2021 Jan;130(1):56-59.