Comparative Analysis of Cranio-Orbito-Zygomatic and Transorbital Routes to the Superior Orbital Fissure, Orbital Apex, Clinoidal Space, and Suprasellar Cisterns

Abstract

The superior orbital fissure (SOF), orbital apex (OA), clinoidal space (ClnS) and suprasellar parachiasmatic cisterns (SSPC) represent frequent surgical targets in skull base neurosurgery. Surgical access to these regions remains challenging due to the high density of critical neurovascular structures within multiple cisternal compartments. This study aimed to evaluate a transorbital surgical route to the SOF, OA, ClnS, and SSPC and compare the limits of exposure with those of the conventional trans-sylvian route through a cranio-orbitozygomatic approach (COZA). Methods: Cadaveric dissections were performed to expose the orbital apex, cavernous sinus, sphenoid wing, and suprasellar parachiasmatic cisterns. Trans-sylvian route via COZA was carried out initially, and this was subsequently followed by a transorbital approach directed at the same anatomical areas. Surgical corridors were systematically analyzed, and exposure boundaries were documented and compared. Results: The transorbital route consistently provided access to the SOF, OA, ClnS in addition to the anteromedial cavernous sinus. The extent of exposure achieved via the transorbital route was comparable to that obtained with the COZA for SSPC; however, the transorbital approach appeared to provide a shorter and more direct working corridor. Intradural access to the carotid and proximal sylvian cisterns was achievable; however, chiasmatic and lamina terminalis cisterns were more effectively accessed through the trans-sylvian route via COZA. Conclusion: The transorbital approach offers a direct surgical corridor to selected anterior skull base and parasellar structures without sylvian fissure dissection. While not a substitute for conventional trans-sylvian exposure for all chiasmatic cisterns, the transorbital approach may serve as a complementary or alternative approach for appropriately selected lesions.

Keywords

• cavernous sinus
• cranio-orbitozygomatic approach
• sphenoid wing
• superior orbital fissure
• Suprasellar parachiasmatic cistern
• Transorbital approach

Supporting Institution

This research received no external funding.

Project Number

2539

Ethical Statement

The study was conducted in accordance with the Declaration of Helsinki and approved by the Ethics Committee of (Ethics Committee of Istanbul Training and Research Hospital (approval number: 2539 date of approval: (02/10/2020).

Kranio-orbito-zigomatik ve Transorbital Yaklaşımların Superior Orbital Fissür, Orbital Apeks, Klinoidal Alan ve Suprasellar Sisternalara Erişim Açısından Karşılaştırmalı Analizi

Abstract

Amaç: Superior orbital fissür (SOF), orbital apeks (OA), klinoidal alan (ClnS) ve suprasellar parakiazmatik sisternalar (SSPC), kafa tabanı nöroşirürjisinde sık karşılaşılan cerrahi hedeflerdir. Bu bölgelere cerrahi erişim, birden fazla sisternal kompartıman içinde yer alan kritik nörovasküler yapıların yoğunluğu nedeniyle zorludur. Bu çalışmada, SOF, OA, ClnS ve SSPC’ye yönelik transorbital cerrahi yolun değerlendirilmesi ve maruziyet sınırlarının kranio-orbitozigomatik yaklaşım (COZA) ile uygulanan konvansiyonel trans-sylvian yol ile karşılaştırılması amaçlandı. Yöntem: Orbital apeks, kavernöz sinüs, sfenoid kanat ve suprasellar sisternaları ortaya koymak için kadavra diseksiyonları yapıldı. Öncelikle COZA ile trans-sylvian yol uygulandı; ardından aynı anatomik alanlara yönelik transorbital yaklaşım gerçekleştirildi. Cerrahi koridorlar sistematik olarak analiz edildi ve maruziyet sınırları belgelendi ve karşılaştırıldı. Bulgular: Transorbital yol, SOF, OA ve ClnS’ye ek olarak anteromedial kavernöz sinüse tutarlı erişim sağladı. Transorbital yol ile SSPC için elde edilen maruziyet, COZA ile elde edilen maruziyetle karşılaştırılabilir düzeydeydi; ancak transorbital yaklaşım daha kısa bir çalışma mesafesi sundu. Karotid ve proksimal sylvian sisternalara intradural erişim sağlanabildi; ancak kiazmatik ve lamina terminalis sisternalarına COZA ile uygulanan trans-sylvian yol üzerinden daha etkili şekilde ulaşıldı. Sonuç: Transorbital yaklaşım, sylvian fissür diseksiyonu gerektirmeden seçilmiş anterior kafa tabanı ve parasellar yapılara doğrudan bir cerrahi koridor sunar. Tüm kiazmatik sisternalar için konvansiyonel trans-sylvian maruziyetin yerine geçmemekle birlikte, uygun seçilmiş lezyonlarda tamamlayıcı veya alternatif bir yaklaşım olarak kullanılabilir.

Keywords

• kavernöz sinüs
• kranio-orbitozigomatik yaklaşım
• sfenoid kanat
• superior orbital fissür
• suprasellar parakiazmatik sisternalar
• transorbital yaklaşım

Project Number

2539

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