Endoscopic orbital roof fenestration as an alternative treatment option for idiopathic intracranial hypertension: a cadaveric anatomical study.
BACKGROUND
We investigated a new minimally invasive surgical technique for the treatment of idiopathic intracranial hypertension in a cadaveric model. This technique aims at establishing a communication between the intraorbital and intracranial compartments by creating a bone, dural, and periorbital window in the anterior cranial fossa. This procedure is predicated on intraorbital absorptive capability that has been demonstrated in animals and discussed in humans.


METHODS
Three fresh cadaver heads were fixed in a head holder so as to mimic the hyperextended supine position. The procedure was conducted bilaterally in each specimen. Our technique is as follows: 1) An incision is made in the eyebrow medial to the supraorbital notch; 2) using an endoscope and a periosteal elevator, the intraorbital surface of the orbital roof is separated from the periorbita in an anteroposterior direction for a length of 1.5-2.5 cm; 3) a 1 cm of the exposed orbital roof is removed, and the dura and arachnoid are opened; and 4) slits are made in the exposed periorbita.


RESULTS
We were able to create a communication between the intracranial and the intraorbital compartments in all specimens.


CONCLUSIONS
Our technique is new and does not require any foreign body implantation. Its applicability in humans needs to be evaluated in a clinical context.
Salma
Asem
A
Dardinger Microneurosurgical Skull Base Laboratory, Department of Neurological Surgery, The Ohio State University Medical Center, Columbus, Ohio 43210, USA. asem.salma@osumc.edu
Lubow
Martin
M
Scheffer
Ashley
A
Ammirati
Mario
M
D002102:Cadaver; D035262:Cranial Fossa, Anterior / Q000033:anatomy & histology* / Q000601:surgery; D004724:Endoscopy / Q000295:instrumentation / Q000379:methods*; D005624:Frontal Bone / Q000033:anatomy & histology* / Q000601:surgery; D006801:Humans; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation / Q000379:methods; D019635:Neurosurgical Procedures / Q000295:instrumentation / Q000379:methods; D009915:Orbit / Q000033:anatomy & histology* / Q000601:surgery; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control; D011559:Pseudotumor Cerebri / Q000601:surgery*