title: Compartmental endoscopic surgical anatomy of the medial intraconal orbital space.
abstract: BACKGROUND
  Surgical management of intraconal pathology represents the next frontier in endoscopic endonasal surgery. Despite this, the medial intraconal space remains a relatively unexplored region, secondary to its variable and technically demanding anatomy. The purpose of this study is to define the neurovascular structures in this region and introduce a compartmentalized approach to enhance surgical planning.
  
  
  METHODS
  This study was an institutional review board (IRB)-exempt endoscopic anatomic study in 10 cadaveric orbits. After dissection of the medial intraconal space, the pattern and trajectory of the oculomotor nerve and ophthalmic arterial arborizations were analyzed. The position of all vessels as well as the length of the oculomotor trunk and branches relative to the sphenoid face were calculated.
  
  
  RESULTS
  A mean of 1.5 arterial branches were identified (n = 15; range, 1-4) at a mean of 8.8 mm from the sphenoid face (range, 4-15 mm). The majority of the arteries (n = 7) inserted adjacent to the midline of medial rectus. The oculomotor nerve inserted at the level of the sphenoid face and arborized with a large proximal trunk 5.5 ± 1.1 mm in length and multiple branches extending 13.2 ± 2.7 mm from the sphenoid face. The most anterior nerve and vascular pedicle were identified at 17.0 and 15.0 mm from the sphenoid face, respectively.
  
  
  CONCLUSIONS
  The neurovascular supply to the medial rectus muscle describes a varied but predictable pattern. This data allows the compartmentalization of the medial intraconal space into 3 zones relative to the neurovascular supply. These zones inform the complexity of the dissection and provide a guideline for safe medial rectus retraction relative to the fixed landmark of the sphenoid face.
authors.affiliation: Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA.
authors.forename: Benjamin S
authors.initials: BS
authors.lastname: Bleier
authors.forename: David Y
authors.initials: DY
authors.lastname: Healy
authors.forename: Nipun
authors.initials: N
authors.lastname: Chhabra
authors.forename: Suzanne
authors.initials: S
authors.lastname: Freitag
mesh_terms: D002102:Cadaver; D004724:Endoscopy / Q000379:methods*; D006801:Humans; D008297:Male; D009296:Nasal Cavity / Q000601:surgery*; D009802:Oculomotor Nerve / Q000033:anatomy & histology* / Q000601:surgery; D009880:Ophthalmic Artery / Q000033:anatomy & histology* / Q000601:surgery; D065866:Optic Tract / Q000033:anatomy & histology; D009915:Orbit / Q000033:anatomy & histology* / Q000098:blood supply / Q000294:innervation; D013100:Sphenoid Bone / Q000033:anatomy & histology
keywords: endoscopic orbital surgery; medial intraconal space; medial rectus muscle; oculomotor nerve; ophthalmic artery; orbital apex; orbital decompression; orbital tumors