title: The extended transorbital craniotomy: an anatomic study.
abstract: BACKGROUND
  Supra-/transorbital approaches are mostly limited to suprasellar and anterior fossa pathologies, whereas lateral supraorbital approaches provide less retrosellar exposure and less overall operative volume, especially in the temporal region.
  
  
  OBJECTIVE
  Our cadaveric study proposes removal of the lesser and greater wings of the sphenoid bone to increase both the lateral angle typically achieved with pterional approaches and exposure to the temporal lobe and perisellar region.
  
  
  METHODS
  In 5 cadaveric specimens, our 3 steps to expand transorbital exposures included the following: step 1, standard transorbital craniotomy via a 3-cm supra-eyebrow incision; step 2, removal of the lesser sphenoid wing completed extradurally; and step 3, partial removal of the greater sphenoid wing. Operative extension in sylvian, parasellar, and anterolateral temporal exposures were quantified for each step (t test).
  
  
  RESULTS
  Step 2 provided the greatest increased exposure in the sylvian and parasellar regions compared with step 3, whereas step 3 provided a significant proportion of the exposure in the lateral temporal region. Finally, the lateral view progressively increased with each subsequent step.
  
  
  CONCLUSIONS
  Our 3-step removal of the lesser and greater wings of the sphenoid bone quantified increased sylvian, anterior temporal, and parasellar exposures for this minimally invasive approach with excellent cosmesis. Its increases the anterolateral view (similar to a subfrontal pterional approach) and offers potential applications to vascular and neoplastic (ie, sphenoid meningiomas) pathologies classically treated via a pterional or frontotemporal orbitozygomatic approach.
authors: Department of Neurosurgery, University of Cincinnati (UC) College of Medicine, Comprehensive Stroke Center at UC Neuroscience Institute, Mayfield Clinic, Cincinnati, Ohio.
authors: Almaz
authors: A
authors: Kurbanov
authors: Chris
authors: C
authors: Sanders-Taylor
authors: Jeffrey T
authors: JT
authors: Keller
authors: Norberto
authors: N
authors: Andaluz
authors: Mario
authors: M
authors: Zuccarello
mesh_terms: D001921:Brain / Q000601:surgery*; D002102:Cadaver; D003399:Craniotomy / Q000379:methods*; D006801:Humans; D008297:Male; D009915:Orbit / Q000601:surgery*; D013100:Sphenoid Bone / Q000601:surgery*