title: Endoscopic Endonasal Approach to the Optic Canal: Anatomic Considerations and Surgical Relevance.
abstract: BACKGROUND
  Increasing use of endoscopic endonasal surgery for suprasellar lesions with extension into the optic canal (OC) has necessitated a better endonasal description of the OC.
  
  
  OBJECTIVE
  To identify the osseous OC transcranially and then investigate its anatomic relationship to the key endonasal intrasphenoidal landmarks. We also aimed to determine and describe the technical nuances for safely opening the falciform ligament and intracanalicular dura (surrounding the optic nerve [ON]) endonasally.
  
  
  METHODS
  Ten fresh human head silicon-injected specimens underwent an endoscopic transtuberculum/transplanum approach followed by 2-piece orbitozygomatic craniotomy to allow identification of 20 OCs. After completing up to 270° of endonasal bony decompression of the OC, a dural incision started at the sella and continued superiorly across the superior intercavernous sinus. Subsequently the dural opening was extended anterolaterally across the dura of the prechiasmatic sulcus, limbus sphenoidale, and planum.
  
  
  RESULTS
  Endonasally, the length of the osseous OC was approximately 6 mm and equivalent to the length of the lateral opticocarotid recess, as measured anteroposteriorly. The ophthalmic artery arose from the supraclinoidal carotid artery at approximately 2.5 mm from the medial osseous OC entrance. Transcranial correlation of the endonasal dural incision confirmed medial detachment of the falciform ligament and exposure of the preforaminal ON.
  
  
  CONCLUSIONS
  The lateral opticocarotid recess allows distinction of the preforaminal ON, roofed by the falciform ligament from the intracanalicular segment in the osseous OC. This facilitates the preoperative surgical strategy regarding the extent of OC decompression and dural opening. Extensive endonasal decompression of the OC and division of the falciform ligament is feasible.
authors.affiliation: Departments of *Neurological Surgery and ‡Otolaryngology University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
authors.forename: Kumar
authors.initials: K
authors.lastname: Abhinav
authors.forename: Yancy
authors.initials: Y
authors.lastname: Acosta
authors.forename: Wei-Hsin
authors.initials: WH
authors.lastname: Wang
authors.forename: Luis R
authors.initials: LR
authors.lastname: Bonilla
authors.forename: Maria
authors.initials: M
authors.lastname: Koutourousiou
authors.forename: Eric
authors.initials: E
authors.lastname: Wang
authors.forename: Carl
authors.initials: C
authors.lastname: Synderman
authors.forename: Paul
authors.initials: P
authors.lastname: Gardner
authors.forename: Juan C
authors.initials: JC
authors.lastname: Fernandez-Miranda
mesh_terms: D000328:Adult; D002102:Cadaver; D019299:Decompression, Surgical; D004388:Dura Mater / Q000033:anatomy & histology / Q000601:surgery; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006423:Hemianopsia / Q000473:pathology / Q000601:surgery; D006801:Humans; D008022:Ligaments / Q000033:anatomy & histology / Q000601:surgery; D008579:Meningioma / Q000473:pathology / Q000601:surgery; D008875:Middle Aged; D009296:Nasal Cavity / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000379:methods*; D009900:Optic Nerve / Q000033:anatomy & histology / Q000601:surgery; D065866:Optic Tract / Q000033:anatomy & histology* / Q000601:surgery*; D009915:Orbit / Q000033:anatomy & histology / Q000601:surgery; D010911:Pituitary Neoplasms / Q000473:pathology / Q000601:surgery; D015050:Zygoma / Q000033:anatomy & histology / Q000601:surgery