title: Transorbital transnasal endoscopic combined approach to the anterior and middle skull base: a laboratory investigation.
abstract: Orbital approaches provide significant trajectory to the skull base and are used with differently designed pathways. The aim of this study is to investigate the feasibility of a combined transorbital and transnasal approach to the anterior and middle cranial fossa. Cadaveric dissection of five silicon-injected heads was used. A total of 10 bilateral transorbital approaches and 5 extended endonasal approaches were performed. Identification of surgical landmarks, main anatomical structures, feasibility of a combined approach and reconstruction of the superior orbital defect were examined. Rod lens endoscope (with 0° and 45° lenses) and endoscopic instruments were used to complete the dissection. The transorbital approach showed good versatility and provides the surgeon with a direct route to the anterior and middle cranial fossa. The transorbital avascular plane showed no conflict with major nerves or vessels. Large exposure area from crista galli to the third ventricle was demonstrated with significant control of different neurovascular structures. A combined transorbital transnasal approach provides considerable value in terms of extent of exposure and free hand movement of the two surgeons, and allows better visualisation and control of the ventral skull base, thus overcoming the current surgical limits of a single approach. Combination of these two minimally invasive approaches should reduce overall morbidity. Clinical trials are needed to evaluate the virtual applications of this approach.
authors.affiliation: Department of Otorhinolaryngology/Head and neck surgery, Prince Sultan Military Medical City, Riyadh, Saudi Arabia; ; Department of Otorhinolaryngology, University of Insubria, Varese, Italy;
authors.forename: A
authors.initials: A
authors.lastname: Alqahtani
authors.affiliation: Department of Otorhinolaryngology, University of Insubria, Varese, Italy;
authors.forename: G
authors.initials: G
authors.lastname: Padoan
authors.affiliation: First Otorhinolaryngology unit, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy;
authors.forename: G
authors.initials: G
authors.lastname: Segnini
authors.affiliation: Department of Otorhinolaryngology, University of Insubria, Varese, Italy;
authors.forename: D
authors.initials: D
authors.lastname: Lepera
authors.affiliation: First Otorhinolaryngology unit, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy;
authors.forename: S
authors.initials: S
authors.lastname: Fortunato
authors.affiliation: First Otorhinolaryngology unit, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy;
authors.forename: I
authors.initials: I
authors.lastname: Dallan
authors.affiliation: Department of Otorhinolaryngology, University of Insubria, Varese, Italy;
authors.forename: A
authors.initials: A
authors.lastname: Pistochini
authors.affiliation: Department of Otorhinolaryngology, University of Insubria, Varese, Italy;
authors.forename: S
authors.initials: S
authors.lastname: Abdulrahman
authors.affiliation: Maxillofacial Department, University of Naples "Federico II", Naples, Italy;
authors.forename: V
authors.initials: V
authors.lastname: Abbate
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, University of Tubingen Medical Center, Tubingen, Germany.
authors.forename: B
authors.initials: B
authors.lastname: Hirt
authors.affiliation: Department of Otorhinolaryngology, University of Insubria, Varese, Italy;
authors.forename: P
authors.initials: P
authors.lastname: Castelnuovo
mesh_terms: D002102:Cadaver; D004724:Endoscopy / Q000379:methods*; D005240:Feasibility Studies; D006801:Humans; D009666:Nose; D009915:Orbit; D019291:Skull Base / Q000033:anatomy & histology / Q000601:surgery*
keywords: Endoscopic; Minimally invasive; Reconstruction; Skull base; Transnasal; Transorbital