title: Endoscopic transorbital route to the cavernous sinus through the meningo-orbital band: a descriptive anatomical study.
abstract: OBJECTIVE Exposure of the cavernous sinus is technically challenging. The most common surgical approaches use well-known variations of the standard frontotemporal craniotomy. In this paper the authors describe a novel ventral route that enters the lateral wall of the cavernous sinus through an interdural corridor that includes the removal of the greater sphenoid wing via a purely endoscopic transorbital pathway. METHODS Five human cadaveric heads (10 sides) were dissected at the Laboratory of Surgical NeuroAnatomy of the University of Barcelona. To expose the lateral wall of the cavernous sinus, a superior eyelid endoscopic transorbital approach was performed and the anterior portion of the greater sphenoid wing was removed. The meningo-orbital band was exposed as the key starting point for revealing the cavernous sinus and its contents in a minimally invasive interdural fashion. RESULTS This endoscopic transorbital approach, with partial removal of the greater sphenoid wing followed by a "natural" ventral interdural dissection of the meningo-orbital band, allowed exposure of the entire lateral wall of the cavernous sinus up to the plexiform portion of the trigeminal root and the petrous bone posteriorly and the foramen spinosum, with the middle meningeal artery, laterally. CONCLUSIONS The purely endoscopic transorbital approach through the meningo-orbital band provides a direct view of the cavernous sinus through a simple and rapid means of access. Indeed, this interdural pathway lies in the same sagittal plane as the lateral wall of the cavernous sinus. Advantages include a favorable angle of attack, minimal brain retraction, and the possibility for dissection through the interdural space without entering the neurovascular compartment of the cavernous sinus. Surgical series are needed to demonstrate any clinical advantages and disadvantages of this novel route.
authors.affiliation: First Otorhinolaryngologic Unit, Azienda Ospedaliero-Universitaria Pisana, Pisa.
authors.forename: Iacopo
authors.initials: I
authors.lastname: Dallan
authors.affiliation: Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli Federico II, Naples.
authors.forename: Alberto
authors.initials: A
authors.lastname: Di Somma
authors.affiliation: Laboratory of Surgical Neuroanatomy (LSNA), Faculty of Medicine, Universitat de Barcelona; and.
authors.forename: Alberto
authors.initials: A
authors.lastname: Prats-Galino
authors.affiliation: Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli Federico II, Naples.
authors.forename: Domenico
authors.initials: D
authors.lastname: Solari
authors.affiliation: Rhinology and Skull Base Unit, Department of Otorhinolaryngology, Hospital Clínic de Barcelona, Universitat de Barcelona, Spain.
authors.forename: Isam
authors.initials: I
authors.lastname: Alobid
authors.affiliation: Unit of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Varese.
authors.forename: Mario
authors.initials: M
authors.lastname: Turri-Zanoni
authors.affiliation: First Otorhinolaryngologic Unit, Azienda Ospedaliero-Universitaria Pisana, Pisa.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Fiacchini
authors.affiliation: Unit of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Varese.
authors.forename: Paolo
authors.initials: P
authors.lastname: Castelnuovo
authors.affiliation: Department of Neuroscience, G. Rummo Hospital, Neurosurgery Operative Unit, Benevento, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Catapano
authors.affiliation: Department of Neuroscience, G. Rummo Hospital, Neurosurgery Operative Unit, Benevento, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: de Notaris
mesh_terms: D002102:Cadaver; D002426:Cavernous Sinus / Q000033:anatomy & histology / Q000601:surgery*; D006801:Humans; D008578:Meninges / Q000033:anatomy & histology; D044583:Neuroendoscopy; D019635:Neurosurgical Procedures / Q000379:methods*; D009915:Orbit / Q000033:anatomy & histology
keywords: MOB = meningo-orbital band; SOF = superior orbital fissure; anatomy; cavernous sinus; endoscopic transorbital; meningo-orbital band; superior eyelid transorbital