2025 Poster Presentations
P015: CADAVERIC STEP-BY-STEP ENDOSCOPIC TRANSORBITAL APPROACH TO THE CAVERNOUS SINUS
Renan Lovato; Feng Cai; Abdullah Keles; Ufuk Erginoglu; Mustafa Baskaya; University of Wisconsin Madison
Objectives: To demonstrate the step-by-step process of performing an endoscopic transorbital approach to the lateral wall of the cavernous sinus, including a critical analysis and discussion of this approach's potential uses.
The study objectives are to demonstrate the step-by-step process of performing an endoscopic transorbital approach to the lateral wall of the cavernous sinus, and to perform a critical analysis of the potential neurosurgical utility of this approach.
Background: The endoscopic transorbital approach offers a minimally invasive alternative for accessing the cavernous sinus, potentially improving surgical outcomes and reducing recovery times in skull base surgery.
Methods: The approach was performed on three cadaver heads, totaling five procedures, at the University of Wisconsin-Madison Microneurosurgery Laboratory. We utilized Storz 0º and 30º degree endoscopes with a 4mm diameter and 275mm length.
All dissections began with a transpalpebral incision, followed by the dissection of the periorbita from the lateral and superior walls of the orbit. We identified key anatomical landmarks for the approach's initiation, including the superior orbital fissure, inferior orbital fissure, optic nerve, and the anterior and posterior ethmoidal arteries. Using a high-speed drill, we performed a craniotomy to open the middle and anterior fossae by removing the sphenoid wing and opening the subtemporal fossa, followed by peeling off the middle fossa. We then measured the distances between the frontozygomatic suture and key skull base structures, including the foramen ovale, foramen rotundum, foramen spinosum, the anterior and posterior ethmoidal arteries, andbetween the supraorbital notch and these structures.
Results: The lateral wall of the cavernous sinus was successfully exposed in all approaches, providing a good view of the lateral wall, along with the nerves and involved vascular structures. The working distance and angles were easily manageable withendoscopic surgical technique.
Conclusions: The endoscopic transorbital approach is a feasible method for exposing the lateral wall of the cavernous sinus and may be considered for various applications in skull base surgery.