2026 Proffered Presentations
S087: THE SUPRAOPTIC RECESS AS A LANDMARK IN ENDOSCOPIC ENDONASAL SURGERY TO THE DORSAL OPTIC CANAL: AN ANATOMICAL, RADIOLOGICAL, AND SURGICAL STUDY
Yuanzhi Xu, MD; Jonathan Lamano, MD; Erik Burgos-Sosa, MD; Hongwei Yu, MD; Collin Liu, MD; Tatsuya Uchida, MD; Vera Vigo, MD; Juan Fernandez-Miranda, MD; Department of Neurosurgery, Stanford Hospital, Stanford, California
Objective: Safe identification of the dorsal optic canal is critical in endoscopic endonasal approaches (EEA) involving the optic nerve. The supraoptic recess (SOR), located at the sphenoethmoidal junction, may provide a reliable landmark for exposure of the dorsal optic canal. This study integrates anatomical, radiological, and surgical perspectives to clarify the significance of the SOR.
Methods: Ten silicon-injected postmortem heads underwent EEA to the dorsal optic canal, with systematic dissection of the SOR, its osseous boundaries, dural/ligamentous attachments and related neurovascular structures. In addition, fifty high-resolution CT scans were analyzed to evaluate the prevalence, pneumatization patterns, and morphometric relationship of the SOR to the optic canal. Three illustrative surgical cases highlighting the involvement of the SOR in the dorsal optic canal region are presented to contextualize the anatomical findings.
Results: The SOR was consistently located at the sphenoethmoidal junction and medial to the roof of the optic canal, approximately 5 ± 1 mm from the canal ostium. Drilling of the SOR and its posterior bony wall enabled direct exposure of the optic canal roof. (Fig.1A,B) Stepwise removal of the attached ligamentous structures—the limbus ligament medially and the falciform ligament posteriorly—was required to achieve safe and complete exposure of the structures above the optic nerve, particularly those centered around the olfactory nerve. (Fig.1C-F) On radiological analysis, the presence of the SOR correlated positively with the degree of sphenoid sinus pneumatization. Overall, the SOR was observed in 41% of optic canals (41/100). Among these, 12 optic canals (12%) demonstrated well-developed pneumatization extending beyond the midline of the dorsal optic canal, whereas 29 hemispheres (29%) showed limited pneumatization that did not cross the canal axis.
Conclusion: The supraoptic recess represents a reliable landmark for dorsal optic canal exposure in endoscopic endonasal surgery. Its recognition on preoperative imaging and use during stepwise ligamentous dissection may improve orientation and surgical safety when addressing lesions extending from the ventral to the dorsal optic canal.
