Transorbital Microsurgery: An Anatomical Description of a Minimally Invasive Corridor to the Anterior Cranial Fossa and Paramedian Structures.

 Transorbital neuroendoscopic surgery (TONES) has ignited interest in the transorbital access corridor, increasing its use for single and multi-portal skull base interventions. However, the crowding of a small corridor and two-dimensional viewing restrict this access portal.  Cadaveric qualitative study to assess the feasibility of transorbital microsurgery (TMS).

The biportal transorbital approach: quantitative comparison of the anterior subfrontal craniotomy, bilateral transorbital endoscopic, and microscopic approaches.

Objective: The aim of this study was to assess the surgical use and applicability of a biportal bitransorbital approach. Single-portal transorbital and combined transorbital transnasal approaches have been used in clinical practice, but no study has assessed the surgical use and applicability of a biportal bitransorbital approach.

Methods: Ten cadaver specimens underwent midline anterior subfrontal (ASub), bilateral transorbital microsurgery (bTMS), and bilateral transorbital neuroendoscopic surgery (bTONES) approaches.

Improving the metric of surgical freedom in the laboratory based on a novel concept of volume.

Background: In laboratory-based neuroanatomical studies, surgical freedom, the most important metric of instrument maneuverability, has been based on Heron's formula. Inaccuracies and limitations hinder this study design's applicability. A new methodology, volume of surgical freedom (VSF), may produce a more realistic qualitative and quantitative representation of a surgical corridor.

Quantitative Anatomic Comparison of the Extreme Lateral Transodontoid vs Extreme Medial Endoscopic Endonasal Approaches to the Jugular Foramen and Craniovertebral Junction.

Background: Large, destructive intracranial and extracranial lesions at the jugular foramen (JF) and anterior craniovertebral junction (CVJ) are among the most challenging lesions to resect.

Objective: To compare the extreme lateral transodontoid approach (ELTOA) with the extreme medial endoscopic endonasal approach (EMEEA) to determine the most effective surgical approach to the JF and CVJ.

Methods: Seven formalin-fixed cadaveric heads were dissected.

Comparative Analysis of Surgical Exposure among Endoscopic Endonasal Approaches to Petrosectomy: An Experimental Study in Cadavers.

 Endoscopic endonasal approaches (EEAs) for petrosectomies are evolving to reduce perioperative brain injuries and complications. Surgical terminology, techniques, landmarks, advantages, and limitations of these approaches remain ill defined. We quantitatively analyzed the anatomical relationships and differences between EEA exposures for medial, inferior, and inferomedial petrosectomies.

Multiple hippocampal transection for mesial temporal lobe epilepsy: A systematic review.

Purpose: Multiple hippocampal transection (MHT) is a surgical technique that offers adequate seizure control with minimal perioperative morbidity. However, there is little evidence available to guide neurosurgeons in selecting this technique for use in appropriate patients. This systematic review analyzes patient-level data associated with MHT for intractable epilepsy, focusing on postoperative seizure control and memory outcomes.

Surgical Anatomy of the Middle Communicating Artery and Guidelines for Predicting the Feasibility of M2-M2 End-to-End Reimplantation.

Background: M2-M2 end-to-end reimplantation that creates a middle communicating artery has recently been proposed as a reconstruction technique to treat complex aneurysms of the middle cerebral artery that are not amenable to clipping.

Objective: To examine the surgical anatomy, define anatomic variables, and explore the feasibility of this bypass.

Methods: Sixteen cadaver heads were prepared for bypass simulation.

Extradural anterior clinoidectomy versus endoscopic transplanum-transcavernous approach to the paraclinoid region: quantitative anatomical exposure analysis.

Background: Transcranial anterior clinoidectomy is a conventional microsurgical approach for treatment of paraclinoid aneurysms. The endoscopic endonasal approach (EEA) is an alternative method for clipping intracranial aneurysms. No analysis has been conducted to anatomically compare approaches with respect to treating paraclinoid aneurysms.

Comparison of Anatomic Exposure After Petrosectomy Using Anterior Transpetrosal and Endoscopic Endonasal Approaches: Experimental Cadaveric Study.

Objective: Transcranial anterior petrosectomy (AP) is a classic approach; however, it is associated with adverse consequences. The endoscopic endonasal approach (EEA) has been developed as an alternative. We describe surgical techniques for AP and EEA and compare the anatomic exposures of each.

Volumetric 3-Dimensional Analysis of the Supraorbital vs Pterional Approach to Paramedian Vascular Structures: Comprehensive Assessment of Surgical Maneuverability.

Background: Both the pterional and supraorbital approaches have been proposed as optimal access corridors to deep and paramedian anatomy.

Objective: To assess key intracranial structures accessed through the surgical approaches using the angle of attack (AOA) and the volume of surgical freedom (VSF) methodologies.

Methods: Ten pterional and 10 supraorbital craniotomies were completed.

Comparative Anatomical Assessment of Full vs Limited Transcavernous Exposure of the Carotid-Oculomotor Window.

Background: Although the full transcavernous approach affords extensive mobilization of the oculomotor nerve (OMN) for exposure of the basilar apex and interpeduncular cistern region, this time-consuming procedure requires substantial dural dissection along the anterior middle cranial fossa.

Objective: To quantify the extent to which limited middle fossa dural elevation affects the carotid-oculomotor window (C-OMW) surgical area during transcavernous exposure after OMN mobilization.

Methods: Four cadaveric specimens were dissected bilaterally to study the C-OMW area afforded by the transcavernous exposure.

Novel System of Simulation Models for Aneurysm Clipping Training: Description of Models and Assessment of Face, Content, and Construct Validity.

Background: Aneurysm clipping simulation models are needed to provide tactile feedback of biological vessels in a nonhazardous but surgically relevant environment.

Objective: To describe a novel system of simulation models for aneurysm clipping training and assess its validity.

Methods: Craniotomy models were fabricated to mimic actual tissues and movement restrictions experienced during actual surgery.