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Minimally invasive surgery of the anterior skull base: transorbital approaches.

Gassner HG, Schwan F, Schebesch KM - GMS Curr Top Otorhinolaryngol Head Neck Surg (2016)

Bottom Line: The more recently described transorbital approaches represent minimally invasive alternatives with a differing spectrum of access corridors.The purpose of the present paper is to discuss transorbital approaches to the anterior skull base in the light of the current literature.Their execution requires an interdisciplinary team approach.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Otolaryngology, Head & Neck Surgery, University Medicine of Regensburg, Germany.

ABSTRACT
Minimally invasive approaches are becoming increasingly popular to access the anterior skull base. With interdisciplinary cooperation, in particular endonasal endoscopic approaches have seen an impressive expansion of indications over the past decades. The more recently described transorbital approaches represent minimally invasive alternatives with a differing spectrum of access corridors. The purpose of the present paper is to discuss transorbital approaches to the anterior skull base in the light of the current literature. The transorbital approaches allow excellent exposure of areas that are difficult to reach like the anterior and posterior wall of the frontal sinus; working angles may be more favorable and the paranasal sinus system can be preserved while exposing the skull base. Because of their minimal morbidity and the cosmetically excellent results, the transorbital approaches represent an important addition to established endonasal endoscopic and open approaches to the anterior skull base. Their execution requires an interdisciplinary team approach.

No MeSH data available.


Related in: MedlinePlus

Endoscopically controlled access to the interfrontal septum. A segment of the anterior wall and the floor of the frontal sinus was temporarily removed.
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Figure 15: Endoscopically controlled access to the interfrontal septum. A segment of the anterior wall and the floor of the frontal sinus was temporarily removed.

Mentions: The team around Moe et al. described the treatment of pathologies of the frontal sinus via transorbital approaches without relevant morbidity [39]. Regarding the access to the frontal sinus, the authors of the present discussion see significant advantages of the transorbital approaches. Depending on the individual anatomy, the access to the frontal sinus in transnasal endoscopic procedures remains limited to the medial and central aspects of the frontal sinus. Timperley et al. evaluated the lateral extent of the transnasal approach in an anatomical investigation. The authors first performed a Draf type III dissection and then they measured the lateral reach of the transnasal procedure. They could show important limitations of the transnasal approach to the lateral segments of the frontal sinus, especially the floor and the roof [129]. Hence, processes located in the lateral frontal sinus are frequently exposed via transfacial or coronal approaches, which require more collateral soft tissue dissection compared to transorbital approaches. Figure 15 (Fig. 15) depicts the access to the posterior wall of the frontal sinus after temporary removal of a segment of the anterior wall of the frontal sinus.


Minimally invasive surgery of the anterior skull base: transorbital approaches.

Gassner HG, Schwan F, Schebesch KM - GMS Curr Top Otorhinolaryngol Head Neck Surg (2016)

Endoscopically controlled access to the interfrontal septum. A segment of the anterior wall and the floor of the frontal sinus was temporarily removed.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4940979&req=5

Figure 15: Endoscopically controlled access to the interfrontal septum. A segment of the anterior wall and the floor of the frontal sinus was temporarily removed.
Mentions: The team around Moe et al. described the treatment of pathologies of the frontal sinus via transorbital approaches without relevant morbidity [39]. Regarding the access to the frontal sinus, the authors of the present discussion see significant advantages of the transorbital approaches. Depending on the individual anatomy, the access to the frontal sinus in transnasal endoscopic procedures remains limited to the medial and central aspects of the frontal sinus. Timperley et al. evaluated the lateral extent of the transnasal approach in an anatomical investigation. The authors first performed a Draf type III dissection and then they measured the lateral reach of the transnasal procedure. They could show important limitations of the transnasal approach to the lateral segments of the frontal sinus, especially the floor and the roof [129]. Hence, processes located in the lateral frontal sinus are frequently exposed via transfacial or coronal approaches, which require more collateral soft tissue dissection compared to transorbital approaches. Figure 15 (Fig. 15) depicts the access to the posterior wall of the frontal sinus after temporary removal of a segment of the anterior wall of the frontal sinus.

Bottom Line: The more recently described transorbital approaches represent minimally invasive alternatives with a differing spectrum of access corridors.The purpose of the present paper is to discuss transorbital approaches to the anterior skull base in the light of the current literature.Their execution requires an interdisciplinary team approach.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Otolaryngology, Head & Neck Surgery, University Medicine of Regensburg, Germany.

ABSTRACT
Minimally invasive approaches are becoming increasingly popular to access the anterior skull base. With interdisciplinary cooperation, in particular endonasal endoscopic approaches have seen an impressive expansion of indications over the past decades. The more recently described transorbital approaches represent minimally invasive alternatives with a differing spectrum of access corridors. The purpose of the present paper is to discuss transorbital approaches to the anterior skull base in the light of the current literature. The transorbital approaches allow excellent exposure of areas that are difficult to reach like the anterior and posterior wall of the frontal sinus; working angles may be more favorable and the paranasal sinus system can be preserved while exposing the skull base. Because of their minimal morbidity and the cosmetically excellent results, the transorbital approaches represent an important addition to established endonasal endoscopic and open approaches to the anterior skull base. Their execution requires an interdisciplinary team approach.

No MeSH data available.


Related in: MedlinePlus