Optic Canal Decompression: Concepts and Techniques: 2-Dimensional Operative Video

2021 ◽  
Author(s):  
Devi P Patra ◽  
Evelyn L Turcotte ◽  
Bernard R Bendok
Keyword(s):  
Optic Nerve ◽  
Optic Canal ◽  
Complete Understanding ◽  
Anterior Clinoid Process ◽  
Endoscopic Endonasal ◽  
Oxford University ◽  
Copyright Information ◽  
Optic Strut ◽  
Transcranial Approach ◽  
Operative Neurosurgery

Abstract The optic canal (OC) is a bony channel that transmits the optic nerve (ON) and ophthalmic artery (OphA) as they course through the lesser wing of the sphenoid bone to the orbital apex. The OC is involved in a variety of intracranial and extracranial pathologies,1 and opening of the canal may be necessary in order to achieve adequate exposure, better disease control, and vision preservation.2 Depending on the location of the pathology and its relationship with the optic nerve, the OC may be decompressed through an open transcranial approach or an endoscopic endonasal approach.1,3 OC drilling can be tailored based on the location of the pathology and its extension. Anterior clinoid process and optic strut drilling can be added based on these factors as well.4,5 In this video, we demonstrate the steps of OC drilling in both transcranial microscopic and endoscopic endonasal approaches through a combination of animated illustrations and operative videos. We present 4 cases, including 2 transcranial microscopic and 2 endoscopic endonasal approaches,6 demonstrating OC decompression and its technical nuances. Each case was selected to represent the range of pathologies relevant to OC drilling to allow for a complete understanding of the techniques and concepts required for optimal treatment. An informed written consent has been obtained from each of the patients in this publication. Video © Mayo Foundation for Medical Education and Research. All rights reserved. Copyright information: Bendok BR, Abi-Aad KR, Sattur MG, Welz ME, Hoxworth JM, Lal D. Endoscopic resection of a paraclinoid meningioma extending into the optic canal: 2-dimensional operative video. Operative Neurosurgery. 2018 September 1;15(3):356 by permission of Oxford University Press. Cadaveric images provided by courtesy of: The Rhoton Collection. http://rhoton.ineurodb.org/.

scholarly journals Extradural clinoidectomy for resection of clinoidal meningioma

2017 ◽  
Vol 43 (videosuppl2) ◽  
pp. V10 ◽  
Author(s):  
Simon Buttrick ◽  
Jacques J. Morcos ◽  
Mohamed S. Elhammady ◽  
Anthony C. Wang
Keyword(s):  
Optic Nerve ◽  
Optic Canal ◽  
Superior Orbital Fissure ◽  
Anterior Clinoid Process ◽  
Anterior Clinoidectomy ◽  
Link Type ◽  
Optic Strut ◽  
Parasellar Region ◽  
Versatile Technique

Extradural anterior clinoidectomy is a versatile technique to increase exposure of the sellar and parasellar region. It is of particular use in the resection of clinoidal meningiomas, as sphenoidal and clinoidal hyperostosis can cause compression of the optic nerve. Extradural clinoidectomy follows a series of steps, consisting of (1) unroofing of the superior orbital fissure, (2) unroofing of the optic canal, (3) removal of the optic strut, and (4) removal of the anterior clinoid process. The authors show these steps in detail, as well as their application to the resection of a large clinoidal meningioma.The video can be found here: https://youtu.be/O1Fcef29ETg.

Refining Operative Strategies for Optic Nerve Decompression: A Morphometric Analysis of Transcranial and Endoscopic Endonasal Techniques Using Clinical Parameters

2017 ◽  
Vol 14 (3) ◽  
pp. 295-302 ◽  
Author(s):  
Steven L Gogela ◽  
Lee A Zimmer ◽  
Jeffrey T Keller ◽  
Norberto Andaluz
Keyword(s):  
Optic Nerve ◽  
Morphometric Analysis ◽  
Sphenoid Sinus ◽  
Internal Carotid ◽  
Optic Canal ◽  
Csf Leak ◽  
Endoscopic Endonasal ◽  
Anatomical Point ◽  
Operative Strategies ◽  
Transcranial Approach

Abstract BACKGROUND Various approaches can be considered for decompression of the intracanalicular optic nerve. Although clinical experience has been reported, no quantitative study has yet compared the extent of decompression achieved by an endoscopic endonasal versus transcranial approach. OBJECTIVE Toward this aim, our morphometric analysis compared both approaches by quantifying the circumferential degree of optic canal decompression that is possible before any meningeal violation, which would result in cerebrospinal fluid (CSF) leak. METHODS From 10 cadaver heads, 20 optic canals were sequentially decompressed using an endoscopic endonasal approach and pterional craniotomy with extradural clinoidectomy. Dissections ended before violation of the sphenoid sinus during the transcranial approach, and before intracranial transgression from the endonasal corridor. Based on our study criteria, decompressions were not maximal for either approach, but were maximal before violating the other compartment. Decompression achieved from each approach was quantified using CT scans for each stage. RESULTS Greater circumferential bony optic canal decompression was obtained from transcranial (245.2°) than endonasal (114.8°) routes (P < .001). By endonasal perspective, the anatomical point where the optic nerve traverses intracranially was approximated by the medial border of the anterior ascending cavernous internal carotid artery. CONCLUSION Our morphometric analysis comparing optic canal decompression for endonasal and transcranial corridors provides important guidance for this location. Ample visualization and wide exposure can be achieved via a transcranial approach with limited risk of CSF leak. A landmark, where the intracanalicular segment ends and optic nerve traverses intracranially, can mark the extent of decompression safely obtained before risking CSF leak.

Endoscopic Endonasal versus Transcranial Optic Canal Decompression: A Morphometric, Cadaveric Study

2021 ◽  
Author(s):  
Jun Kim ◽  
Aaron R Plitt ◽  
Awais Vance ◽  
Scott Connors ◽  
James Caruso ◽  
...  
Keyword(s):  
Anatomical Study ◽  
Contralateral Side ◽  
Lateral Approach ◽  
Ct Scans ◽  
Optic Canal ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Endoscopic Endonasal ◽  
Transcranial Approach ◽  
The Mean

Abstract Introduction Decompression of the optic nerve within the optic canal is indicated for compressive visual decline. The two most common approaches utilized for optic canal decompression are a medial approach with an endoscopic endonasal approach and a lateral approach with a craniotomy. Our study is a cadaveric anatomical study comparing the length and circumference of the orbit decompressed via an endoscopic endonasal approach versus a frontotemporal craniotomy. Methods Five cadaveric specimens were utilized. Predissection computed tomography (CT) scans were performed on each specimen. On each specimen, a standard frontotemporal craniotomy with anterior clinoidectomy and superolateral orbital decompression was performed on one side and an endoscopic endonasal approach with medial wall decompression was performed on the contralateral side. Post-dissection CT scans were performed. An independent radiologist provided measurements of the length (mm) and circumference (degrees) of optic canal decompression bilaterally. Results The mean length of optic canal decompression for open and endoscopic approach was 13 mm (range 12–15 mm) and 12.4 mm (range 10–16 mm), respectively. The mean circumference of decompression for open and endoscopic approaches was 252.8 degrees (range 205–280 degrees) and 124.6 degrees (range 100–163 degrees), respectively. Conclusion The endoscopic endonasal and the transcranial approaches provide a similar length of optic canal decompression, but the transcranial approach leads to greater circumferential decompression. The endoscopic endonasal approach has the benefit of being minimally invasive, though. Ultimately, the surgical approach decision should be based on the location of the pathology and the surgeon's comfort.

Interdural course of the ophthalmic artery in the optic canal

2020 ◽  
Vol 132 (1) ◽  
pp. 277-283
Author(s):  
Ali Tayebi Meybodi ◽  
Leandro Borba Moreira ◽  
Michael T. Lawton ◽  
Jennifer M. Eschbacher ◽  
Evgenii G. Belykh ◽  
...  
Keyword(s):  
Optic Nerve ◽  
Histological Examination ◽  
Direct Contact ◽  
Ophthalmic Artery ◽  
Optic Canal ◽  
Endoscopic Endonasal ◽  
Orbital Fat ◽  
The Relationship ◽  
Exact Relationship

OBJECTIVEIn the current neurosurgical and anatomical literature, the intracanalicular segment of the ophthalmic artery (OphA) is usually described to be within the optic nerve dural sheath (ONDS), implying direct contact between the nerve and the artery inside the optic canal. In the present study, the authors sought to clarify the exact relationship between the OphA and ONDS.METHODSTen cadaveric heads were subjected to endoscopic endonasal and transcranial exposures of the OphA in the optic canal (5 for each approach). The relationship between the OphA and ONDS was assessed. Histological examination of one specimen of the optic nerve and the accompanying OphA was also performed to confirm the relationship with the ONDS.RESULTSIn all specimens, the OphA coursed between the two layers of the dura (endosteal and meningeal) and was not in direct contact with the optic nerve, except for the first few millimeters of the proximal optic canal before it pierced the ONDS. Upon reaching the orbit, the two layers of the dura separated and allowed the OphA to literally float within the orbital fat. The meningeal dura continued as the ONDS, whereas the endosteal dura became the periorbita.CONCLUSIONSThis study clarifies the interdural course of the OphA within the optic canal. This anatomical nuance has important neurosurgical implications regarding safe exposure and manipulation of the OphA.

scholarly journals Selection of endoscopic or transcranial surgery for tuberculum sellae meningiomas according to specific anatomical features: a retrospective multicenter analysis (KOSEN-002)

2019 ◽  
Vol 130 (3) ◽  
pp. 838-847 ◽  
Author(s):  
Doo-Sik Kong ◽  
Chang-Ki Hong ◽  
Sang Duk Hong ◽  
Do-Hyun Nam ◽  
Jung-Il Lee ◽  
...  
Keyword(s):  
Visual Outcome ◽  
Visual Disturbance ◽  
Optic Canal ◽  
Surgical Approaches ◽  
Anterior Clinoid Process ◽  
Endoscopic Endonasal ◽  
Anatomical Features ◽  
Significant Difference ◽  
Stable Vision ◽  
Tuberculum Sellae

OBJECTIVEThe endoscopic endonasal approach (EEA) and the transcranial approach (TCA) are good options for the treatment of tuberculum sellae (TS) meningiomas. The objective of this study was to identify the key anatomical features in TS meningiomas and compare the two surgical approaches.METHODSThe authors retrospectively reviewed clinical data in 178 patients with TS meningiomas treated at 3 institutions between January 2010 and July 2016. Patients with tumors encasing the internal carotid artery or anterior cerebral artery or involving the anterior clinoid process or cavernous sinus were excluded. Tumors were classified as high-lying or low-lying based on their location, and involvement of the optic canal was evaluated. The surgical outcomes of EEA and TCA were analyzed according to the relevant anatomical features.RESULTSDuring the study period, 84 patients underwent EEA and 94 patients underwent TCA. Based on preoperative MR images, 43 (24.2%) meningiomas were classified as high-lying tumors, 126 (70.8%) as low-lying, and 9 (5.0%) as nonspecific. Gross-total resection (GTR) was performed in 145 patients (81.5%); the GTR rate did not differ significantly between the EEA and TCA groups. Of 157 patients with preoperative visual disturbance, 140 had improved or stable vision postoperatively. However, 17 patients (9.6%) experienced some visual deterioration after surgery. The TCA group had a worse visual outcome than the EEA group in patients with preoperative optic canal involvement (77.6% vs 93.2%, p = 0.019), whereas there was no significant difference in visual outcome based on whether tumors were high-lying or low-lying.CONCLUSIONSThe results of this study support EEA over TCA, at least with respect to visual improvement with acceptable complications, although TCA is still an effective approach for TS meningioma.

Endoscopic Endonasal Optic Nerve Decompression for Benign Pathology of the Optic Canal

2014 ◽  
Vol 75 (S 02) ◽  
Author(s):  
T. Deklotz ◽  
S. Stefko ◽  
J. Fernandez-Miranda ◽  
P. Gardner ◽  
C. Snyderman ◽  
...  
Keyword(s):  
Optic Nerve ◽  
Optic Canal ◽  
Endoscopic Endonasal ◽  
Nerve Decompression ◽  
Optic Nerve Decompression ◽  
Benign Pathology

The “No-drill” Technique of Anterior Clinoidectomy: A Cranial Base Approach To The Paraclinoid And Parasellar Region

2009 ◽  
Vol 64 (suppl_1) ◽  
pp. ONS96-ONS106 ◽  
Author(s):  
Dongwoo John Chang
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Cranial Base ◽  
Optic Canal ◽  
Anterior Clinoid Process ◽  
Anterior Clinoidectomy ◽  
Computed Tomographic ◽  
Optic Strut ◽  
Neurovascular Structures

Abstract Introduction: A high-speed power-drilling technique of anterior clinoidectomy has been advocated in all publications on paraclinoid region surgery. The entire shaft of the power drill is exposed in the operative field; thus, all neurovascular structures in proximity to any portion of the full length of the rotating drill bit are at risk for direct mechanical and/or thermal injury. Ultrasonic bone removal has recently been developed to mitigate the potential complications of the traditional power-drilling technique of anterior clinoidectomy. However, ultrasound-related cranial neuropathies are recognized complications of its use, as well as the increased cost of device acquisition and maintenance. Methods: A retrospective review of a cerebrovascular/cranial base fellowship-trained neurosurgeon's 45 consecutive cases of anterior clinoidectomy using the “no-drill” technique is presented. Clinical indications have been primarily small to giant aneurysms of the proximal internal carotid artery; however, in addition to ophthalmic segment aneurysms, selected internal carotid artery-posterior communicating artery aneurysms and internal carotid artery bifurcation aneurysms, and other large/giant/complex anterior circulation aneurysms, this surgical series of “no-drill” anterior clinoidectomy includes tuberculum sellae meningiomas, clinoidal meningiomas, cavernous sinus lesions, pituitary macroadenomas with significant suprasellar extension, other perichiasmal lesions (sarcoid), and fibrous dysplasia. A bony opening is made in the mid- to posterior orbital roof after the initial pterional craniotomy. Periorbita is dissected off the bone from inside the orbital compartment. Subsequent piecemeal resection of the medial sphenoid wing, anterior clinoid process, optic canal roof, and optic strut is performed with bone rongeurs of various sizes via the bony window made in the orbital roof. Results: No power drilling was used in this surgical series of anterior clinoidectomies. Optimal microsurgical exposure was obtained in all cases to facilitate complete aneurysm clippings and lesionectomies. There were no cases of direct injury to surrounding neurovascular structures from the use of the “no-drill” technique. The surgical technique is presented with illustrative clinical cases and intraoperative photographs, demonstrating the range of applications in anterior and central cranial base neurosurgery. Conclusion: Power drilling is generally not necessary for removal of the anterior clinoid process, optic canal roof, and optic strut. Rigorous study of preoperative computed tomographic scans/computed tomographic angiography scans, magnetic resonance imaging scans, and angiograms is essential to identify important anatomic relationships between the anterior clinoid process, optic strut, optic canal roof, and neighboring neurovascular structures. The “no-drill” technique eliminates the risks of direct power-drilling mechanical/ thermal injury and the risks of ultrasound-associated cranial neuropathies. The “no-drill” technique provides a direct, time-efficient, and efficacious approach to the paraclinoid/ parasellar/pericavernous area, using a simplified mechanical route.This technique is applicable to any neurosurgical diagnosis and approach in which anterior clinoidectomy is necessary. It is arguably the gentlest and most efficient method for exposing the paracli-noid/parasellar/pericavernous region.

scholarly journals Strategies for Optic Pathways Decompression for Extra-Axial Tumors or Intracranial Aneurysms: A Technical Note

2021 ◽  
Author(s):  
Pier Paolo Mattogno ◽  
Carmelo Lucio Sturiale ◽  
Alessandro Rapisarda ◽  
Alessandro Olivi ◽  
Alessio Albanese
Keyword(s):  
Optic Nerve ◽  
Intracranial Aneurysms ◽  
Nerve Compression ◽  
Optic Canal ◽  
Falciform Ligament ◽  
Optic Strut ◽  
Paraclinoid Aneurysms ◽  
Optic Pathways ◽  
Optic Canal Unroofing ◽  
Optic Nerve Compression

Abstract Background Different types of skull base tumors and intracranial aneurysms may lead to compression of the optic pathways. Since most of them are biologically benign conditions, the first aim of surgery is preservation of optic nerves rather than the oncologic radicality. Materials and methods Based on the progressive technical refinements coming from our institutional experience of optic nerve compression from aneurysms and extra-axial tumors, we analyzed the surgical steps to release nerves and chiasm during tumor debulking and aneurysm clipping. Results We distinguished vascular and tumor lesions according to the main direction of optic nerve compression: lateral to medial, medial to lateral, inferior to superior, and anterior to posterior. We also identified four fundamental sequential maneuvers to release the optic nerve, which are (1) falciform ligament (FL) section, (2) optic canal unroofing, (3) anterior clinoid process drilling, and (4) optic strut removal. The FL section is always recommended when a gentle manipulation of the optic nerve is required. Optic canal unroofing is suggested in case of lateral-to-medial compression (i.e., clinoid meningiomas), medial-to-lateral compression (i.e., tuberculum sellae meningiomas), and inferior-to-superior compression (i.e., suprasellar lesions). Anterior clinoidectomy and optic strut removal may be necessary in case of lateral-to-medial compression from paraclinoid aneurysms or meningiomas. Conclusions Preservation of the visual function is the main goal of surgery for tumors and aneurysms causing optic nerve compression. This mandatory principle guides the approach, the timing, and the technical strategy to release the optic nerve, and is principally based on the direction of the compression vector.

Endoscopic endonasal approach for a tuberculum sellae meningioma

2012 ◽  
Vol 32 (Suppl1) ◽  
pp. E8 ◽  
Author(s):  
Juan C. Fernandez-Miranda ◽  
Carlos D. Pinheiro-Neto ◽  
Paul A. Gardner ◽  
Carl H. Snyderman
Keyword(s):  
Optic Nerve ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Optic Canal ◽  
Csf Leak ◽  
Endoscopic Endonasal ◽  
Tuberculum Sellae Meningioma ◽  
Tuberculum Sellae

The authors present the technical and anatomical nuances needed to perform an endoscopic endonasal removal of a tuberculum sellae meningioma. The patient is a 47-year-old female with headaches and an incidental finding of a small tuberculum sellae meningioma with no vascular encasement, no optic canal invasion, but mild inferior to superior compression of the cisternal segment of the left optic nerve. Neuroophthalmology assessment revealed no visual defects. Treatment options included clinical observation with imaging follow-up studies, radiosurgery, and resection. The patient elected to undergo surgical removal and an endonasal endoscopic approach was the preferred surgical option. Preoperative radiological studies showed the presence of an osseous ring between the left middle and anterior clinoids, the so-called carotico-clinoidal ring. The surgical implications of this finding and its management are illustrated. The surgical anatomy of the suprasellar region is reviewed, including concepts such as the chiasmatic sulcus and limbus sphenoidale, medial and lateral optico-carotid recesses, and the paraclinoidal and supraclinoidal segments of the internal carotid artery. Emphasis is made in the importance of exposing the distal dural ring of the internal carotid artery and the precanalicular segment of the optic nerve for adequate intradural dissection. The endonasal route allows for early coagulation of the tumor meningeal supply and extensive resection of dural attachments, and importantly, provides an inferior to superior access to the infrachiasmatic region that facilitates complete tumor removal without any manipulation of the optic nerve. The lateral limit of dural removal is formed by the distal dural ring, which is gently coagulated after the tumor is resected. A 45° scope is used to inspect for any residual tumor, in particular at the entrance of the optic nerve into the optic canal and at the most anterior margin of the exposure (limbus sphenoidale). The steps for reconstruction are detailed and include intradural placement of dural substitute and extradural placement of the nasoseptal flap. The nuances for proper harvesting, positioning, and reinforcement of the flap are described. No lumbar drain was used. The patient had an uneventful recovery with no CSF leak or any other complications. Imaging follow-up at 6 months showed complete removal of the tumor. The patient had no sinonasal or neurological symptoms, and olfaction was fully preserved. The video can be found here: http://youtu.be/kkuV-yyEHMg.

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