The Experts below are selected from a list of 132 Experts worldwide ranked by ideXlab platform
Sébastien Froelich - One of the best experts on this subject based on the ideXlab platform.
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the orbitopterygoid corridor as a deep keyhole for endoscopic access to the paranasal sinuses and clivus
Journal of Neurosurgery, 2021Co-Authors: Kenichi Oyama, Shunya Hanakita, Kentaro Watanabe, Annelaure Bernat, Pierreolivier Champagne, Thibault Passeri, Eduard H Voormolen, Nicolas Penet, Takanori Fukushima, Sébastien FroelichAbstract:Objective The anteromedial triangle (AMT) is the triangle formed by the ophthalmic (V1) and maxillary (V2) nerves. Opening of this bony space offers a limited access to the sphenoid sinus (SphS). This study aims to demonstrate the utility of the orbitopterygopalatine corridor (OPC), obtained by enlarging the AMT and transposing the contents of the pterygopalatine fossa (PPF) and V2, as an entrance to the SphS, maxillary sinus (MaxS), and nasal cavity. Methods Five formalin-injected cadaveric specimens were used for this study (10 approaches). A classic pterional approach was performed. An OPC was created through the Inferior Orbital Fissure, between the orbit and the PPF, by transposing the PPF Inferiorly. The extent of the OPC was measured using neuronavigation and manual measurements. Two illustrative cases using the OPC to access skull base tumors are presented in the body of the article. Results Via the OPC, the SphS, MaxS, ethmoid sinus (EthS), and nasal cavity could be accessed. The use of endoscopic assistance through the OPC achieved better visualization of the EthS, SphS, MaxS, clivus, and nasal cavity. A significant gain in the area of exposure could be achieved using the OPC compared to the AMT (22.4 mm2 vs 504.1 mm2). Conclusions Opening of the AMT and transposition of V2 and the contents of the PPF creates the OPC, a potentially useful deep keyhole to access the paranasal sinuses and clival region through a middle fossa approach. It is a valuable alternative approach to reach deep-seated skull base lesions infiltrating the cavernous sinus and middle cranial fossa and extending into the paranasal sinus.
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endoscopic endonasal approach to the anteromedial temporal fossa and mobilization of the lateral wall of the cavernous sinus through the Inferior Orbital Fissure and v1 v2 corridor an anatomic study and clinical considerations
World Neurosurgery, 2018Co-Authors: Shunya Hanakita, Weichieh Chang, Kentaro Watanabe, Daniel Ronconi, Moujahed Labidi, Hun Ho Park, Kenichi Oyama, Annelaure Bernat, Sébastien FroelichAbstract:Objective The aim of this study was to identify key anatomic landmarks useful in gaining access to the anteromedial temporal region via the corridor formed by the Inferior Orbital Fissure (IOF), the ophthalmic branch of the trigeminal nerve (V1), and the maxillary branch of the trigeminal nerve (V2) via an endoscopic endonasal approach (EEA). Methods An anatomic dissection of 6 cadaver heads was performed to confirm the feasibility and applicability of an EEA for accessing the anteromedial temporal region. Results After middle turbinectomy, the lateral recess of the sphenoid sinus was opened, the Orbital apex was exposed, and the posterior wall of the maxillary sinus was removed, in sequence. The IOF and the pterygopalatine fossa (PPF) were then identified. After opening the foramen rotundum (FR) and removing the bony structure between the FR, V2 was transposed downward. The Orbital muscle of Muller was removed. The PPF was mobilized downward exposing the greater wing of the sphenoid bone (GWS). The GWS between V1 and V2 was drilled, therefore exposing the temporal dura. With blunt dissection, the medial temporal dura was peeled away from the cavernous sinus to increase access to the anteromedial temporal region. Conclusions The anteromedial temporal fossa was exposed by drilling the V1-V2 triangle corridor via an EEA. Endoscopic endonasal exposure of the anteromedial temporal fossa is feasible and requires limited endonasal work. This approach may be considered as an alternate surgical corridor to the temporomesial lobe that offers the advantages of a direct route with less temporal lobe retraction.
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anatomy of the Inferior Orbital Fissure implications for endoscopic cranial base surgery
Skull Base Surgery, 2012Co-Authors: Juan Carlos De Battista, Sébastien Froelich, Lee A Zimmer, Philip V Theodosopoulos, Jeffrey T KellerAbstract:Considering many approaches to the skull base confront the Inferior Orbital Fissure (IOF) or sphenomaxillary Fissure, the authors examine this anatomy as an important endoscopic surgical landmark. In morphometric analyses of 50 adult human dry skulls from both sexes, we divided the length of the IOF into three segments (anterolateral, middle, posteromedial). Hemotoxylin- and eosin-stained sections were analyzed. Dissections were performed using transnasal endoscopy in four formalin-fixed cadaveric cranial specimens (eight sides); three endoscopic approaches to the IOF were performed. IOF length ranged from 25 to 35 mm (mean 29 mm). Length/width of the individual anterolateral, middle, and posteromedial segments averaged 6.46/5, 4.95/3.2, and 17.6/ 2.4 mm, respectively. Smooth muscle within the IOF had a consistent relationship with several important anatomical landmarks. The maxillary antrostomy, total ethmoidectomy approach allowed access to the posteromedial segment of the Fissure. The endoscopic modified, medial maxillectomy approach allowed access to the middle and posterior-medial segment. The Caldwell-Luc approach allowed complete exposure of the IOF. The IOF serves as an important anatomic landmark during endonasal endoscopic approaches to the skull base and orbit. Each of the three segments provides a characteristic endoscopic corridor, unique to the orbit and different fossas surrounding the Fissure.
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the one piece orbitozygomatic approach the maccarty burr hole and the Inferior Orbital Fissure as keys to technique and application
Acta Neurochirurgica, 2002Co-Authors: K Abdel M Aziz, Sébastien Froelich, P L Cohen, A Sanan, Jeffrey T Keller, H R Van LoverenAbstract:Objective. Use of the MacCarty keyhole burr hole and the Inferior Orbital Fissure provides simplicity and safety to perform the one-piece frontotemporal orbitozygomatic (FTOZ1) approach. Methods. We performed the FTOZ1 approach with its three subtypes (i.e., total, temporal, and frontal) in cadaveric head specimens in the Goodyear Laboratory and subsequently in surgical cases. Results. The orbitozygomatic osteotomy, when added to a frontotemporal craniotomy, comprises the frontotemporal orbitozygomatic (FTOZ) approach, provides an expanded exposure to the anterior and middle cranial fossae, and enables the surgeon to create a window to the posterior cranial fossa. The MacCarty burr hole is used to facilitate Orbital cuts, and the anterolateral portion of the Inferior Orbital Fissure connects the Orbital cuts to the zygomatic cuts. This allows the FTOZ1 craniotomy flap to be “out-fractured” with ease. The three types of FTOZ1 approach, i.e., the total, the temporal, and the frontal, are described step by step. Conclusions. Understanding the MacCarty keyhole burr hole and the microsurgical anatomy of the Inferior Orbital Fissure is essential to performing the FTOZ1 approach. The three types of FTOZ1 approach enable the surgeon to tailor the approach according to the surgical exposure needed for each lesion.
Hillary R Kelly - One of the best experts on this subject based on the ideXlab platform.
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prolapse of Orbital fat through the Inferior Orbital Fissure description prevalence and assessment of possible pathologic associations
American Journal of Neuroradiology, 2019Co-Authors: Paul M Bunch, Karen Buch, Hillary R KellyAbstract:BACKGROUND AND PURPOSE: A few patterns of Orbital fat prolapse have been described. Some are associated with disease, and others may mimic a neoplasm. We have observed prolapse of Orbital fat into the infratemporal fossa via the Inferior Orbital Fissure on MR imaging. The clinical relevance of this finding, if any, is unknown. The purposes of this study were to describe the MR imaging appearance of Orbital fat prolapse through the Inferior Orbital Fissure, to estimate the prevalence of this finding, and to assess possible pathologic associations. MATERIALS AND METHODS: For this retrospective study of 228 Orbital MR imaging examinations, 3 neuroradiologists independently assessed the presence of prolapse on high-resolution T1-weighted images. Discrepancies were resolved by consensus, and interobserver agreement was calculated. Patient demographics, indications for imaging, and pertinent clinical history were recorded. One-way analysis of variance and the Fisher exact test were used to assess possible associations between prolapse and specific patient characteristics. RESULTS: Orbital fat prolapse through the Inferior Orbital Fissure was observed in 20/228 patients (9%). This finding was unilateral in 11 patients (55%) and bilateral in 9 patients (45%). There was no significant association with age, sex, obesity, Graves disease, hypercortisolism, prior Orbital trauma, proptosis, or enophthalmos. Interobserver agreement was 90%. CONCLUSIONS: Prolapse of Orbital fat into the infratemporal fossa via the Inferior Orbital Fissure is a relatively common finding on Orbital MR imaging that has no identified pathologic association. Neuroradiologists should recognize this finding so as not to report it as pathologic.
Ricardo L Carrau - One of the best experts on this subject based on the ideXlab platform.
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a novel landmark for endonasal surgery of the pterygopalatine fossa and Inferior Orbital Fissure the orbito pterygo sphenoidal ligament
Head and Neck-journal for The Sciences and Specialties of The Head and Neck, 2021Co-Authors: Daniel M Prevedello, Nyall R London, Ricardo L CarrauAbstract:The pterygopalatine fossa contains a dense and complex array of neurovascular structures vulnerable to accidental surgical injury. This study aims to describe a novel landmark, the orbito-pterygo-sphenoidal ligament (OPSL), and implications of this structure for surgery in the pterygopalatine fossa and the Inferior Orbital Fissure. Six cadaveric specimens (12 sides) were dissected using an endonasal approach to expose the periosteal layers associated with the pterygopalatine fossa and orbit. The thickened triangular-shaped ligament at their confluence was termed the OPSL. Dimensions of its lateral, Inferior, and medial borders were measured, and their anatomical relationships defined. The pterygopalatine ganglion and the maxillary nerve lie immediately Inferior and deep into the OPSL. The superior aspect of the posterior nasoseptal artery and nerve are covered by the medial OPSL. The lateral and Inferior borders of the OPSL are contiguous with the periorbita and the periosteum of the pterygopalatine fossa, respectively. Along the medial border of the ligament, the openings of the palatovaginal Fissure, vidian canal, and foramen rotundum were sequentially identified in a medial to lateral trajectory. The length of the lateral, Inferior, and medial borders of the triangular OPSL were 13.25 ± 0.62, 14.25 ± 0.45, and 12.08 ± 0.90 mm, respectively. The OPSL is a thick, triangular-shaped fascial confluence, which may serve as a landmark for procedures within the pterygopalatine fossa and the Inferior Orbital Fissure.
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endoscopic transOrbital ligation of the maxillary artery through the Inferior Orbital Fissure
Head and Neck-journal for The Sciences and Specialties of The Head and Neck, 2021Co-Authors: Mohammad S Mahmoud, Ahmed Sholkamy G Diab, Stephany Ngombu, Daniel M Prevedello, Ricardo L CarrauAbstract:OBJECTIVE Determine the feasibility of accessing the internal maxillary artery (IMA) through a transOrbital endoscopic assisted approach through the Inferior Orbital Fissure (IOF). MATERIALS AND METHODS Six adult cadaveric specimens were injected intravascularly with colored latex and dissected on 12 sides. A transOrbital endoscopic approach was used to expose the IOF and reach the IMA. RESULTS The average length and width of the anterolateral segment of the IOF were 7.3 and 4 mm, respectively, on the right side and 6.7 and 3.8 mm, respectively, on the left side. Surgical exposure and modification of the IOF allowed the exposure and control of the IMA in all 12 sides. CONCLUSIONS The IOF is a feasible portal to the IMA. The benefits of this approach include vascular control of the distal segment of the maxillary artery. It may provide access in clinical scenarios where endonasal access is not possible (e.g., extensive tumors) or serve as an alternative or complementary surgical route (e.g., control during a total or radical maxillectomy).
Shunya Hanakita - One of the best experts on this subject based on the ideXlab platform.
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the orbitopterygoid corridor as a deep keyhole for endoscopic access to the paranasal sinuses and clivus
Journal of Neurosurgery, 2021Co-Authors: Kenichi Oyama, Shunya Hanakita, Kentaro Watanabe, Annelaure Bernat, Pierreolivier Champagne, Thibault Passeri, Eduard H Voormolen, Nicolas Penet, Takanori Fukushima, Sébastien FroelichAbstract:Objective The anteromedial triangle (AMT) is the triangle formed by the ophthalmic (V1) and maxillary (V2) nerves. Opening of this bony space offers a limited access to the sphenoid sinus (SphS). This study aims to demonstrate the utility of the orbitopterygopalatine corridor (OPC), obtained by enlarging the AMT and transposing the contents of the pterygopalatine fossa (PPF) and V2, as an entrance to the SphS, maxillary sinus (MaxS), and nasal cavity. Methods Five formalin-injected cadaveric specimens were used for this study (10 approaches). A classic pterional approach was performed. An OPC was created through the Inferior Orbital Fissure, between the orbit and the PPF, by transposing the PPF Inferiorly. The extent of the OPC was measured using neuronavigation and manual measurements. Two illustrative cases using the OPC to access skull base tumors are presented in the body of the article. Results Via the OPC, the SphS, MaxS, ethmoid sinus (EthS), and nasal cavity could be accessed. The use of endoscopic assistance through the OPC achieved better visualization of the EthS, SphS, MaxS, clivus, and nasal cavity. A significant gain in the area of exposure could be achieved using the OPC compared to the AMT (22.4 mm2 vs 504.1 mm2). Conclusions Opening of the AMT and transposition of V2 and the contents of the PPF creates the OPC, a potentially useful deep keyhole to access the paranasal sinuses and clival region through a middle fossa approach. It is a valuable alternative approach to reach deep-seated skull base lesions infiltrating the cavernous sinus and middle cranial fossa and extending into the paranasal sinus.
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endoscopic endonasal approach to the anteromedial temporal fossa and mobilization of the lateral wall of the cavernous sinus through the Inferior Orbital Fissure and v1 v2 corridor an anatomic study and clinical considerations
World Neurosurgery, 2018Co-Authors: Shunya Hanakita, Weichieh Chang, Kentaro Watanabe, Daniel Ronconi, Moujahed Labidi, Hun Ho Park, Kenichi Oyama, Annelaure Bernat, Sébastien FroelichAbstract:Objective The aim of this study was to identify key anatomic landmarks useful in gaining access to the anteromedial temporal region via the corridor formed by the Inferior Orbital Fissure (IOF), the ophthalmic branch of the trigeminal nerve (V1), and the maxillary branch of the trigeminal nerve (V2) via an endoscopic endonasal approach (EEA). Methods An anatomic dissection of 6 cadaver heads was performed to confirm the feasibility and applicability of an EEA for accessing the anteromedial temporal region. Results After middle turbinectomy, the lateral recess of the sphenoid sinus was opened, the Orbital apex was exposed, and the posterior wall of the maxillary sinus was removed, in sequence. The IOF and the pterygopalatine fossa (PPF) were then identified. After opening the foramen rotundum (FR) and removing the bony structure between the FR, V2 was transposed downward. The Orbital muscle of Muller was removed. The PPF was mobilized downward exposing the greater wing of the sphenoid bone (GWS). The GWS between V1 and V2 was drilled, therefore exposing the temporal dura. With blunt dissection, the medial temporal dura was peeled away from the cavernous sinus to increase access to the anteromedial temporal region. Conclusions The anteromedial temporal fossa was exposed by drilling the V1-V2 triangle corridor via an EEA. Endoscopic endonasal exposure of the anteromedial temporal fossa is feasible and requires limited endonasal work. This approach may be considered as an alternate surgical corridor to the temporomesial lobe that offers the advantages of a direct route with less temporal lobe retraction.
Navarro,joão Adolfo Caldas - One of the best experts on this subject based on the ideXlab platform.
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Surgical anatomy of the maxillary nerve in the zygomatic region
Faculdade De Odontologia De Bauru - USP, 2005Co-Authors: Moretto,elizandra Paccola, Silva,gustavo Henrique De Souza, Toledo Filho,joão Lopes, Andreo,jesus Carlos, Navarro,ricardo De Lima, Navarro,joão Adolfo CaldasAbstract:Anatomic knowledge on the zygomatic fossa is of primary importance to improve the regional anesthetic technique of the maxillary nerve. Few reports in the literature have addressed the trajectory of the maxillary nerve and its branches in this region; thus, this study aimed at presenting information about the trajectory of these nerves. Thirty human half-heads of both genders were fixed in 10% formalin and demineralized in 5% nitric acid, and the maxillary nerve was dissected since its origin on the pterygopalatine fossa until penetration into the Inferior Orbital Fissure. It was observed that the maxillary nerve sends one to three posterior superior alveolar branches and tuberal descendent branches, which supply the soft tissue structures of the region. The posterior superior alveolar nerves are Inferiorly oriented near the maxillary tuberosity, where they penetrate the alveolar canals with the posterior superior alveolar artery and send small nerve branches that continue in an extraosseous trajectory. This study found that nearly 2/3 of the trajectory of the maxillary nerve is located in the zygomatic region, with a short segment (1/3) in the pterygopalatine fossa
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Anatomia cirúrgica do nervo maxilar na região zigomática
Faculdade De Odontologia De Bauru - USP, 2005Co-Authors: Moretto,elizandra Paccola, Silva,gustavo Henrique De Souza, Toledo Filho,joão Lopes, Andreo,jesus Carlos, Navarro,ricardo De Lima, Navarro,joão Adolfo CaldasAbstract:Anatomic knowledge on the zygomatic fossa is of primary importance to improve the regional anesthetic technique of the maxillary nerve. Few reports in the literature have addressed the trajectory of the maxillary nerve and its branches in this region; thus, this study aimed at presenting information about the trajectory of these nerves. Thirty human half-heads of both genders were fixed in 10% formalin and demineralized in 5% nitric acid, and the maxillary nerve was dissected since its origin on the pterygopalatine fossa until penetration into the Inferior Orbital Fissure. It was observed that the maxillary nerve sends one to three posterior superior alveolar branches and tuberal descendent branches, which supply the soft tissue structures of the region. The posterior superior alveolar nerves are Inferiorly oriented near the maxillary tuberosity, where they penetrate the alveolar canals with the posterior superior alveolar artery and send small nerve branches that continue in an extraosseous trajectory. This study found that nearly 2/3 of the trajectory of the maxillary nerve is located in the zygomatic region, with a short segment (1/3) in the pterygopalatine fossa.O conhecimento anátomo-cirúrgico da região zigomática é fundamental para o aprimoramento de técnicas anestésicas tronculares do nervo maxilar. A literatura pouco se refere à trajetória do nervo maxilar e seus ramos nessa região, portanto, o presente estudo tem como objetivo esclarecer o percurso desses nervos. Foram dissecadas ao microscópio cirúrgico MC900 (D.F.Vasconcelos), 30 hemicabeças humanas, de ambos os sexos, que foram previamente formolizadas a 10% e desmineralizadas em ácido nítrico a 5%. Observou-se que o nervo maxilar, desde sua origem na fossa pterigopalatina até penetrar na fissura Orbital Inferior, emite de um a três ramos alveolares superiores posteriores e ramos tuberais descendentes que vão para estruturas moles da região. Os nervos alveolares superiores posteriores, descem adjacentes à tuberosidade da maxila, na qual penetram através dos canais alveolares junto com a artéria homônima e podem emitir filetes nervosos que continuam trajeto extra-ósseo. Contrariando os achados da literatura, com este estudo observou-se que o nervo maxilar apresenta praticamente dois terços de sua trajetória na região zigomática e o restante na fossa pterigopalatina