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Bony landmarks in the endoscopic endonasal transoculomotor approach

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Abstract

The endoscopic endonasal transoculomotor approach (EETA) has been recently described as a doorway to access the parapeduncular space and treat pituitary adenomas with oculomotor extension. Intraoperative identification of the oculomotor triangle endonasally is challenging and dissection can put the internal carotid artery (ICA) at risk. The aim of the present study is to find reliable landmarks that identify the oculomotor triangle (OCMT) during the EETA and protect the ICA from injury. Several lines were defined for calculations. Among them, one oblique line that extends from the inferior margin of the lateral orbital canal recess to the vidian canal was named the clinoid-to-vidian line (CVL), while a vertical line that extends over the most medial point of the paraclival ICA was titled the sagittal paraclival line (SPL). Anatomic relationships between the OCMT to these lines were assessed in 7 cadaveric heads. The intersecting point between the CVL and SPL is located within 2 mm of the center of the OCMT (mean 0.8 ± 0.5 mm), and 1.1 ± 0.8 mm medially and above the parasellar ICA. CVL and SPL are reliable landmarks during the EETA that can both protect the parasellar ICA and anatomically orientate to the blind spot that corresponds with the OCMT. We recommend starting dissection medial and superior to the CVL-SPL intersecting point, and carry the dissection laterally thereafter to avoid inadvertent injury of the ICA.

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Authors and Affiliations

  1. Department of Neurological Surgery, University of Colorado, 12631 E 17th Ave, Aurora, CO, USA

    Rafael Martinez-Perez

  2. Department of Neurological Surgery, The Ohio State University, Columbus, OH, 80045, USA

    Douglas A. Hardesty, Giuliano Silveira-Bertazzo, Ricardo L. Carrau & Daniel M. Prevedello

  3. Head and Neck Surgery, The Ohio State University Wexner Medical Center, 410 W. 10th Ave., N-1049 Doan Hall, Columbus, OH, 43210, USA

    Douglas A. Hardesty, Ricardo L. Carrau & Daniel M. Prevedello

Authors
  1. Rafael Martinez-Perez
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  2. Douglas A. Hardesty
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  3. Giuliano Silveira-Bertazzo
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  4. Ricardo L. Carrau
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  5. Daniel M. Prevedello
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Contributions

Conception and design of study: Rafael Martinez-Perez and Daniel Prevedello; acquisition of data: Rafael Martinez-Perez and Giuliano Silveira-Bertazzo; analysis and/or interpretation of data: Rafael Martinez-Perez and Ricardo Carrau; drafting the manuscript: Rafael Martinez-Perez; revising the manuscript critically for important intellectual content: Daniel Prevedello, Ricardo Carrau, and Douglas Hardesty; approval of the version of the manuscript to be published: Rafael Martinez-Perez, Douglas Hardesty, Giuliano Silveira-Bertazzo, Ricardo Carrau, and Daniel Prevedello.

Corresponding authors

Correspondence to Rafael Martinez-Perez or Daniel M. Prevedello.

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Conflict of interest

Dr Prevedello is a consultant for Integra, Stryker Corp., Medtronic Corp.; has received royalties from KLSMartin, ACE Medical and Mizuho and honorarium from Karl Storz.

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Informed consent and ethical approval were not deemed necessary by the local ethics in view of the design of the study.

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Martinez-Perez, R., Hardesty, D.A., Silveira-Bertazzo, G. et al. Bony landmarks in the endoscopic endonasal transoculomotor approach. Neurosurg Rev 44, 2717–2725 (2021). https://doi.org/10.1007/s10143-020-01458-1

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  • DOI: https://doi.org/10.1007/s10143-020-01458-1

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