• Salvatore Chibbaro, Mario Ganau, Antonino Scibilia, Julien Todeschi, Ismail Zaed, Maria Teresa Bozzi, Irène Ollivier, Hélène Cebula, Marie des Neiges Santin, Idir Djennaoui, Christian Debry, Pierre Mahoudau, Paolo Di Emidio, Stephane Kraemer, Seyyid Baloglu, Francois Proust, and Beniamino Alessandro Nannavecchia.
• Department of Neurosurgery, Strasbourg University Hospital, Strasbourg, France.
• World Neurosurg. 2021 Jun 1; 150: e74-e80.

BackgroundAmong the new perspectives to revolutionize skull base surgery, there are the transorbital neuroendoscopic (TONES) approaches to reach the anterior and middle cranial fossa (ACF and MCF). We conceived to explore the potentialities of a modified superiorly and medially extended lateral retrocanthal (LRC) approach.MethodsSix head specimens were dissected. Applying the established conic model and the key surgical landmark of sphenofrontal suture, we tested the feasibility of a modified LRC to reach ACF and MCF; computed tomography (CT) scans were performed before and after dissection to obtain a morphometric analysis of the surgical corridors using a polygonal surfaces model.ResultsThrough our anatomical study, we were able to identify and explore 3 different surgical corridors to reach the ACF and MCF: the superomedial, the superolateral, and the inferolateral. The superomedial corridor appeared most suitable to reach the medial part of the ACF and the optic-carotid region, whereas through the superolateral and inferolateral corridors it was possible to reach and explore the lateral part of ACF and MCF. The mean volumes of the 3 surgical corridors calculated on post-dissection CT scans were: 12.72 ± 1.99, 5.69 ± 0.34, and 6.24 ± 0.47 cm3, respectively.ConclusionsThe development of TONES approaches has not replaced the traditional open or endoscopic approach; nonetheless, identification of surgical corridors and the possibility to combine them represent a major breakthrough. Clinical studies are necessary to demonstrate their validity and test the effectiveness, safety, and reproducibility of TONES approaches in managing lesions harboring in the ACF and MCF.Copyright © 2021 Elsevier Inc. All rights reserved.

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