Journal of Neurological Surgery Part B: Skull Base最新文献

{"title":"Anatomical Step-by-Step Dissection of Complex Skull Base Approaches for Trainees: Surgical Anatomy of the Translabyrinthine and Transcochlear Approaches","authors":"Avital Perry, Lucas P. Carlstrom, Alex Yohan Alexander, Luciano C.P.C. Leonel, Ashley M. Nassiri, Bachtri Nguyen, Jonathan M. Morris, Colin L.W. Driscoll, Michael J. Link, Christopher S. Graffeo, Maria Peris-Celda","doi":"10.1055/s-0044-1786736","DOIUrl":"https://doi.org/10.1055/s-0044-1786736","url":null,"abstract":"<p>\u0000<b>Introduction</b> Skull base neuroanatomy is traditionally learned through two-dimensional anatomical atlases, which while are of unquestionable value, lack the nuanced association of three-dimensional relationships between fundamental anatomical structures relevant to surgical approaches. Surgically focused step-by-step anatomical dissections can augment trainee learning of complex skull base techniques, particularly multistep and nuanced techniques such as translabyrinthine and transcochlear approaches.</p> <p>\u0000<b>Methods</b> Translabyrinthine and transcochlear approaches were performed on six sides of three formalin-fixed latex-injected specimens. The study objective was the completion and photo documentation of the steps involved in the approach in order to provide a comprehensive, intelligible, and anatomically oriented resource for multilevel trainees. Illustrative case examples were prepared to supplement approach dissections.</p> <p>\u0000<b>Results</b> The translabyrinthine and transcochlear approaches offer unique lateral windows through the temporal bone into the posterior fossa, providing excellent access to pathology at the petrous apex, internal auditory canal, Meckel's cave, and anterolateral brainstem. The transcochlear approach, which is an anterior extension of the translabyrinthine, particularly provides excellent exposure of the prepontine region and clivus. Important surgical considerations include patient position, temporal bone drilling and identification of critical landmarks, dural opening and identification of neurovascular structures, and reconstruction/closure techniques.</p> <p>\u0000<b>Conclusion</b> The translabyrinthine and transcochlear approaches are fundamental techniques for lateral skull base and posterior fossa pathologies. Both approaches are hearing-sacrificing but often require minimal to no cerebellar retraction and deliver unique visualization of prepontine neurovascular structures. This step-by-step approach guide provides a unique practical and high-yield surgically oriented learning resource for neurosurgery and otolaryngology trainees.</p> ","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140929753","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management and Outcomes of Facial Nerve Hemangiomas: A Systematic Review of the Literature","authors":"Emal Lesha, John E. Dugan, Arba Cecia, C Stewart Nichols, Taylor J. Orr, Anxhela Nezha, Kara A. Parikh, Nickalus R. Khan","doi":"10.1055/a-2301-3761","DOIUrl":"https://doi.org/10.1055/a-2301-3761","url":null,"abstract":"<p>\u0000<b>Objectives</b> To conduct a systematic review of facial nerve hemangiomas (FNH), focusing on patient characteristics, management options, and treatment outcomes.</p> <p>\u0000<b>Design</b> A systematic review was performed following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, utilizing PubMed, EMBASE, Scopus, and Cochrane databases from inception to December 31, 2022.</p> <p>\u0000<b>Setting</b> Literature sourced from various databases providing information on FNH cases.</p> <p>\u0000<b>Participants</b> A total of 176 patients with FNH were included in the study, identified from 40 articles meeting inclusion criteria.</p> <p>\u0000<b>Main Outcome Measures</b> Patient demographics, lesion characteristics, preoperative symptoms, surgical approaches, and postoperative outcomes, including House-Brackmann (HB) grades.</p> <p>\u0000<b>Results</b> Among the 1,682 initially identified articles, 40 were included in the final review. From these, a total of 176 patients (mean age = 42.7 ± 12.8, 51.1% male) were included for analysis. Bivariate analysis showed that patients with longer preoperative symptom duration and facial nerve sacrifice had significantly greater postoperative HB Grades (<i>p</i> < 0.001). Additionally, a strong positive correlation was observed between pre- and postoperative HB Grades (Spearman's rho = 0.649). Multivariable linear regression analysis showed that both facial nerve sacrifice (β = 0.86, 95% confidence interval [CI]: 0.38–1.34; <i>p</i> < 0.001) and greater preoperative HB Grades (β = 0.36, 95% CI: 0.20–0.53; <i>p</i> < 0.001) were associated with significantly greater postoperative HB Grades, but preoperative symptom duration did not persist as a significant predictor of postoperative HB Grades.</p> <p>\u0000<b>Conclusions</b> FNHs are rare lesions of the skull base affecting the temporal bone. Our findings highlight the role of preoperative facial nerve function and intraoperative preservation of the facial nerve in predicting postoperative outcomes. Timely resection of lesions that prioritizes facial nerve preservation is critical to achieving optimal patient outcomes.</p> ","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140929819","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Concept Recognition and Characterization of Patients Undergoing Resection of Vestibular Schwannoma Using Natural Language Processing","authors":"Simon C. Williams, Kawsar Noor, Siddharth Sinha, Richard J.B. Dobson, Thomas Searle, Jonathan P. Funnell, John G. Hanrahan, William R. Muirhead, Neil Kitchen, Hala Kanona, Sherif Khalil, Shakeel R. Saeed, Hani J. Marcus, Patrick Grover","doi":"10.1055/s-0044-1786738","DOIUrl":"https://doi.org/10.1055/s-0044-1786738","url":null,"abstract":"<p>\u0000<b>Background</b> Natural language processing (NLP), a subset of artificial intelligence (AI), aims to decipher unstructured human language. This study showcases NLP's application in surgical health care, focusing on vestibular schwannoma (VS). By employing an NLP platform, we identify prevalent text concepts in VS patients' electronic health care records (EHRs), creating concept panels covering symptomatology, comorbidities, and management. Through a case study, we illustrate NLP's potential in predicting postoperative cerebrospinal fluid (CSF) leaks.</p> <p>\u0000<b>Methods</b> An NLP model analyzed EHRs of surgically managed VS patients from 2008 to 2018 in a single center. The model underwent unsupervised (trained on one million documents from EHR) and supervised (300 documents annotated in duplicate) learning phases, extracting text concepts and generating concept panels related to symptoms, comorbidities, and management. Statistical analysis correlated concept occurrences with postoperative complications, notably CSF leaks.</p> <p>\u0000<b>Results</b> Analysis included 292 patients' records, yielding 6,901 unique concepts and 360,929 occurrences. Concept panels highlighted key associations with postoperative CSF leaks, including “antibiotics,” “sepsis,” and “intensive care unit admission.” The NLP model demonstrated high accuracy (precision 0.92, recall 0.96, macro F1 0.93).</p> <p>\u0000<b>Conclusion</b> Our NLP model effectively extracted concepts from VS patients' EHRs, facilitating personalized concept panels with diverse applications. NLP shows promise in surgical settings, aiding in early diagnosis, complication prediction, and patient care. Further validation of NLP's predictive capabilities is warranted.</p> ","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140929655","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fenestrated Aneurysm Clip Trigeminal Decompression after CyberKnife Treatment Failure","authors":"M. Vanloon, Barbara Verbraeken, Thibault Remacle, T. Menovsky","doi":"10.1055/s-0044-1786737","DOIUrl":"https://doi.org/10.1055/s-0044-1786737","url":null,"abstract":"","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140999369","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of 3D Printing in the Management of Frontal Bone Trauma","authors":"Mohamed Safwat Kassem, M. Hagras, Mohamed Nasser Elsheikh, Fathhe Ali Erfan, Mohamed Amer","doi":"10.1055/a-2321-0223","DOIUrl":"https://doi.org/10.1055/a-2321-0223","url":null,"abstract":"Background/Objective: Craniomaxillofacial (CMF) trauma surgery is difficult because of its unique architecture and vast range of injuries in the head and neck area. This study aimed to determine the potential of employing preoperative 3D-printed models to improve frontal fracture healing outcomes. Methods: This prospective cohort clinical trial involved 20 patients who were surgically fitted and had a frontal bone fracture, as evidenced by computed tomography (CT). The patients were separated into two groups. Group A: Patients with frontal bone trauma reduced using 3D printing. Group B: Patients with frontal bone trauma reduced without 3D printing. Results: Compared to Group B, Group A had a considerably shorter operational time (P < 0.001). The aesthetic results, complications, and functional outcomes were not significantly different between the two groups. All patients in Groups A and B underwent accurate radiographic evaluations (correct placement of the titanium mesh). Conclusion: 3D printing in preoperative planning improves frontal fracture repair with respect to operative length but does not reduce intraoperative blood loss or improve postoperative function compared with normal management.","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141004424","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Effect of Different Anesthesia Depths on Postoperative Cognitive Function of Tumor Patients Monitored by Narcotrend","authors":"Xueli Zhao, Ruina Guo, Xizhong Ma, Zhixun Hu, Jianghong Liu","doi":"10.1055/s-0044-1786734","DOIUrl":"https://doi.org/10.1055/s-0044-1786734","url":null,"abstract":"<p>\u0000<b>Objectives</b> The study aimed to examine the influence of different anesthesia depths monitored by Narcotrend on postoperative cognitive dysfunction (POCD) in elderly patients undergoing radical resection of gastrointestinal malignancies.</p> <p>\u0000<b>Methods</b> Individuals in the control group (<i>n</i> = 40) maintained the Narcotrend index (NTI) at 50 to 59 monitored by Narcotrend, whereas the experimental group at 30 to 39. The mini-mental state examination (MMSE) scale and serum S100β concentration were used to evaluate the cognitive function. Cerebral oxygen metabolism and inflammation were evaluated, presenting as regional oxygen saturations of brain (rSO₂) and cerebral oxygen uptake rate (CERO2), serum tumor necrosis factor-α (TNF-α), and interleukin-6 (IL-6).</p> <p>\u0000<b>Results</b> Experimental group presented prominently high levels of rSO2 and low levels of CERO2 relative to controls, meanwhile with reduced serum TNF-α and IL-6. Individuals receiving deep anesthesia owned low levels of S100β and enhanced MMSE score, which showed negative correlation. Low incidence rate of POCD was detected in the experimental group. Both age (hazard ratio = 5.219, 95% confidence interval = 1.813–15.025) and NTI score (hazard ratio = 3.707, 95% confidence interval = 1.292–10.633) were independent influence factors for the onset of POCD.</p> <p>\u0000<b>Conclusion</b> NTI maintained at 30 to 39 can reduce the incidence of POCD in the early postoperative period for elderly patients receiving gastrointestinal tumors surgery, the contribution might be attributed to the improvement of perioperative cerebral oxygen metabolism and inflammatory stress response.</p> ","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140827478","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"EARLY PREDICTORS OF REMISSION IN ACROMEGALY PATIENTS AFTER PURE ENDOSCOPIC ENDONASAL TRANSSPHENOIDAL SURGERY","authors":"N. Çetinalp, Gamze Akkus, G. Seydaoglu, K. Ozsoy, Mevlana Akbaba, Okay Baykara, K. Oktay, T. Erman","doi":"10.1055/a-2319-0344","DOIUrl":"https://doi.org/10.1055/a-2319-0344","url":null,"abstract":"Surgery is the first line treatment in acromegaly but it takes months to confirm remission. It is crucial to determine remission early in order to inform the patient and plan further treatment options. We aimed to evaluate the predictors of remission at the early phase after endoscopic endonasal pituitary surgery in acromegaly patients. \u0000Methods: Fifty-four GH-adenoma patients operated via pure endoscopic endonasal approach were analysed in this observational study. We compared the basic clinical, radiological characteristics, and the preoperative and postoperative hormone levels in terms of remission according to current guidelines.\u0000Results: The surgical remission rate was 61.1%. When the patients were compared according to surgical remission, the age, gender, and immunohistochemical granulation type were non-significant, while diabetes mellitus was more common (55.6% vs 44.4%), the preoperative tumor volume (1.2  0.9 cm3 vs 4.1  4.2 cm3), postoperative GH and IGF-1 levels were higher in the non-remission group (p0.05). We defined a number of cut-off values of both GH and IGF-1 levels to predict remission at the postoperative phase. Age standardized regression analyses showed that postoperative day 1 (POD-1) GH levels (OR:8.9; 95%CI:1.99-40.0, p=0.004) and tumor volume (OR:3.14; 95%CI:1.09-9.0, p=0.034) were found to be significant independent predictors for remission.\u0000\u0000\u0000Conclusion: We demonstrated that tumor volume and POD1 GH levels are independent predictors of remission in acromegaly patients operated via pure endoscopic endonasal technique and may be used as an early marker of remission and this may lead to taking adjuvant medical therapies early into account to improve prognosis. \u0000","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141015095","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Training in Endoscopic Endonasal Neurosurgical Procedures: a Systematic Review of Available Models","authors":"Edoardo Porto, Alejandra Rodas, Hanyao Sun, Manuel Revuelta-Barbero, Megan Cosgrove, Leonardo Tariciotti, Alessandro Perin, Gabriel Zada, Francesco DiMeco, C. Solares, Tomas Garzon, Gustavo Pradilla","doi":"10.1055/a-2319-0425","DOIUrl":"https://doi.org/10.1055/a-2319-0425","url":null,"abstract":"Background\u0000Proficiency in endoscopic endonasal neurosurgery (EEN) requires a unique skill set and is associated with a steep learning curve. Endoscopic simulation models present an opportunity for trainees to enhance their surgical skills and anatomical knowledge in a risk-free environment. To date, four main categories of training modalities have been recorded: cadaveric, synthetic, animal, and virtual reality (VR) models.\u0000Objective\u0000To analyze the features, advantages, and disadvantages of each EEN training model, describe the stages of simulation training, and propose future directions and an algorithm for EEN training.\u0000Methods\u0000A comprehensive search was performed including studies published before August 2023. Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed in the search and selection of studies included. Terms for searching title and abstract were (“simulation”)AND(“endoscopic endonasal”)AND(“neurosurgery”). Articles were screened for duplicates.\u0000Results\u0000We identified 176 references, and 43 studies met the inclusion criteria. Twelve articles described cadaveric models, with 7 of them studying internal carotid artery injury (ICAI) management and 3 of them CSF leak management; fourteen articles illustrated synthetic models, one article described animal models, and sixteen articles outlined virtual reality (VR) simulations. \u0000Conclusion\u0000Cadaveric models provide realistic hands-on surgical training with acceptable cost and remain the gold standard method for training. Synthetic models are most effective for preoperative surgical planning and animal models are best suited for testing of hemostatic techniques. VR simulations may become the primary training tool for novices to acquire basic anatomical knowledge as their role in advanced surgical planning is evolving.","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141015866","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Price Transparency in the Management of Skull Base Tumors—The Price to Operate","authors":"Shrey Patel, Julianna Mastropierro, Genevieve Spagnuolo, Jacob Kosarchuk, Monica O'Brien, Julian Wu, Carl Heilman, Kathryn Noonan","doi":"10.1055/s-0044-1786367","DOIUrl":"https://doi.org/10.1055/s-0044-1786367","url":null,"abstract":"<p>\u0000<b>Background</b> Due to the escalating health care costs in the United States, the Centers for Medicare and Medicaid Services (CMS) implemented a cost transparency initiative on January 1, 2021. Hospitals lack functional cost estimators or fail to provide pricing information for common skull base procedures.</p> <p>\u0000<b>Methods</b> A list of the top 70 neurosurgery and otolaryngology hospital systems according to the US News and World Report rankings was made. Google searches for each hospital's cost estimator tool were conducted, recording its presence and accessibility time. Using the cost estimator tool, specific skull base procedure prices, Current Procedural Terminology codes, and contact information for personalized estimates were searched.</p> <p>\u0000<b>Results</b> Fifty-seven hospitals (81%) were privately funded. The majority were urban teaching hospitals (<i>n</i> = 68; 97%). Geographical locations included 19 (27%) in the Northeast, 21 (30%) in the Midwest, 20 (29%) in the South, and 10 (14%) in the West. Of the 70 hospitals, 4 (5.7%) did not have a cost estimation website. Of the 66 hospitals that did, the average time to locate the cost of the skull-based procedures was 17.8 seconds (range 12–28 seconds). Only two (2.9%) hospitals had information for skull base procedures; both were radiosurgery procedures. The most common stereotactic radiosurgery offered was gamma knife radiosurgery (<i>n</i> = 50; 71%). A total of 19 hospitals (27%) did not include contact information for personalized cost estimation.</p> <p>\u0000<b>Conclusion</b> The CMS price transparency guidelines are not designed to encompass skull base procedures. Due to this ambiguity, patients are unable to make informed financial decisions when selecting treatment options.</p> ","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140827477","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quantitative Analysis of the Supraorbital, Transorbital Microscopic, and Transorbital Neuroendoscopic Approaches to the Anterior Skull Base and Paramedian Vasculature","authors":"Lena Mary Houlihan, Thanapong Loymak, Irakliy Abramov, Jubran H. Jubran, Ann J. Staudinger Knoll, Michael G. J. O'Sullivan, Michael T. Lawton, Mark C. Preul","doi":"10.1055/s-0044-1786373","DOIUrl":"https://doi.org/10.1055/s-0044-1786373","url":null,"abstract":"<p>\u0000<b>Objectives</b> Our objective was to compare transorbital neuroendoscopic surgery (TONES) with open craniotomy and analyze the effect of visualization technology on surgical freedom.</p> <p>\u0000<b>Design</b> Anatomic dissections included supraorbital craniotomy (SOC), transorbital microscopic surgery (TMS), and TONES.</p> <p>\u0000<b>Setting</b> The study was performed in a neurosurgical anatomy laboratory.</p> <p>\u0000<b>Participants</b> Neurosurgeons dissecting cadaveric specimens were included in the study.</p> <p>\u0000<b>Main Outcome Measures</b> Morphometric analysis of cranial nerve (CN) accessible lengths, frontal lobe base area of exposure, and craniocaudal and mediolateral angle of attack and volume of surgical freedom (VSF) of the paraclinoid internal carotid artery (ICA), terminal ICA, and anterior communicating artery (ACoA).</p> <p>\u0000<b>Results</b> The mean (standard deviation [SD]) frontal lobe base parenchymal exposures for SOC, TMS, and TONES were 955.4 (261.7) mm², 846.2 (249.9) mm², and 944.7 (158.8) mm², respectively. Access to distal vasculature was hindered when using TMS and TONES. Multivariate analysis estimated that accessing the paraclinoid ICA with SOC would provide an 11.2- mm³ increase in normalized volume (NV) compared with transorbital corridors (<i>p</i> < 0.001). There was no difference between the three approaches for ipsilateral terminal ICA VSF (<i>p</i> = 0.71). Compared with TONES, TMS provided more access to the terminal ICA. For the ACoA, SOC produced the greatest access corridor maneuverability (mean [SD] NV: 15.6 [5.6] mm³ for SOC, 13.7 [4.4] mm³ for TMS, and 7.2 [3.5] mm³ for TONES; <i>p</i> = 0.01).</p> <p>\u0000<b>Conclusion</b> SOC provides superior surgical freedom for targets that require more lateral maneuverability, but the transorbital corridor is an option for accessing the frontal lobe base and terminal ICA. Instrument freedom differs quantifiably between the microscope and endoscope. A combined visualization strategy is optimal for the transorbital corridor.</p> ","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140827818","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}