Meningo-orbital band detachment: A key step for the extradural exposure of the cavernous sinus and anterior clinoid process |
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| Affiliation: | 1. LINT, Facultad de Medicina, Universidad Nacional de Tucumán, Tucumán, Argentina;2. Department of Neurosciences, Reproductive and Odontostomatological Sciences, Division of Neurosurgery, Università degli Studi di Napoli Federico II, Naples, Italy;3. Servicio de Neurocirugía, Hospital de Pediatría Juan P. Garrahan, Buenos Aires, Argentina;4. Departamento de Neurocirugía, Hospital de Civil de Guadalajara, Guadalajara, Mexico;5. Servicio de Neurocirugía, Hospital Padilla, Tucumán, Argentina;1. Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA;2. Department of Otolaryngology Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA;3. Brain Tumor Center at University of Cincinnati Gardner Neuroscience Institute, Cincinnati, Ohio, USA;4. Mayfield Clinic, Cincinnati, Ohio, USA;5. Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università; degli Studi di Napoli Federico II, Naples, Italy;1. Neurosurgery Department, Hospital Santo Tomas, Panamá, Panama;2. Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, USA;3. Division of Gross and Clinical Anatomy, Department of Anatomy, Kurume University School of Medicine, Kurume, Japan;4. Dental and Oral Medical Center, Kurume University School of Medicine, Kurume, Japan;5. Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany;6. Aiken Regional Medical Centers, Aiken, SC, USA;7. Anatomy, Faculty of Medicine, University of Ankara, Ankara, Turkey;8. Department of Neuroscience, Ankara University Graduate School of Health Science, Ankara University School of Medicine, Ankara, Turkey;9. Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, LA, USA;10. Department of Anatomical Sciences, St. George’s University, St. George’s, Grenada;11. Department of Structural & Cellular Biology, Tulane University School of Medicine, New Orleans, LA, USA;1. Department of Neurosurgery, Weill Cornell Medicine, New York Presbyterian Hospital, New York, New York, USA;2. Department of Neurosurgery, Otolaryngology−Head and Neck Surgery, University of Washington, Seattle, Washington, USA;3. Department of Neurological Surgery, Clinical Institute of Neurosciences, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain;4. Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea;5. Department of Neuroscience, “G. Rummo” Hospital, Benevento, Italy |
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| Abstract: | The meningo-orbital band (MOB) is the most superficial dural band that tethers the fronto-temporal dura to the periorbita. It is usually encountered when performing a pterional or fronto-temporo-sphenoidal approach, and it disrupts surgical access to deeper regions.Our objective was to perform a detailed anatomy study and a stepwise method to successfully detach the MOB using cadaveric specimens. We used six formalin‐fixed, silicone‐injected cadaveric heads. On each side, we performed a pterional approach plus mini‐peeling of the anterior third of the middle fossa and/or extradural anterior clinoidectomy. We also applied this technique in three clinical cases to prove its safety and efficacy. The detachment of the MOB consists in four steps, 1) detachment of the temporal and frontal dura, 2) cutting of the MOB, 3) exposure and drilling of the anterior clinoid process, and 4) pealing of the lateral wall of the cavernous sinus. Using clinical cases, we explain how to adapt the technique depending on the localization of the lesion. The detachment of the MOB is the key to safely expose the cavernous sinus and the anterior clinoid process. The authors proposed a step-by-step method for the safe and effective detachment of the MOB. It is recommended, particularly to less experienced neurosurgeons that are starting with skull base surgery, and also to experts that want to expand their knowledge. |
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| Keywords: | Meningo-Orbital Band Anterior Fossa Middle Fossa Skull Base Anterior Clinoid Process Cavernous Sinus |
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