{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T00:59:25Z","timestamp":1793149165949,"version":"4.5.0"},"reference-count":19,"publisher":"Georg Thieme Verlag KG","issue":"04","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Neurol Surg B Skull Base"],"published-print":{"date-parts":[[2021,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\n          Background\u2003Transorbital neuroendoscopic (TONES) approaches promise to open up new horizons for skull base surgery, offering alternative routes to reach the anterior and middle cranial fossa (ACF and MCF, respectively).<\/jats:p><jats:p>\n          Objective\u2003The aim of this anatomical study is to acquire new surgical anatomy knowledge and exploit it for the refinement of TONES approaches, as an alternative to open surgery, to reduce the distance to the target, and the risk of neurovascular lesions in pathological conditions extending beyond the orbital cavity.<\/jats:p><jats:p>\n          Materials and Methods\u2003Six head specimens (12 orbits) were studied\/dissected. The orbit was approached and divided in a four clockwise quadrants manner to simulate three transconjunctival routes: the precaruncular (PC), preseptal (PS), and lateral retrocanthal (LRC), and one transpalpebral route\u2014the superior eyelid crease (SLC). The boundaries and the most important anatomical landmarks were identified and are herein duly detailed with particular attention to the neurovascular structures encountered in each of those routes.<\/jats:p><jats:p>\n          Results\u2003The dissections showed that the PC approach facilitates the treatment of optic nerve and frontal sinus pathologies, whereas LRC appears safer to reach ACF and MCF allowing for a free multiplanar working channel (up to 180\u2009degrees) to the floor, roof, and lateral-to-medial walls.<\/jats:p><jats:p>\n          Conclusion\u2003The plane of tendon lateral canthal's insertion and the sphenofrontal suture (SFS) were identified as the key anatomical landmarks for TONES approaches. Further studies are warranted to establish a practical clinical algorithm based on the anatomical four clockwise quadrants herein implemented\/proposed, and the key surgical landmarks identified.<\/jats:p>","DOI":"10.1055\/s-0040-1713101","type":"journal-article","created":{"date-parts":[[2020,6,19]],"date-time":"2020-06-19T23:21:07Z","timestamp":1592608867000},"page":"443-449","source":"Crossref","is-referenced-by-count":9,"title":["Endoscopic Transorbital Approaches to Anterior and Middle Cranial Fossa: A Laboratory Investigation on Surgical Anatomy and Potential Routes"],"prefix":"10.1055","volume":"82","author":[{"given":"Beniamino A.","family":"Nannavecchia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mario","family":"Ganau","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Strasbourg University Hospital, Strasbourg, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H\u00e9l\u00e8ne","family":"Cebula","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Strasbourg University Hospital, Strasbourg, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonino","family":"Scibilia","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Strasbourg University Hospital, Strasbourg, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria T.","family":"Bozzi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3506-4111","authenticated-orcid":false,"given":"Ismail","family":"Zaed","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Strasbourg University Hospital, Strasbourg, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolo","family":"Gallinaro","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Strasbourg University Hospital, Strasbourg, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fazel","family":"Boujan","sequence":"additional","affiliation":[{"name":"Department of Radiology, Strasbourg University Hospital, Strasbourg, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean-Louis","family":"Dietemann","sequence":"additional","affiliation":[{"name":"Department of Radiology, Strasbourg University Hospital, Strasbourg, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Idir","family":"Djennaoui","sequence":"additional","affiliation":[{"name":"ENT Department, Strasbourg University Hospital, Strasbourg, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Debry","sequence":"additional","affiliation":[{"name":"ENT Department, Strasbourg University Hospital, Strasbourg, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gianfranco K.I.","family":"Ligarotti","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Strasbourg University Hospital, Strasbourg, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Signorelli","sequence":"additional","affiliation":[{"name":"Departement of Neurosurgery, Azienda Ospedaliero Universitaria Policlinico di Bari, Bari Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francois","family":"Proust","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Strasbourg University Hospital, Strasbourg, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salvatore","family":"Chibbaro","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Strasbourg University Hospital, Strasbourg, France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2020,6,19]]},"reference":[{"issue":"01","key":"ref1","doi-asserted-by":"crossref","first-page":"E1","DOI":"10.3171\/foc.2005.19.1.2","article-title":"Skull base surgery: past, present, and future trends","volume":"19","author":"J C Maroon","year":"2005","journal-title":"Neurosurg Focus"},{"issue":"03","key":"ref2","doi-asserted-by":"crossref","first-page":"563","DOI":"10.1016\/j.jamcollsurg.2005.11.019","article-title":"Endoscopic techniques for pathology of the anterior cranial fossa and ventral skull base","volume":"202","author":"C H Snyderman","year":"2006","journal-title":"J Am Coll Surg"},{"key":"ref3","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1007\/978-3-211-72283-1_4","article-title":"Extended endoscopic endonasal approach to the midline skull base: the evolving role of transsphenoidal surgery","volume":"33","author":"P Cappabianca","year":"2008","journal-title":"Adv Tech Stand Neurosurg"},{"issue":"01","key":"ref4","first-page":"E3","article-title":"Expanded endonasal approach: the rostrocaudal axis. 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