{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T14:08:36Z","timestamp":1790777316471,"version":"4.1.0"},"reference-count":34,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","license":[{"start":{"date-parts":[[2018,8,10]],"date-time":"2018-08-10T00:00:00Z","timestamp":1533859200000},"content-version":"vor","delay-in-days":1,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Operative Surg.","ONSURG"],"published-print":{"date-parts":[[2019,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>The treatment of cerebrospinal fluid leaks of the lateral recess of the sphenoid sinus (LRSS) faces difficulties due to the deep location of the osseous defect. When treated with craniotomies, brain retraction is a concern. The endoscopic endonasal transpterygoid approach (EETA) is a direct and less invasive procedure; however, it may require transection of the vidian nerve (VN).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>To investigate the feasibility of a lateral transorbital approach (LTOA) as an alternative pathway to the LRSS that avoids VN sacrifice.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>Six embalmed heads with well-pneumatized LRSS were preselected by inspecting their computed tomography scans. One LTOA and one EETA were performed on 1 side of each specimen. The approaches were compared regarding working distance and neurovascular structures being sacrificed. The working area of the LTOA was also measured.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>\n                      The average working distances were 59.9 (\u00b12.94) mm for the LTOA and 76.4 (\u00b13.99) mm for the EETA (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt;\u00a0.001). The LTOA generated a working area with a diameter of 9 to 14 mm. The EETA demanded the sacrifice of VN and the sphenopalatine artery in all specimens to expose the LRSS. No neurovascular structures were found in the trajectory of the LTOA.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSION<\/jats:title>\n                    <jats:p>The LTOA to the LRSS is feasible, with minimal risk of injuring neurovascular structures. It offers a shorter pathway when compared to the EETA. Although the LTOA provides no options for vascularized flap reconstruction, it allows immediate access to muscle grafts. The LTOA may serve as an alternative to treating cerebrospinal fluid leaks of the LRSS.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ons\/opy211","type":"journal-article","created":{"date-parts":[[2018,8,10]],"date-time":"2018-08-10T09:25:59Z","timestamp":1533893159000},"page":"600-606","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":24,"title":["Lateral Transorbital Versus Endonasal Transpterygoid Approach to the Lateral Recess of the Sphenoid Sinus\u2014A Comparative Anatomic Study"],"prefix":"10.1227","volume":"16","author":[{"given":"Joao T","family":"Alves-Belo","sequence":"first","affiliation":[{"name":"Surgical Neuroanatomy Lab, UPMC Cen-ter for Cranial Base Surgery, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joao","family":"Mangussi-Gomes","sequence":"additional","affiliation":[{"name":"Surgical Neuroanatomy Lab, UPMC Cen-ter for Cranial Base Surgery, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huy Q","family":"Truong","sequence":"additional","affiliation":[{"name":"Surgical Neuroanatomy Lab, UPMC Cen-ter for Cranial Base Surgery, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salomon","family":"Cohen","sequence":"additional","affiliation":[{"name":"Surgical Neuroanatomy Lab, UPMC Cen-ter for Cranial Base Surgery, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul A","family":"Gardner","sequence":"additional","affiliation":[{"name":"Department of Neuro-surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carl H","family":"Snyderman","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, Univer-sity of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S Tonya","family":"Stefko","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric W","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, Univer-sity of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan C","family":"Fernandez-Miranda","sequence":"additional","affiliation":[{"name":"Department of Neuro-surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania"},{"name":"Department of Neurosurgery, Stanford University School of Medicine, Stanford, 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