{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,30]],"date-time":"2026-05-30T09:06:27Z","timestamp":1780131987083,"version":"3.54.0"},"reference-count":46,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,4]]},"abstract":"\n OBJECTIVE<\/jats:title>\n The lateral retrocanthal transorbital endoscopic approach (LRCTEA) facilitates trajectory to the middle fossa, preserving the lateral canthal tendon and thus avoiding postoperative complications such as eyelid malposition. Here, the authors sought to define the surgical anatomy and technique of LRCTEA using a stepwise approach in cadaveric heads and offer an in-depth examination of existing quantitative data from cadaveric studies.<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n The authors performed LRCTEA to the middle cranial fossa under neuronavigation in 7 cadaveric head specimens that underwent high-resolution (1-mm) CT scans preceding the dissections.<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n The LRCTEA provided access to middle fossa regions including the cavernous sinus, Meckel\u2019s cave, and medial temporal lobe. The trajectories and endpoints of the approach were confirmed using electromagnetic neuronavigation. A stepwise approach was delineated and recorded.<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n The authors\u2019 cadaveric study delineates the surgical anatomy and technique of the LRCTEA, providing a stepwise approach for its implementation. As these approaches continue to evolve, their development and refinement will play an important role in expanding the surgical options available to neurosurgeons, ultimately improving outcomes for patients with complex skull base pathologies. The LRCTEA presents a promising advancement in skull base surgery, particularly for accessing challenging middle fossa regions. However, surgeons must remain vigilant to potential complications, including transient diplopia, orbital hematoma, or damage to the optic apparatus.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2024.1.focus23839","type":"journal-article","created":{"date-parts":[[2024,4,1]],"date-time":"2024-04-01T02:18:24Z","timestamp":1711937904000},"page":"E6","source":"Crossref","is-referenced-by-count":5,"title":["The lateral retrocanthal transorbital endoscopic approach to the middle fossa: cadaveric stepwise approach and review of quantitative cadaveric data"],"prefix":"10.3171","volume":"56","author":[{"given":"Spyridon","family":"Komaitis","sequence":"first","affiliation":[{"name":"Queens Medical Center, Nottingham University Hospitals NHS Foundation Trust, Nottingham, United Kingdom;"},{"name":"Athens Microneurosurgery Laboratory, Evangelismos Hospital, Athens, Greece;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georgios P.","family":"Skandalakis","sequence":"additional","affiliation":[{"name":"Athens Microneurosurgery Laboratory, Evangelismos Hospital, Athens, Greece;"},{"name":"Department of Neurosurgery, Evangelismos Hospital National, and Kapodistrian University of Athens, Greece;"},{"name":"Section of Neurosurgery, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evangelos","family":"Drosos","sequence":"additional","affiliation":[{"name":"Athens Microneurosurgery Laboratory, Evangelismos Hospital, Athens, Greece;"},{"name":"Manchester Centre for Clinical Neurosciences, Northern Care Alliance NHS Foundation Trust, Manchester, United Kingdom;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eleftherios","family":"Neromyliotis","sequence":"additional","affiliation":[{"name":"Athens Microneurosurgery Laboratory, Evangelismos Hospital, Athens, Greece;"},{"name":"Department of Neurosurgery, Evangelismos Hospital National, and Kapodistrian University of Athens, Greece;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eirini","family":"Charalampopoulou","sequence":"additional","affiliation":[{"name":"Athens Microneurosurgery Laboratory, Evangelismos Hospital, Athens, Greece;"},{"name":"Department of Neurosurgery, Evangelismos Hospital National, and Kapodistrian University of Athens, Greece;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lykourgos","family":"Anastasopoulos","sequence":"additional","affiliation":[{"name":"Athens Microneurosurgery Laboratory, Evangelismos Hospital, Athens, Greece;"},{"name":"Department of Neurosurgery, Evangelismos Hospital National, and Kapodistrian University of Athens, Greece;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georgios","family":"Zenonos","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, UPMC, Pittsburgh, Pennsylvania; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George","family":"Stranjalis","sequence":"additional","affiliation":[{"name":"Athens Microneurosurgery Laboratory, Evangelismos Hospital, Athens, Greece;"},{"name":"Department of Neurosurgery, Evangelismos Hospital National, and Kapodistrian University of Athens, Greece;"},{"name":"Hellenic Center for Neurosurgical Research, \"Petros Kokkalis,\" Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aristotelis","family":"Kalyvas","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Department of Surgery, University Health Network, Temetry Faculty of Medicine, University of Toronto, Ontario, Canada;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christos","family":"Koutsarnakis","sequence":"additional","affiliation":[{"name":"Athens Microneurosurgery Laboratory, Evangelismos Hospital, Athens, Greece;"},{"name":"Department of Neurosurgery, Evangelismos Hospital National, and Kapodistrian University of Athens, Greece;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"3","key":"b1","series-title":"J Neurooncol","first-page":"461","article-title":"Modern endoscopic skull base neurosurgery","volume":"151","author":"Martinez-Perez R","year":"2021","unstructured":"Martinez-Perez R, Requena LC, Carrau RL, Prevedello DM. Modern endoscopic skull base neurosurgery. J Neurooncol. 2021;151(3):461\u2013475."},{"issue":"5","key":"b2","series-title":"Neurosurgery","first-page":"1006","article-title":"Pure endoscopic endonasal approach for pituitary adenomas: early surgical results in 200 patients and comparison with previous microsurgical series","volume":"62","author":"Dehdashti AR","year":"2008","unstructured":"Dehdashti AR, Ganna A, Karabatsou K, Gentili F. Pure endoscopic endonasal approach for pituitary adenomas: early surgical results in 200 patients and comparison with previous microsurgical series. Neurosurgery. 2008;62(5):1006\u20131017."},{"issue":"4","key":"b3","series-title":"Neurosurg Clin N Am","first-page":"621","article-title":"Expanded endonasal approaches to middle cranial fossa and posterior fossa tumors","volume":"21","author":"Prevedello DM","year":"2010","unstructured":"Prevedello DM, Ditzel Filho LFS, Solari D, Carrau RL, Kassam AB. Expanded endonasal approaches to middle cranial fossa and posterior fossa tumors. Neurosurg Clin N Am. 2010;21(4):621\u2013635, vi."},{"issue":"1","key":"b4","series-title":"Neurosurg Focus","first-page":"E6","article-title":"Expanded endonasal approach: fully endoscopic, completely transnasal approach to the middle third of the clivus, petrous bone, middle cranial fossa, and infratemporal fossa","volume":"19","author":"Kassam AB","year":"2005","unstructured":"Kassam AB, Gardner P, Snyderman C, Mintz A, Carrau R. Expanded endonasal approach: fully endoscopic, completely transnasal approach to the middle third of the clivus, petrous bone, middle cranial fossa, and infratemporal fossa. Neurosurg Focus. 2005;19(1):E6."},{"issue":"6","key":"b5","series-title":"J Neurosurg","first-page":"1855","article-title":"Expanding the endoscopic transpterygoid corridor to the petroclival region: anatomical study and volumetric comparative analysis","volume":"128","author":"Freeman JL","year":"2018","unstructured":"Freeman JL, Sampath R, Quattlebaum SC, Expanding the endoscopic transpterygoid corridor to the petroclival region: anatomical study and volumetric comparative analysis. J Neurosurg. 2018;128(6):1855\u20131864."},{"issue":"5","key":"b6","series-title":"Oper Neurosurg (Hagerstown)","first-page":"557","article-title":"Endoscopic endonasal petrosectomy: anatomical investigation, limitations, and surgical relevance","volume":"16","author":"Borghei-Razavi H","year":"2019","unstructured":"Borghei-Razavi H, Truong HQ, Fernandes Cabral DT, Endoscopic endonasal petrosectomy: anatomical investigation, limitations, and surgical relevance. 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Quantitative analysis of the surgical exposure and surgical freedom between transcranial and transorbital endoscopic anterior petrosectomies to the posterior fossa. J Neurosurg. 2018;131(2):569\u2013577."},{"issue":"2","key":"b13","series-title":"Oper Neurosurg (Hagerstown)","first-page":"174","article-title":"Comparative analysis of the exposure and surgical freedom of the endoscopic extended minipterional craniotomy and the transorbital endoscopic approach to the anterior and middle cranial fossae","volume":"17","author":"Noiphithak R","year":"2019","unstructured":"Noiphithak R, Yanez-Siller JC, Revuelta Barbero JM, Comparative analysis of the exposure and surgical freedom of the endoscopic extended minipterional craniotomy and the transorbital endoscopic approach to the anterior and middle cranial fossae. Oper Neurosurg (Hagerstown). 2019;17(2):174\u2013181."},{"issue":"8","key":"b14","series-title":"Acta Neurochir (Wien)","first-page":"1633","article-title":"Endoscopic endo- and extra-orbital corridors for spheno-orbital region: anatomic study with illustrative case","volume":"161","author":"De Rosa A","year":"2019","unstructured":"De Rosa A, Pineda J, Cavallo LM, Endoscopic endo- and extra-orbital corridors for spheno-orbital region: anatomic study with illustrative case. Acta Neurochir (Wien). 2019;161(8):1633\u20131646."},{"issue":"1","key":"b15","series-title":"J Neurol Surg B Skull Base","first-page":"11","article-title":"Lateral transorbital neuroendoscopic approach to the lateral cavernous sinus","volume":"75","author":"Bly RA","year":"2014","unstructured":"Bly RA, Ramakrishna R, Ferreira M, Moe KS. Lateral transorbital neuroendoscopic approach to the lateral cavernous sinus. 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Front Surg. 2022;9:1007447."},{"issue":"9","key":"b18","series-title":"Acta Neurochir (Wien)","first-page":"2097","article-title":"Endoscopic endonasal and transorbital routes to the petrous apex: anatomic comparative study of two pathways","volume":"162","author":"Topczewski TE","year":"2020","unstructured":"Topczewski TE, Di Somma A, Pineda J, Endoscopic endonasal and transorbital routes to the petrous apex: anatomic comparative study of two pathways. Acta Neurochir (Wien). 2020;162(9):2097\u20132109."},{"issue":"5","key":"b19","series-title":"Oper Neurosurg (Hagerstown)","first-page":"614","article-title":"A side door to Meckel\u2019s cave: anatomic feasibility study for the lateral transorbital approach","volume":"13","author":"Priddy BH","year":"2017","unstructured":"Priddy BH, Nunes CF, Beer-Furlan A, Carrau R, Dallan I, Prevedello DMS. A side door to Meckel\u2019s cave: anatomic feasibility study for the lateral transorbital approach. Oper Neurosurg (Hagerstown). 2017;13(5):614\u2013621."},{"key":"b20","series-title":"World Neurosurg","first-page":"e236","article-title":"A Frontal route to middle and posterior cranial fossa: quantitative study for the lateral transorbital endoscopic approach and comparison with the subtemporal approach","volume":"167","author":"Garc\u00eda-P\u00e9rez D","year":"2022","unstructured":"Garc\u00eda-P\u00e9rez D, Abarca J, Gonz\u00e1lez-L\u00f3pez P, Nieto J, Lagares A, Paredes I. A Frontal route to middle and posterior cranial fossa: quantitative study for the lateral transorbital endoscopic approach and comparison with the subtemporal approach. World Neurosurg. 2022;167:e236\u2013e250."},{"issue":"9","key":"b21","series-title":"Acta Neurochir (Wien)","first-page":"2119","article-title":"Biportal endoscopic transorbital approach: a quantitative anatomical study and clinical application","volume":"162","author":"Lim J","year":"2020","unstructured":"Lim J, Roh TH, Kim W, Biportal endoscopic transorbital approach: a quantitative anatomical study and clinical application. Acta Neurochir (Wien). 2020;162(9):2119\u20132128."},{"issue":"4","key":"b22","series-title":"J Neurosurg","first-page":"1126","article-title":"Endoscopic transorbital surgery for Meckel\u2019s cave and middle cranial fossa tumors: surgical technique and early results","volume":"131","author":"Jeon C","year":"2018","unstructured":"Jeon C, Hong CK, Woo KI, Endoscopic transorbital surgery for Meckel\u2019s cave and middle cranial fossa tumors: surgical technique and early results. J Neurosurg. 2018;131(4):1126\u20131135."},{"issue":"2","key":"b23","series-title":"Neurosurgery","first-page":"309","article-title":"Lateral orbitotomy approach for lesions involving the middle fossa: a retrospective review of thirteen patients","volume":"80","author":"Chabot JD","year":"2017","unstructured":"Chabot JD, Gardner PA, Stefko ST, Zwagerman NT, Fernandez-Miranda JC. Lateral orbitotomy approach for lesions involving the middle fossa: a retrospective review of thirteen patients. Neurosurgery. 2017;80(2):309\u2013322."},{"issue":"3","key":"b1","series-title":"J Neurooncol","first-page":"461","article-title":"Modern endoscopic skull base neurosurgery","volume":"151","author":"Martinez-Perez R","year":"2021","unstructured":"Martinez-Perez R, Requena LC, Carrau RL, Prevedello DM. Modern endoscopic skull base neurosurgery. J Neurooncol. 2021;151(3):461\u2013475."},{"issue":"5","key":"b2","series-title":"Neurosurgery","first-page":"1006","article-title":"Pure endoscopic endonasal approach for pituitary adenomas: early surgical results in 200 patients and comparison with previous microsurgical series","volume":"62","author":"Dehdashti AR","year":"2008","unstructured":"Dehdashti AR, Ganna A, Karabatsou K, Gentili F. Pure endoscopic endonasal approach for pituitary adenomas: early surgical results in 200 patients and comparison with previous microsurgical series. Neurosurgery. 2008;62(5):1006\u20131017."},{"issue":"4","key":"b3","series-title":"Neurosurg Clin N Am","first-page":"621","article-title":"Expanded endonasal approaches to middle cranial fossa and posterior fossa tumors","volume":"21","author":"Prevedello DM","year":"2010","unstructured":"Prevedello DM, Ditzel Filho LFS, Solari D, Carrau RL, Kassam AB. Expanded endonasal approaches to middle cranial fossa and posterior fossa tumors. Neurosurg Clin N Am. 2010;21(4):621\u2013635, vi."},{"issue":"1","key":"b4","series-title":"Neurosurg Focus","first-page":"E6","article-title":"Expanded endonasal approach: fully endoscopic, completely transnasal approach to the middle third of the clivus, petrous bone, middle cranial fossa, and infratemporal fossa","volume":"19","author":"Kassam AB","year":"2005","unstructured":"Kassam AB, Gardner P, Snyderman C, Mintz A, Carrau R. Expanded endonasal approach: fully endoscopic, completely transnasal approach to the middle third of the clivus, petrous bone, middle cranial fossa, and infratemporal fossa. Neurosurg Focus. 2005;19(1):E6."},{"issue":"6","key":"b5","series-title":"J Neurosurg","first-page":"1855","article-title":"Expanding the endoscopic transpterygoid corridor to the petroclival region: anatomical study and volumetric comparative analysis","volume":"128","author":"Freeman JL","year":"2018","unstructured":"Freeman JL, Sampath R, Quattlebaum SC, Expanding the endoscopic transpterygoid corridor to the petroclival region: anatomical study and volumetric comparative analysis. J Neurosurg. 2018;128(6):1855\u20131864."},{"issue":"5","key":"b6","series-title":"Oper Neurosurg (Hagerstown)","first-page":"557","article-title":"Endoscopic endonasal petrosectomy: anatomical investigation, limitations, and surgical relevance","volume":"16","author":"Borghei-Razavi H","year":"2019","unstructured":"Borghei-Razavi H, Truong HQ, Fernandes Cabral DT, Endoscopic endonasal petrosectomy: anatomical investigation, limitations, and surgical relevance. Oper Neurosurg (Hagerstown). 2019;16(5):557\u2013570."},{"key":"b7","series-title":"World Neurosurg","first-page":"e1491","article-title":"Endoscopic endonasal versus transorbital surgery for middle cranial fossa tumors: comparison of clinical outcomes based on surgical corridors","volume":"122","author":"Lee MH","year":"2019","unstructured":"Lee MH, Hong SD, Woo KI, Endoscopic endonasal versus transorbital surgery for middle cranial fossa tumors: comparison of clinical outcomes based on surgical corridors. World Neurosurg. 2019;122:e1491\u2013e1504."},{"issue":"3 Suppl Operative","key":"b8","series-title":"Neurosurgery","first-page":"ons16","article-title":"Transorbital neuroendoscopic surgery","volume":"67","author":"Moe KS","year":"2010","unstructured":"Moe KS, Bergeron CM, Ellenbogen RG. Transorbital neuroendoscopic surgery. 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World Neurosurg. 2021;152:167\u2013179.e4."},{"issue":"4","key":"b11","series-title":"Oper Neurosurg (Hagerstown)","first-page":"359","article-title":"Lateral transorbital endoscope-assisted approach to the cavernous sinus","volume":"25","author":"Bander ED","year":"2023","unstructured":"Bander ED, Carnevale JA, Tosi U, Godfrey KJ, Schwartz TH. Lateral transorbital endoscope-assisted approach to the cavernous sinus. Oper Neurosurg (Hagerstown). 2023;25(4):359\u2013364."},{"issue":"2","key":"b12","series-title":"J Neurosurg","first-page":"569","article-title":"Quantitative analysis of the surgical exposure and surgical freedom between transcranial and transorbital endoscopic anterior petrosectomies to the posterior fossa","volume":"131","author":"Noiphithak R","year":"2018","unstructured":"Noiphithak R, Yanez-Siller JC, Revuelta Barbero JM, Otto BA, Carrau RL, Prevedello DM. Quantitative analysis of the surgical exposure and surgical freedom between transcranial and transorbital endoscopic anterior petrosectomies to the posterior fossa. J Neurosurg. 2018;131(2):569\u2013577."},{"issue":"2","key":"b13","series-title":"Oper Neurosurg (Hagerstown)","first-page":"174","article-title":"Comparative analysis of the exposure and surgical freedom of the endoscopic extended minipterional craniotomy and the transorbital endoscopic approach to the anterior and middle cranial fossae","volume":"17","author":"Noiphithak R","year":"2019","unstructured":"Noiphithak R, Yanez-Siller JC, Revuelta Barbero JM, Comparative analysis of the exposure and surgical freedom of the endoscopic extended minipterional craniotomy and the transorbital endoscopic approach to the anterior and middle cranial fossae. Oper Neurosurg (Hagerstown). 2019;17(2):174\u2013181."},{"issue":"8","key":"b14","series-title":"Acta Neurochir (Wien)","first-page":"1633","article-title":"Endoscopic endo- and extra-orbital corridors for spheno-orbital region: anatomic study with illustrative case","volume":"161","author":"De Rosa A","year":"2019","unstructured":"De Rosa A, Pineda J, Cavallo LM, Endoscopic endo- and extra-orbital corridors for spheno-orbital region: anatomic study with illustrative case. Acta Neurochir (Wien). 2019;161(8):1633\u20131646."},{"issue":"1","key":"b15","series-title":"J Neurol Surg B Skull Base","first-page":"11","article-title":"Lateral transorbital neuroendoscopic approach to the lateral cavernous sinus","volume":"75","author":"Bly RA","year":"2014","unstructured":"Bly RA, Ramakrishna R, Ferreira M, Moe KS. Lateral transorbital neuroendoscopic approach to the lateral cavernous sinus. 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Front Surg. 2022;9:1007447."},{"issue":"9","key":"b18","series-title":"Acta Neurochir (Wien)","first-page":"2097","article-title":"Endoscopic endonasal and transorbital routes to the petrous apex: anatomic comparative study of two pathways","volume":"162","author":"Topczewski TE","year":"2020","unstructured":"Topczewski TE, Di Somma A, Pineda J, Endoscopic endonasal and transorbital routes to the petrous apex: anatomic comparative study of two pathways. Acta Neurochir (Wien). 2020;162(9):2097\u20132109."},{"issue":"5","key":"b19","series-title":"Oper Neurosurg (Hagerstown)","first-page":"614","article-title":"A side door to Meckel\u2019s cave: anatomic feasibility study for the lateral transorbital approach","volume":"13","author":"Priddy BH","year":"2017","unstructured":"Priddy BH, Nunes CF, Beer-Furlan A, Carrau R, Dallan I, Prevedello DMS. A side door to Meckel\u2019s cave: anatomic feasibility study for the lateral transorbital approach. Oper Neurosurg (Hagerstown). 2017;13(5):614\u2013621."},{"key":"b20","series-title":"World Neurosurg","first-page":"e236","article-title":"A Frontal route to middle and posterior cranial fossa: quantitative study for the lateral transorbital endoscopic approach and comparison with the subtemporal approach","volume":"167","author":"Garc\u00eda-P\u00e9rez D","year":"2022","unstructured":"Garc\u00eda-P\u00e9rez D, Abarca J, Gonz\u00e1lez-L\u00f3pez P, Nieto J, Lagares A, Paredes I. A Frontal route to middle and posterior cranial fossa: quantitative study for the lateral transorbital endoscopic approach and comparison with the subtemporal approach. 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