Анатомическое исследование возможности прямого эндоскопического выключения решетчатых артерий для деваскуляризации структур передних отделов основания черепа
Background. Many tumors of different histologic structure originate from the anterior skull base. These lesions may be highly vascularized leading to limited resection and severe intraoperative blood loss. Midline tumors are primarily supplied by ethmoidal arteries, which are not subject to endovascular embolization. Aim of this study was comparative experimental analysis of different surgical approaches to the ethmoidal arteries.
Materials and methods. The anatomical study was performed on 12 fresh human cadavers without diseases involving the anterior skull base, orbits, and paranasal sinuses (24 sides). In all specimens internal and external carotid arteries were injected by silicone dye. Anatomical dissection was carried on investigating four different minimally invasive endoscopic approaches to the ethmoidal arteries: 1) transorbital approach to the ethmoidal arteries via bicoronal incision; 2) pre/trans/retrocaruncular approach to the ethmoidal arteries; 3) endoscopic endonasal transethmoidal approach to the canals of ethmoidal arteries; 4) endoscopic endonasal transethmoidal-transorbital approach to the ethmoidal arteries in the orbit.
Results. Surgical technique of the mentioned approaches was described, and their advantages and disadvantages were analyzed. We propose the algorithm for selection of direct endoscopic ligation of ethmoidal arteries based on selected surgical approach for tumor resection and its extracranial extension.
Conclusion. Decision making for tumor devascularization must be substantiated by visualization of vasculature (CT or MR angiography). The study has demonstrated advantages and disadvantages of different endoscopic approaches to the ethmoidal arteries for their ligation aiming at early devascularization of anterior skull base lesions. All four are minimally invasive and provide good functional outcome and cosmesis.