Introduction: The objective of this clinical and cadaveric study is to describe the contralateral supraorbital keyhole approach to medial optic nerve pathology.
Methods: In 3 cadaver heads, bilateral supraorbital keyhole mini-craniotomies were performed to expose the ipsilateral and contralateral optic nerves. The extent of exposure of the medial optic nerve was assessed. In 2 patients, a contralateral supraorbital keyhole approach was used to remove pathology of the contralateral medial optic nerve and tract.
Results: The supraorbital keyhole craniotomy provided better exposure of the contralateral superomedial nerve compared with the same portion of the ipsilateral nerve. Both patients had gross total resections of their pathology.
Conclusions: The authors demonstrate the suitability of the contralateral supraorbital keyhole approach for lesions involving the superomedial optic nerve.
Patient Care: We describe a novel application of a previously described approach that was used for ophthalmic aneurysm clipping.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) Identify pathology that can be suitably targeted using this approach 2) Get introduced to the concept that the approach is actually better suited to expose contralateral optic nerve, and in particular, its medial aspect, which is difficult to reach using an ipsilateral approach.