Endoscopic transpalpebral transorbital anterior petrosectomy: does “safer surgical freedoms” necessitates modifications?
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We have read with great consideration the paper “Endoscopic transorbital route to the petrous apex: a feasibility anatomic study,” by Professor Paolo Cappabianca and colleagues . The authors  presented an excellent qualitative stepwise endoscopic transpalpebral transorbital route to the petrous apex with adequate petrous apicectomy. Additionally, they were able to delineate three anatomic spaces (cerebellopontine angle, middle tentorial incisura, and ventral brainstem) and they analyzed the limitations of their technique .
As our lead author (A.N.) is involved in the endoscopic transorbital anatomical studies and collecting novel data , he would like to ask the authors  about specific surgical nuances that might allow surgeons to create an ideal surgical space with safer exposure and good maneuverability that evolved from combinations of pearls from multiple approaches [1, 2, 3, 4, 5] while avoiding major drawbacks.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
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- 2.Almeida JP, Ruiz-Treviño AS, Shetty SR, Omay SB, Anand VK, Schwartz TH (2017) Transorbital endoscopic approach for exposure of the sylvian fissure, middle cerebral artery and crural cistern: an anatomical study. Acta Neurochir doi: https://doi.org/10.1007/s00701-017-3296-8
- 4.Nagm A, Ogiwara T, Goto T, Hongo K, Ohata K (2018) Letter to the Editor. Collecting data about the transorbital endoscopic eyelid approach. J Neurosurg 1–2. doi: https://doi.org/10.3171/2017.11.JNS172670
- 5.Noiphithak R, Yanez-Siller JC, Revuelta Barbero JM, Otto BA, Carrau RL, Prevedello DM (2018) Comparative analysis between lateral orbital rim preservation and osteotomy for transorbital endoscopic approaches to the cavernous sinus: an anatomic study. Oper Neurosurg (Hagerstown) 2018. doi: https://doi.org/10.1093/ons/opy054