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Endoscopic endonasal surgical anatomy of the optic canal: key anatomical relationships between the optic nerve and ophthalmic artery

  • Original Article - Neurosurgical Anatomy
  • Published:
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Abstract

Purpose

A detailed understanding of the neurovascular relationships between the optic nerve (ON) and the ophthalmic artery (OA) in the optic canal (OC) is paramount for safe surgery. We focused on the neurovascular anatomy of this area from both an endoscopic endonasal and transcranial trajectories to compare the surgical exposures and perspectives offered by these different views and provide recommendations to increase the intraoperative safety.

Methods

Twenty sides of ten formalin-fixed, latex-injected head specimens were utilized. The surgical anatomy and anatomical relationships of the OA in relationship to the ON along their intracranial and intracanalicular segments was studied from endoscopic endonasal and transcranial perspectives.

Results

Three types of OA-ON relationships at the origin of the OA were identified: inferomedial (type 1, 35%), inferior (type 2, 55%), and inferolateral (type 3, 10%).

The endoscopic endonasal trajectory offers an inferomedial perspective of the ON-OA neurovascular complex, in which the OA, especially when located inferomedially, is first encountered. When comparing with the transcranial view, all OA were covered by the nerve, type 1 was located below the medial third, type 2 below the middle third, and type 3 below the lateral third of the OC.

The mean extension of the intracanalicular portion of both OA and ON was 8.9 mm, while the intracranial portion of the OA and ON were 9.3 mm and 12.4 mm, respectively. The OA, endoscopically, is located within the inferior half of the OC, and occupies 39%, 43%, and 42% of the OC height at its origin, mid, and end points, respectively. The mean distance between the superior margin of the OC at its origin and superior margin of the OA is 1.4 mm.

Conclusions

Detailed anatomical understanding of the OC, and the ON and OA at their intracranial and intracanalicular segments is paramount to safe surgery. When opening the OC dura endoscopically, our results suggest that a medial incision along the superior third of the OC with a proximal to distal direction is recommended to avoid injury of the OA.

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Data availability

All data analyzed during this study are included in this published article.

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Funding

This work was supported in part by Joseph I. and Barbara Ashkins Endowed Professorship in surgery.

Author information

Authors and Affiliations

  1. Mayo Clinic Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, 200 First Street, SW, Rochester, MN, 55905, USA

    Edoardo Agosti, Luciano C. P. C. Leonel, A. Yohan Alexander, Carlos D. Pinheiro-Neto & Maria Peris-Celda

  2. Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA

    Edoardo Agosti, Luciano C. P. C. Leonel, A. Yohan Alexander, Stephen Graepel, Carlos D. Pinheiro-Neto & Maria Peris-Celda

  3. Division of Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy

    Edoardo Agosti

  4. Department of Otolaryngology / Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA

    Carlos D. Pinheiro-Neto & Maria Peris-Celda

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  1. Edoardo Agosti
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  2. Luciano C. P. C. Leonel
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  6. Maria Peris-Celda
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Contributions

All authors contributed to the study conception and design. Data collection and analysis were performed by Edoardo Agosti, Luciano C.P.C. Leonel, A. Yohan Alexander, and Graepel Stephen. The manuscript was written by Edoardo Agosti and Maria Peris-Celda, and reviewed by all authors. All authors reviewed and approved the final manuscript.

Corresponding author

Correspondence to Maria Peris-Celda.

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Ethical approval

This retrospective chart review study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The Human Investigation Committee (IRB) of the Mayo Clinic approved this study (17–005898).

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Agosti, E., Leonel, L.C.P.C., Alexander, A.Y. et al. Endoscopic endonasal surgical anatomy of the optic canal: key anatomical relationships between the optic nerve and ophthalmic artery. Acta Neurochir 165, 525–534 (2023). https://doi.org/10.1007/s00701-022-05395-4

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  • DOI: https://doi.org/10.1007/s00701-022-05395-4

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