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This study has been funded by the Instituto de Salud Carlos III (ISCIII) through project PI19/00592 and cofunded by the European Union; it has also been funded by the Fundacio La Marato de TV3 (Reg. 95/210; Codi projecte 201914).

Analysis of institutional authors

Di Somma ACorresponding AuthorFerrés AAuthorRoldán PAuthorTorné RAuthorEnseñat JAuthorPrats-Galino AAuthor

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November 8, 2022
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Superior eyelid endoscopic transorbital approach to the tentorial area: A qualitative and quantitative anatomic study

Publicated to:Front Surg. 9 1007447- - 2022-10-21 9(), DOI: 10.3389/fsurg.2022.1007447

Authors: De Rosa, Andrea; Di Somma, Alberto; Mosteiro, Alejandra; Ferres, Abel; Reyes, Luis Alberto; Roldan, Pedro; Torne, Ramon; Torales, Jorge; Solari, Domenico; Cavallo, Luigi Maria; Ensenat, Joaquim; Prats-Galino, Alberto

Affiliations

Department of Neurosurgery, Hospital Clínic, Barcelona, Spain. - Author
Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli "Federico II", Naples, Italy. - Author
Hosp Clin Barcelona, Dept Neurosurg, Barcelona, Spain - Author
Inst Invest Biomed August Pi & Sunyer IDIBAPS, Res Grp Clin Neurophysiol, Barcelona, Spain - Author
Laboratory of Surgical Neuroanatomy, Faculty of Medicine, Universitat de Barcelona, Barcelona, Spain. - Author
Univ Barcelona, Fac Med, Lab Surg Neuroanat, Barcelona, Spain - Author
Univ Napoli Federico II, Dept Neurosci Reprod & Odontostomatol Sci, Div Neurosurg, Naples, Italy - Author
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Abstract

Superior eyelid endoscopic transorbital approach (SETOA) is nowadays gaining progressive application in neurosurgical scenarios. Both anatomic and clinical reports have demonstrated the possibility of taking advantage of the orbital corridor as a minimally invasive route to reach anterior and middle cranial fossae and manage selected surgical lesions developing in these areas. The aim of this paper is to further shed light on other anatomic regions of the skull base as seen from a transorbital perspective, namely, the posterior cranial fossa and tentorial area, describing technical feasibility and steps in reaching this area through an extradural-transtentorial approach and providing quantitative evaluations of the "working area" obtained through this route.Four cadaveric heads (eight sides) were dissected at the Laboratory of Surgical Neuroanatomy (LSNA) of the University of Barcelona, Spain. A stepwise dissection of the transorbital approach to the tentorial area was described. Qualitative anatomical descriptions and quantitative analyses of working were evaluated by using pre- and postdissections CT and MRI scans, and three-dimensional reconstructions were made using Amira software.With the endoscopic transorbital approach, posterior cranial fossa dura was reached by an extradural middle cranial fossa approach and drilling of the petrous apex. After clipping the superior petrosal sinus, the tentorium was divided and cut. An endoscope was then introduced in the posterior cranial fossa at the level of the tentorial incisura. Qualitative analysis provided a description of the tentorial and petrosal surfaces of the cerebellum, middle tentorial incisura, cerebellopontine fissures, and, after arachnoid dissection, by a 30° endoscopic visualization, the posterior aspect of the cerebellomesencephalic fissure. Quantitative analysis of the "working area" obtained after bone removal was also provided.This anatomic qualitative and quantitative study sheds light on the anatomy of the posterior cranial fossa contents, such as the tentorial area and incisura, as seen through a transorbital perspective. The first aim of the article is to enrich the anatomical knowledge as seen through this relatively new corridor and to provide quantitative details and insights into the technical feasibility of reaching these regions in a surgical scenario.© 2022 De Rosa, Di Somma, Mosteiro, Ferrés, Reyes, Roldån, Torné, Torales, Solari, Cavallo, Enseñat and Prats-Galino.

Keywords

basic and clinical researchbrain tumorsendoscopicfeasibilityinfratentorial approachmiddle fossaneurosurgeryroutesubtemporal approachtransorbital approachBasic and clinical researchBrain tumorsEndoscopicNeurosurgerySkull baseTransorbital approachTranstentorial approach

Quality index

Bibliometric impact. Analysis of the contribution and dissemination channel

The work has been published in the journal Front Surg due to its progression and the good impact it has achieved in recent years, according to the agency Scopus (SJR), it has become a reference in its field. In the year of publication of the work, 2022, it was in position , thus managing to position itself as a Q2 (Segundo Cuartil), in the category Surgery. Notably, the journal is positioned en el Cuartil Q3 for the agency WoS (JCR) in the category Surgery.

From a relative perspective, and based on the normalized impact indicator calculated from World Citations provided by WoS (ESI, Clarivate), it yields a value for the citation normalization relative to the expected citation rate of: 2.51. This indicates that, compared to works in the same discipline and in the same year of publication, it ranks as a work cited above average. (source consulted: ESI Nov 14, 2024)

This information is reinforced by other indicators of the same type, which, although dynamic over time and dependent on the set of average global citations at the time of their calculation, consistently position the work at some point among the top 50% most cited in its field:

  • Weighted Average of Normalized Impact by the Scopus agency: 2.29 (source consulted: FECYT Feb 2024)
  • Field Citation Ratio (FCR) from Dimensions: 10.71 (source consulted: Dimensions Jul 2025)

Specifically, and according to different indexing agencies, this work has accumulated citations as of 2025-07-02, the following number of citations:

  • WoS: 12
  • Scopus: 11
  • Europe PMC: 9

Impact and social visibility

From the perspective of influence or social adoption, and based on metrics associated with mentions and interactions provided by agencies specializing in calculating the so-called "Alternative or Social Metrics," we can highlight as of 2025-07-02:

  • The use, from an academic perspective evidenced by the Altmetric agency indicator referring to aggregations made by the personal bibliographic manager Mendeley, gives us a total of: 14.
  • The use of this contribution in bookmarks, code forks, additions to favorite lists for recurrent reading, as well as general views, indicates that someone is using the publication as a basis for their current work. This may be a notable indicator of future more formal and academic citations. This claim is supported by the result of the "Capture" indicator, which yields a total of: 14 (PlumX).

With a more dissemination-oriented intent and targeting more general audiences, we can observe other more global scores such as:

  • The Total Score from Altmetric: 1.
  • The number of mentions on the social network X (formerly Twitter): 1 (Altmetric).

It is essential to present evidence supporting full alignment with institutional principles and guidelines on Open Science and the Conservation and Dissemination of Intellectual Heritage. A clear example of this is:

  • The work has been submitted to a journal whose editorial policy allows open Open Access publication.

Leadership analysis of institutional authors

This work has been carried out with international collaboration, specifically with researchers from: Italy.

There is a significant leadership presence as some of the institution’s authors appear as the first or last signer, detailed as follows: Last Author (Prats Galino, Albert).

the author responsible for correspondence tasks has been Di Somma, Alberto.