Endoscopic Orbital Roof Fenestration as an Alternative Treatment Option for Idiopathic Intracranial Hypertension: A Cadaveric Anatomical Study

BACKGROUND:We investigated a new minimally invasive surgical technique for the treatment of idiopathic intracranial hypertension in a cadaveric model. This technique aims at establishing a communication between the intraorbital and intracranial compartments by creating a bone, dural, and periorbital window in the anterior cranial fossa. This procedure is predicated on intraorbital absorptive capability that has been demonstrated in animals and discussed in humans. METHODS:Three fresh cadaver heads were fixed in a head holder so as to mimic the hyperextended supine position. The procedure was conducted bilaterally in each specimen. Our technique is as follows1) An incision is made in the eyebrow medial to the supraorbital notch; 2) using an endoscope and a periosteal elevator, the intraorbital surface of the orbital roof is separated from the periorbita in an anteroposterior direction for a length of 1.5-2.5 cm; 3) a 1 cm of the exposed orbital roof is removed, and the dura and arachnoid are opened; and 4) slits are made in the exposed periorbita. RESULTS:We were able to create a communication between the intracranial and the intraorbital compartments in all specimens. CONCLUSION:Our technique is new and does not require any foreign body implantation. Its applicability in humans needs to be evaluated in a clinical context.