Quantitative Anatomical Comparison of Anterior, Anterolateral and Lateral, Microsurgical and Endoscopic Approaches To The Middle Cranial Fossa

Original Article
Quantitative Anatomical Comparison of Anterior, Anterolateral and Lateral, Microsurgical

and Endoscopic Approaches to the Middle Cranial Fossa
Giorgio Saraceno1, Edoardo Agosti1, Jimmy Qiu4, Barbara Buffoli5, Marco Ferrari2, Elena Raffetti6, Francesco Belotti1,
Marco Ravanelli3, Davide Mattavelli2, Alberto Schreiber2, Lena Hirtler7, Luigi F. Rodella5, Roberto Maroldi3,
Piero Nicolai2, Fred Gentili8, Walter Kucharczyk9, Marco M. Fontanella1, Francesco Doglietto1
- OBJECTIVE: To quantitatively compare different micro- transcranial ones. Transcranial approaches with larger
surgical and endoscopic approaches to the middle cranial craniotomies allowed the widest exposure of super-
fossa in a preclinical setting with a novel, computer-based omedial anatomical structures (e.g., roof of cavernous si-
research method. nus). The resection of the zygomatic arch allowed
exposure of more medial surfaces with an inferior to su-
- METHODS: Different approaches were performed bilat-
perior trajectory.
erally in 5 head and neck specimens that underwent high-
resolution computed tomography scans: 5 transcranial - CONCLUSIONS: This study implemented a novel
anterolateral (supraorbital, mini-pterional, pterional, neuronavigation-based research method to quantitatively
pterional-transzygomatic, fronto-temporal-orbito-zygo- compare different approaches to the middle cranial fossa;
matic) without and with anterior clinoidectomy; 2 trans- its results might guide, after consideration of clinical im-
cranial lateral (subtemporal and subtemporal- plications, the choice of the neurosurgical approach to
transzygomatic); 2 endoscopic transnasal (transpterygoid, different areas of this complex skull base region.
transpterygoid to infratemporal fossa); 2 endoscopic
transorbital (superior eyelid and inferolateral), and endo-
scopic transmaxillary. A dedicated navigation system was
used to quantify surgical working volumes and exposure of
different areas of the middle cranial fossa (Approach- INTRODUCTION
D
Viewer, part of GTx-Eyes II, University Health Network, ifferent neurosurgical approaches have been described to
Toronto, Canada). Statistical analysis was performed using access lesions involving the middle cranial fossa.1 With
a mixed linear model with bootstrap resampling. the evolution of endoscopic techniques, endoscopic-
based or endoscopic-assisted microsurgical approaches are advo-
- RESULTS: Endoscopic transnasal and fronto-temporal-
cated for an increasing number of lesions involving this area.2-5
orbito-zygomatic approaches with anterior clinoidectomy The choice of a surgical approach often relies on personal pref-
showed the largest surgical volumes. Endoscopic ap- erence, level of comfort of the surgeon, type and location of the
proaches allowed a wider exposure of medial anatomical pathology, as well as on the overall goals of the procedure (simple
surfaces (e.g., the petrous apex) compared with debulking for mass effect release, radical resection, etc.).6
Key words From the 1Neurosurgery, 2Otorhinolaryngology, and 3Radiology, Department of Medical and
- Endoscopy Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia,
- Middle cranial fossa Italy; 4TECHNA Institute, University Health Network, Toronto, Ontario, Canada; 5Section of
- Quantification Anatomy and Physiopathology, Department of Clinical and Experimental Sciences, University
- Transcranial
of Brescia, Brescia, Italy; 6Department of Public Health Sciences, Karolinska Institute,
Stockholm, Sweden; 7Division of Anatomy, Center for Anatomy and Cell Biology, Medical
- Transnasal
University of Vienna, Vienna, Austria; 8Department of Neurosurgery, Toronto Western
- Transorbital
Hospital, University of Toronto, Toronto, Ontario; and 9Division of Neuroradiology,
Department of Medical Imaging, University Health Network, Toronto, Ontario, Canada
Abbreviations and Acronyms
CLIN: Anterior clinoidectomy To whom correspondence should be addressed: Francesco Doglietto, M.D., Ph.D.
EETI: Endoscopic endonasal tranpterygoid infratemporal fossa approach [E-mail: francesco.doglietto@unibs.it]
FTOZ: Fronto-temporal-orbito-zygomatic approach Citation: World Neurosurg. (2020) 134:e682-e730.
IOF: Inferior orbital fissure https://doi.org/10.1016/j.wneu.2019.10.178
PTTZ: Pterional-transzygomatic approach Journal homepage: www.journals.elsevier.com/world-neurosurgery
SOF: Superior orbital fissure
Available online: www.sciencedirect.com
ST: Subtemporal extradural approach
STTZ: Subtemporal-transzygomatic extradural approach 1878-8750/$ - see front matter ª 2019 Elsevier Inc. All rights reserved.
e682 www.SCIENCEDIRECT.com WORLD NEUROSURGERY, https://doi.org/10.1016/j.wneu.2019.10.178
Descargado para Andres Botello (andres.botello24@gmail.com) en University of Guadalajara de ClinicalKey.es por Elsevier en marzo 30, 2024. Para
uso personal exclusivamente. No se permiten otros usos sin autorización. Copyright ©2024. Elsevier Inc. Todos los derechos reservados.
ORIGINAL ARTICLE
GIORGIO SARACENO ET AL. MIDDLE CRANIAL FOSSA APPROACHES COMPARISON
A comparative analysis of different neurosurgical approaches 2. Mini-pterional approach, as described by Figueiredo et al.19
based on clinical outcomes might be limited by small, single- After skin incision, the craniotomy extended along the
center clinical series or, in case of large series with a wide time superior temporal line, then curved downward to include the
frame, might not reflect modern results, especially for new tech- pterion and anteriorly along the sphenoid bone to the initial
nologies and approaches. To address the issues of surgical keyhole.
research, its preclinical phase should be implemented to provide
3. Pterional approach, as described by Yaşargil.20 A fronto-
an initial evaluation of new technologies and approaches.7
temporo-sphenoidal osteotomy was performed. The lateral
To provide a quantitative assessment of traditional microsur-
wall of the orbit and the lesser wing of the sphenoid bone were
gical and recent endoscopic approaches, an anatomical compar-
drilled until their base was flattened. The dura mater was
ative study was performed with a recently developed new research
opened in a semilunar fashion and the Sylvian fissure was
method, based on neuronavigation,8-14 to collect objective mea-
opened from distal to proximal.
sures of surgical volume (i.e., the available working space) and
exposure provided by each approach for different areas of the 4. Pterional-transzygomatic approach (PTTZ), as described by
middle cranial fossa. Campero et al.21 The zygomatic arch was cut in 2 points:
posteriorly near the temporomandibular joint and anteriorly
just behind the zygomatic bone. The inferior margin of the
MATERIALS AND METHODS
pterional craniotomy was flattened at the middle fossa floor.
This work was conducted in accordance with the institutional
Ethical Committee guidelines and was performed according to the 5. Fronto-temporal-orbito-zygomatic approach (FTOZ), as
ethical standards of our institutional review board. Five cadaveric described by van Furth et al.22 A curved sharp dissector was
heads (10 sides) were used. The specimens originated from used to separate the periorbita from the orbital roof. The
voluntary body donation to the Center for Anatomy and Cell osteotomy on the medial side was made lateral to the
Biology of the Medical University of Vienna, Vienna, Austria. supraorbital foramen. The lateral side of the osteotomy was
Fixation was performed via an immersion technique in a 20% made just lateral to the frontozygomatic suture.
alcohol solution. In each specimen, the arterial system was
injected with red-stained silicon. All specimens were dissected in For each of these approaches, quantification was carried out
the Anatomy Laboratory of the University of Brescia, Brescia, Italy, before and after extradural anterior clinoidectomy, performed
in co-operation with the Division of Anatomy of the Medical according to Lehmberg et al.23 Quantification after extradural
University of Vienna. clinoidectomy was performed with only the corresponding bone
A multidetector computed tomography scan was performed on flap removed; the margins of the craniotomy were checked to be
each specimen. Digital Imaging and Communications in Medicine unvaried, as compared with before the clinoidectomy, with the
files were uploaded on dedicated software (ApproachViewer, navigation system.
Guided Therapeutics Program, University Health Network, Tor- Two lateral approaches were performed (Supplementary
onto, Ontario, Canada) coupled with an optical neuronavigation Figure 2):
system (Polaris Vicra; Northern Digital Imaging, Waterloo,
Ontario, Canada).8,10,15-17 1. Subtemporal extradural approach (ST) as described by
A neuronavigation error of <1 mm was considered acceptable Dolenc.24 A craniotomy with a 2.5-cm base parallel to the
for quantification. ApproachViewer was used to quantify both zygomatic arch and 2 cm high was performed. The dura was
exposed middle cranial fossa areas and volumes of each surgical peeled off the bone of the middle cranial fossa, cutting the
corridor. A high-definition endoscopic camera (Karl Storz, Tüt- middle meningeal artery at foramen spinosum; the floor of the
tlingen, Germany) with a 4-mm 0 Hopkins rod-lens endoscope middle cranial fossa was flattened with a high-speed drill and
(Karl Storz) and a complete set of instruments for endoscopic the dissection was continued extradurally.
transnasal skull base surgery (Karl Storz) were used. The surgical
microscope Leica M320 (Leica Microsystems, Wetzlar, Germany) 2. Subtemporal-transzygomatic extradural approach (STTZ), as
was used for microsurgical approaches. described by Ustun et al.25 After the ST approach was
performed, the zygomatic arch was cut in 2 points:
posteriorly near the temporomandibular joint and anteriorly
Surgical Approaches
just behind the zygomatic bone.
To avoid any potential interference of different approaches, care
was taken as to perform each one in a modular way (i.e., from the
less invasive to the more extensive one). A standard temporal lobe retraction of 1e1.5 cm from the floor
Five transcranial anterolateral approaches were performed of the middle cranial fossa was applied in the lateral approaches.
(Supplementary Figure 1): Five endoscopic approaches were performed (Supplementary
Figure 3):
1. Supraorbital approach, as described by Perneczky et al.18 A
frontobasal burr hole was placed just posterior to the anterior 1. Endoscopic transorbital superior eyelid approach, as described
portion of the temporal line. A bone flap of 2 cm width, by Locatelli et al.26 The area delimited superomedially by the
parallel to the orbital rim, and 1.5 cm frontal extension was superior orbital fissure (SOF), inferomedially by the inferior
performed. orbital fissure (IOF), and laterally by the temporalis muscle
WORLD NEUROSURGERY 134: e682-e730, FEBRUARY 2020 www.journals.elsevier.com/world-neurosurgery e683
ORIGINAL ARTICLE
(corresponding to the major wing of the sphenoid bone) was Surgical Corridor Quantification
drilled to expose the dura of the middle cranial fossa. After a simulation of each approach, quantification of the surgical
corridor was obtained with dedicated software (ApproachViewer,
2. Endoscopic transorbital inferolateral approach, as described by
part of GTx-Eyes II, University Health Network, Toronto, Can-
Ferrari et al.16 A triangular-shape craniectomy was performed
ada).15,17 Navigation hardware (Northern Digital Imaging)
with these margins: inferiorly the IOF, superiorly the SOF with
included a passive rigid body, passive probe (pointer) with 4
its virtual prolongation, and anteriorly a vertical line passing
markers, and the Polaris Vicra Optical Tracking System
from the lateral part of the IOF to the intersection with the
(Northern Digital Imaging).
prolongation of the SOF.
The navigation pointer was used to trace the limits of the
3. Endoscopic endonasal transpterygoid approach, as described reachable deep surface (i.e., the exposed area of the middle cranial
by Kassam et al.27 Bilateral middle turbinectomy, posterior fossa). After coordinate collection was stopped, the Approach-
nasal septectomy, sphenoidotomy, bilateral uncinectomy, and Viewer automatically elaborated the pyramid volume from the
posterior ethmoidectomy were performed. The posterior wall collected measurements.17 Each quantification was repeated 6
of the antrum was removed exposing the pterygopalatine times for each approach: the first 3 times it was carried out to
fossa. Finally, a quadrangular bony area limited superiorly by record the “non-crossing” volume, which defines the widest
the maxillary nerve, inferiorly by Vidian nerve, and medially surgical corridor that allows a bimanual dissection for each
by the paraclival internal carotid artery was removed. point of the exposed area8; the following 3 times the volumes
4. Endoscopic endonasal tranpterygoid infratemporal fossa were obtained moving the pointer in maximal crossing position,
approach (EETI), as described by Oyama et al.2 The dissection as described by Belotti et al.8 (i.e., defining the widest possible
proceeded identifying the mandibular nerve and the foramen exposed area).
spinosum. Both these structures were released from the The height of the surgical pyramid was fixed at 90 mm for
foramens using a high-speed diamond burr. The greater wing transcranial approaches and 120 mm for endoscopic approaches,
of the sphenoid bone was drilled to reach a point just lateral to using the “Tool Length” option in ApproachViewer (Qiu et al,
the foramen spinosum. unpublished data, 2019). In the postdissection analysis, volumes
were cut in ApproachViewer at the level of the craniotomy to
5. Endoscopic transmaxillary approach, as described by Truong obtain the absolute value of the surgical pyramid (Qiu, et al, un-
et al.28 A sublabial incision (from the lateral incisor to the published data, 2019).
second or third molar) was performed, followed by anterior
(2 2cm) and posterior maxillary osteotomies to expose the
pterygopalatine fossa. The greater sphenoid wing was drilled Quantification of Middle Cranial Fossa Exposure
after the following anatomical landmarks were defined: the To allow an in-depth evaluation of middle cranial fossa exposure,
inferior orbital fissure anteriorly, the foramen rotundum 5 macroregions and 29 surfaces were drawn on computed to-
medially, the foramen ovale posteriorly, and the mography scans with ITK-SNAP software (http://www.itksnap.
infratemporal crest laterally. org/pmwiki/pmwiki.php). Given that the aforementioned
ORIGINAL ARTICLE
surfaces were drawn as contiguous, some macroregions were Glasscock triangle, petrous apex, and trigeminal impression
created through the sum of adjacent surfaces (Figure 1).29-38 The 5 surfaces.
macroregions were as follows:
4. Squamous region: covering the area bounded by the sphe-
nosquamosal suture anteriorly, the temporoparietal suture
1. Lateral cavernous sinus region: defined as the surface at the laterally, the lateral wall of the cavernous sinus medially, and
level of the dura between the cavernous sinus and the temporal the petrous bone posteriorly.
lobe, extending from the base of the anterior clinoid process
anteriorly to the petrous apex posteriorly. 5. Roof of the cavernous sinus: defined as the surface at the level
of the dura located between the lower margin of the anterior
2. Spheno-orbital region: the area obtained merging the greater clinoid and the posterior clinoid.29
wing, superior orbital fissure, and sphenoid ridge surfaces.
3. Petrous region: the area obtained merging the tegmen, arcuate Segmentation images created in ITK-SNAP were saved both in
eminence, anterior surface of petrous bone, Kawase triangle, “.mha” and “.stl” extensions. The .stl file was imported in Autodesk
Figure 1. Three-dimensional representation of the anatomical subdivision of the middle cranial fossa in 29 surfaces and 6
macroregions, as drawn on ITK-SNAP. (A) Anterior view; (B) superior view; (C) lateral view after removal of squamous and
tegmen surfaces; and (D) medial view. 1. Roof of the cavernous sinus: the surface at the level of the dura located between the
lower margin of the anterior clinoid and the posterior clinoid.29 2. Trigeminal impression: the surface covering a grooved bone
between the petroclival region medially and the arcuate eminence laterally where the trigeminal nerve is located. 3. Kawase
triangle: covering a triangular space situated between the lateral margin of the trigeminal nerve proximal to the point where the
greater petrosal nerve passes below the trigeminal nerve, the greater petrosal nerve and a line connecting the hiatus Falopi to
the dural opening of Meckel’s cave.29 4. Arcuate eminence: the surface covering a smooth rounded bulge close to the superior
border of the petrosal part of the temporal bone, at the junction between the lateral third and medial two thirds.30 The surface
was drawn on the anterior surface of the petrous bone until the superior semicircular canal (SSC) weren’t recognizable. 5.
Tegmen: bounded anteriorly by the greater petrosal nerve, medially by the arcuate eminence, posteriorly by the superior margin
of the petrosal bone, and laterally by the squamosal part of temporal bone.31 6. Squamous area: covering the space bounded by
the sphenosquamosal suture anteriorly, the temporoparietal suture laterally, the lateral wall of the cavernous sinus medially, and
the petrous bone posteriorly. 7. Greater sphenoid wing: covering the space bounded by the sphenoparietal suture laterally, the
sphenosquamosal suture posteriorly, the lateral wall of the cavernous sinus medially, and the superior orbital fissure anteriorly.
8. Lateral cavernous sinus region: the surface covering the dura between the cavernous sinus and the temporal lobe, extending
from the base of the anterior clinoid process anteriorly to the petrous apex posteriorly. 9. Sphenoid ridge: the surface covering
the posterior free edge of the lesser wing of the sphenoid bone32 that is continuous with the anterior clinoid process medially
and approximates the pterion at the sphenosquamosal suture laterally.33,34 10. Anterior clinoid process—lateral part: covering
the bone projection directed medio-posteriorly in continuity with the medial end of the lesser wing of the sphenoid bone
anteriorly and with the body of the sphenoid bone medially (i.e., the roof of the optic canal and the optic strut).35 11. Anterior
clinoid process—medial part. 12. Cavernous carotid—medial part: covering the internal carotid artery from its exits at the
foramen lacerum, lateral to the posterior clinoid process under the petrolingual ligament to the medial side of both the anterior
clinoid process and the posterior surface of the optic strut where it penetrates the roof of the cavernous sinus.29 13. Cavernous
carotid—lateral part. 14. Gasserian ganglion: the surface covering the dura of the lateral wall of the cavernous sinus
corresponding to the small fibers36 of the trigeminal nerve until the proximal part of its main trunks (i.e., ophthalmic, maxillary
and mandibular) are identified. 15. Anterolateral triangle: covering a triangular space situated between the lower margin of the
maxillary nerve, the medial margin of the mandibular nerve and a line connecting the points where each nerve pass into cranial
base foramen (i.e. foramen rotundum and foramen ovale, respectively).29 16. V1—lateral part: covering the dura of the lateral
wall of the cavernous sinus corresponding to the ophthalmic nerve from the Gasserian ganglion to the lateral margin of the
superior orbital fissure. 17. V1—medial part. 18. Petrous carotid—medial part: covering the posterior genu, the horizontal and
the vertical portion of the petrous carotid artery from a point posterior to the entrance of the Eustachian tube into the middle ear
to the petrolingual ligament (the superior margin of the petrolingual ligament is identified at the level of a line extending
backward along the upper edge of the maxillary nerve across the Gasserian ganglion).37 19. Petrous carotid—lateral part. 20.
Petrous apex: the surface extending from the Kawase triangle laterally to the most medial part of the petrous bone medially. 21.
Anterior surface of the petrous bone: covering the anterior surface of the petrous bone from the arcuate eminence superiorly to
the floor of the middle cranial fossa inferiorly. 22. Superior orbital fissure: bounded inferiorly by the greater sphenoid wing,
superiorly by the lesser sphenoid wing and medially by the optic strut and the sphenoid bone.38 23. V3—lateral part: covering the
dura of the lateral wall of the cavernous sinus corresponding to the mandibular nerve from the Gasserian ganglion to the
endocranial opening of the foramen ovale. 24. Foramen ovale—lateral part: covering the endocranial side of the foramen
bounded (in coronal section) superiorly by the previous surface and inferiorly by the inferior limit of the cortical bone. 25. V2—
medial part: covering the dura of the lateral wall of the cavernous sinus corresponding to the maxillary nerve from the Gasserian
ganglion to the endocranial opening of the foramen rotundum. 26. Foramen rotundum—lateral part: covering the endocranial
side of the foramen bounded superiorly by the previous surface and inferiorly by the inferior limit of the cortical bone. 27.
Foramen rotundum—medial part. 28. Anteromedial triangle: covering a triangular space situated between the lower margin of
the ophthalmic nerve, the upper margin of the maxillary nerve and a line connecting the points where each nerve pass into
cranial base foramen (i.e., superior orbital fissure and foramen rotundum, respectively).29 29. V2—lateral part. 30. Foramen
ovale—medial part; 31. V3—medial part. 32. Glasscock triangle: the surface covering a triangular space situated between the
lateral margin of the mandibular nerve distal to the point where the greater petrosal nerve passes below the trigeminal nerve,
the greater petrosal nerve29 and a line connecting these 2 structures from the hiatus Falopi to the foramen rotundum.
ORIGINAL ARTICLE
Meshmixer 3.5 (Autodesk, Inc., San Rafael, California, USA): trough with anterior clinoidectomy (FTOZCLIN) and EETI have the
the “Analysis” tool the software calculated the total surface area of greatest values, which are statistically significant when
the segmentation image. Then, the .mha file was imported in compared with other approaches, except ST and STTZ.
GtxEyesII: with “Tool Volume Segmentation,” the software calcu- The exposure of each anatomical surface is reported in detail
lated the intersection absolute value, i.e., the deep surface included in Supplementary Tables 1e34. The mean percentage value of
in a surgical volume. Finally, data were collected in Microsoft Excel the exposed areas of the 5 macroregions is shown in the radar
16.16.1 (Redmond, Washington, USA): the intersection percentage charts of Figure 3. The petrous region was better exposed by
were obtained by dividing each absolute intersection value obtained STTZ approaches compared with all others (P < 0.05). The
in ApproachViewer by the total surface area of the respective seg- squamous region was exposed significantly more by STTZ
mentation image obtained in Autodesk Meshmixer 3.5. Volumes of approach, as compared with others, with the exception of ST.
each surgical pyramid were automatically calculated by Approach- The non-crossing PTTZCLIN approach exposed the roof of the
Viewer and expressed in cubic centimeters. cavernous sinus significantly more than other non-crossing
endoscopic, lateral and anterolateral approaches, with the
exception of FTOZCLIN. Crossing FTOZ approach exposed a
Statistical Analysis
significantly greater surface compared with other crossing and
A descriptive statistical analysis was performed to summarize the
non-crossing approaches, with the exception of crossing and non-
main characteristics of the study sample. Linear mixed models
crossing PTTZCLIN.
were fit to evaluate the association between surface exposure and
The lateral wall of the cavernous sinus was significantly
each surgical crossing and non-crossing volume with random
better exposed by non-crossing EETI compared with other non-
intercepts for specimens, using STATA Software (StataCorp LLC,
crossing approaches. The crossing EETI approach covered a
College Station, Texas, USA). Bootstrap re-sampling method was
significantly greater surface compared with other crossing and
used to estimate the 95% confidence interval with 1000-fold
non-crossing approaches, with the exception of crossing
replication. Analysis was stratified also for crossing measures.
endoscopic transmaxillary approach and crossing STTZ
Statistical significance was set at P < 0.05.
approach.
The spheno-orbital region was significantly better exposed
RESULTS by non-crossing FTOZCLIN compared with other non-crossing
A total of 34,561 intersection data were obtained and analyzed. approaches, with the exception of non-crossing EETI, non-
Analysis of surgical volumes (Figure 2) documented that FTOZ crossing transorbital approaches, PTTZ, and PTTZCLIN.
Figure 2. Boxplot representing the mean (cross in the blot), median fronto-temporal-orbito-zygomatic approach; ST, subtemporal approach;
(horizontal line in the box), Q1 (inferior limit of the box), Q3 (superior limit of STTZ, subtemporal-transzygomatic approach; EET, endoscopic endonasal
the box), minimum (inferior limit of the interval), and maximum (superior transpterygoid approach; EETI, endoscopic endonasal transpterygoid
limit of the interval) of each surgical approach. SO, supraorbital approach; approach to the infratemporal fossa; SEY, superior eyelid approach; ILTEA,
CLIN, anterior clinoidectomy; MPT, mini-pterional approach; PT, pterional inferolateral transorbital approach; ETM, endoscopic transmaxillary
approach; PTTZ, pterional-transzygomatic approach; FTOZ, approach.
ORIGINAL ARTICLE
ORIGINAL ARTICLE
Table 1. Principal Findings of This Study

Anatomical Region Findings
Cavernous sinus Transnasal endoscopic approaches allow better exposure of the anteromedial surface, whereas anterolateral approaches provide
better exposure of its lateral surface.
Middle cranial fossa foramina are better exposed by purely endoscopic approaches. Zygoma resection provides better exposure of
structures that are superior to it.
Anterior clinoid/roof of the The anterior clinoid process could be well exposed with “minimally-invasive” anterolateral approaches.
cavernous sinus The exposure of the roof of the cavernous sinus increases with the size of the craniotomy.
Petrous region Lateral approaches (e.g., subtemporal approach) best expose the petrous region.
Endoscopic approaches could expose medial structures (e.g., the petrous apex) but are limited in lateral extension.
Spheno-orbital region Anterolateral approaches expose a significantly larger surface than all other approaches. Endoscopic transorbital approaches provide
exposure of the greater sphenoid wing.
Squamous region Lateral approaches provide a good exposure of this region.
A brief summary of the main findings of the study (see text and Supplementary Tables 1e34 for further details).
Crossing STTZ covered a significantly greater surface compared anterolateral triangles were traversed27 and the temporal lobe
with other crossing approaches, with the exception of crossing retracted.39
superior eyelid approach, crossing ST, and crossing Zygomatic arch resection allowed a wider exposure of surfaces
FTOZCLIN. located in the same axial plane as the zygoma or superior to it
(e.g., the tegmen and the lateral wall of the cavernous sinus,
respectively), providing an increased volume of exposure if an
DISCUSSION inferior to superior trajectory is required (Figure 5).
In this study, a computer-based application was used to quantify No advantage was gained in accessing surfaces located in an
both working volume and exposure of different regions of the axial plane inferior to it (e.g., the foramen ovale). In detail, middle
middle cranial fossa obtained by modern endoscopic and micro- cranial fossa foramina were better exposed by purely endoscopic
surgical approaches. Different studies applied this research approaches.
method,8-14 and further software implementations might have
important and practical implications. The collected anatomical
data can be integrated into clinical practice by considering Roof of the Cavernous Sinus Region
patient-specific factors, such as displacement of normal anatomy There is little information in literature about comparison of
and the space-occupying effect generated by a lesion (Table 1). different approaches in relation to the area of the anterior clinoid
process.19,41 In this study, irrespective of the size of the
craniotomy, the area of the anterior clinoid process could be
Lateral Cavernous Sinus Region exposed (Figure 6), supporting increasing reports of adequate
In accordance with previous data,39,40 pure endoscopic-based exposure and removal of large meningiomas or tumors of this
approaches provided better exposure of the antero-infero-medial area with a less-invasive bone removal.42,43 In contrast, the
surface of Meckel’s cave, whereas more traditional transcranial exposure of the roof of the cavernous sinus increased with the
anterolateral approaches allowed better exposure of its antero- size of the craniotomy, as reported by Jagersberg.44 The anterior
lateral surface (Figure 4). Furthermore, anterolateral approaches clinoidectomy also offered significant exposure of superomedial
reached the medial compartment only if anteromedial and located structures.
Figure 3. Radar diagrams documenting percentage of exposed macroregions by each

approach, quantified with non-crossing (blue) and crossing (gray) modalities. Each circle
indicates 20% of additive exposure from 0% (center) to 100% (outer circle). (A) Lateral
wall of the cavernous sinus. (B) Roof of the cavernous sinus. (C) Spheno-orbital region.
(D) Petrous region. (E) Squamous region. EET, endoscopic endonasal transpterygoid
approach; EETI, endoscopic endonasal transpterygoid approach to the infratemporal
fossa; ETM, endoscopic transmaxillary approach; FTOZ, fronto-temporal-orbito-
zygomatic approach; ILTEA, inferolateral transorbital approach; MPT, mini-pterional
approach; PT, pterional approach; PTTZ, pterional-transzygomatic approach; SEY,
superior eyelid approach; SO, supraorbital approach; ST, subtemporal approach; STTZ,
subtemporal-transzygomatic approach; ETM, endoscopic transmaxillary approach.
ORIGINAL ARTICLE
Figure 4. Comparison between crossing anterolateral (A) and crossing mini-pterional approach; yellow, pterional approach (A) and endoscopic
endoscopic anterior surgical corridors (B) for lateral cavernous surface transnasal transpterygoid approach (B); purple,
exposure with screenshots (axial, coronal, sagittal planes and volumetric fronto-temporal-orbito-zygomatic approach; Light blue, endoscopic
analysis from left posterolateral view) from ApproachViewer. Red, transnasal transpterygoid infratemporal fossa approach.
Petrous Region ones.6 Our results prove that anterolateral approaches exposed a
One of the latest frontiers of the endoscopic approaches refers to significantly greater surface than the endoscopic and lateral
the exposure of the anteromedial petrous region, and several au- ones. Different modern minimally invasive techniques have been
thors reported successful removal of trigeminal schwannomas or proposed to reach the orbit and middle cranial fossa.26,47
other tumors involving this area.3,5,45 The objective data obtained Between them, endoscopic transorbital approaches are rarely
in this study indeed support these observations: the more medial used to treat spheno-orbital meningiomas with limited intracra-
the area of interest is located (e.g., the petrous apex), the larger is nial disease that does not require extensive intracranial debulking
the exposure obtained by endoscopic endonasal approaches, as (i.e., patients in whom proptosis and visual deficits are the main
compared to lateral ones. In fact, endoscopic endonasal symptoms).48-50 Our results suggest that an endoscopic trans-
approaches were limited laterally by the contents of the orbital approach provide a small exposure limited to the most
infratemporal fossa: visualization becomes more challenging as anterior part of the greater sphenoid wing, leading to the
the target is located more laterally.46 In contrast, a transcranial conclusion that this group of approaches could be used only in
lateral approach was limited in its medial extension by the selected cases or in combined multi-portal techniques.49
degree of temporal lobe retraction (Figure 7).
Spheno-Orbital Region Squamous Region

Our results have not been reported in the literature. The most Finally, the results about the squamous region have not been re-
commonly used approaches to reach this area are the anterolateral ported in the literature in detail but are rather intuitive: lateral
ORIGINAL ARTICLE
Figure 5. Comparison between non-crossing (A) and crossing (B) lateral posterolateral view) from ApproachViewer. Green, subtemporal extradural
surgical corridor for lateral cavernous sinus region exposure with approach; red, subtemporal-transzygomatic extradural approach.
screenshots (axial, coronal, sagittal planes and volumetric analysis from left
Figure 6. Comparison between crossing anterolateral surgical corridors for ApproachViewer. Red, mini-pterional approach; yellow, pterional approach;
anterior clinoid process exposure with screenshots (axial, coronal, sagittal light blue, pterional-transzygomatic approach; purple,
planes and volumetric analysis from left posterolateral view) from fronto-temporal-orbito-zygomatic approach.
ORIGINAL ARTICLE
Figure 7. Comparison between non-crossing lateral (A) and non-crossing planes and volumetric analysis from posterior view) from ApproachViewer.
endoscopic anterior surgical corridors (B) for medial petrous surface Green, subtemporal extradural approach; yellow, endoscopic transnasal
exposure (e.g., petrous apex) with screenshots (axial, coronal, sagittal transpterygoid infratemporal fossa approach.
approaches provide a clear advantage and zygoma resection might CONCLUSIONS

provide better exposure of the region inferior to it. This study might be helpful in providing a comprehensive un-
derstanding of the main features of the surgical corridors through
Limitations of the Present Study a 3-dimensional representation of surgical pyramids. The infor-
This is the first study that provides a systematic, quantified mation gained in this study provides objective information useful
overview of neurosurgical approaches to the middle cranial fossa to tailor the surgical strategy to the individual patient. This
using a novel, neuronavigation-based research method. This study anatomical information must be integrated with other factors,
has limitations in a clinical setting considering that the extension which play an important role in the clinical surgical decision-
of the pathology, especially when dealing with neoplastic lesion, making, but is a preclinical contribution towards evidence-based
alters the local anatomical relationship and often influences the surgery.
type of surgical strategy. However, this study provides an objective
computer-based quantification of the extent of the window pro- ACKNOWLEDGMENTS
vided by every single route to the middle cranial fossa. Using fixed We thank Prof. Rita Rezzani, Ph.D., Head of the Section of
specimens, brain and nasal structures hardening could have Anatomy and Pathophysiology, University of Brescia, for study
influenced some measurements (especially for the anterolateral supervision, Prof. Giuseppe Lanzino, M.D., for his support and
and lateral approaches). Elisa Colombo, M.D., for her guidance.
ORIGINAL ARTICLE
15. Doglietto F, Qiu J, Ravichandiran M, et al. 32. Rhoton AL Jr. The sellar region. Neurosurgery.
REFERENCES Quantitative comparison of cranial approaches in 2002;51(4 suppl):335-374.
the anatomy laboratory: a neuronavigation-based
1. Rychen J, Croci D, Roethlisberger M, et al. Mini-
research method. World J Methodol. 2017;7:139-147. 33. Spiriev T, Poulsgaard L, Fugleholm K. One piece
mally invasive alternative approaches to pterional
orbitozygomatic approach based on the sphenoid
craniotomy: a systematic review of the literature.
16. Ferrari M, Schreiber A, Mattavelli D, et al. The ridge keyhole: anatomical study. J Neurol Surg B
World Neurosurg. 2018;113:163-179.
inferolateral transorbital endoscopic approach: a Skull Base. 2016;77:199-206.
preclinical anatomic study. World Neurosurg. 2016;
2. Oyama K, Tahara S, Hirohata T, et al. Surgical 34. Tubbs RS, Salter EG, Oakes WJ. Quantitation of
90:403-413.
anatomy for the endoscopic endonasal approach and measurements utilizing the sphenoid ridge.
to the ventrolateral skull base. Neurol Med Chir Clin Anat. 2007;20:131-134.
17. Daly MJ, Chan H, Nithiananthan S, et al. Clinical
(Tokyo). 2017;57:534-541.
implementation of intraoperative cone-beam CT
in head and neck surgery. Proc SPIE. 2011:7964. 35. Huynh-Le P, Natori Y, Sasaki T. Surgical anatomy
3. Raza SM, Donaldson AM, Mehta A, Tsiouris AJ, of the anterior clinoid process. J Clin Neurosci.
Anand VK, Schwartz TH. Surgical management of 2004;11:283-287.
18. Perneczky A. Keyhole Concept in Neurosurgery. New
trigeminal schwannomas: defining the role for
York: Thieme Medical Publishers, Inc; 1999.
endoscopic endonasal approaches. Neurosurg Focus. 36. Rubinstein D, Stears RL, Stears JC. Trigeminal
2014;37:E17. nerve and ganglion in the Meckel cave: appear-
19. Figueiredo EG, Deshmukh P, Nakaji P, et al. The
minipterional craniotomy: technical description ance at CT and MR imaging. Radiology. 1994;193:
4. Tang CT, Baidya NB, Ammirati M. Endoscope- 155-159.
assisted neurovascular decompression of the tri- and anatomic assessment. Neurosurgery. 2007;61(5
geminal nerve: a cadaveric study. Neurosurg Rev. suppl 2):255-256.
37. Osawa S, Rhoton ALJ, Tanriover N, Shimizu S,
2013;36:403-410. Fujii K. Microsurgical anatomy and surgical
20. Yaşargil MG. Microneurosurgery. New York: Thieme
Medical Publishers, Inc; 1984. exposure of the petrous segment of the internal
5. Zoli M, Ratti S, Guaraldi F, et al. Endoscopic carotid artery. Neurosurgery. 2008;63(4 suppl 2):
endonasal approach to primitive Meckel’s cave 210-238 [discussion: 239].
tumors: a clinical series. Acta Neurochir (Wien). 21. Campero A, Campero AA, Socolovsky M, et al.
2018;160:2349-2361. The transzygomatic approach. J Clin Neurosci. 2010;
38. Rhoton AL Jr. The orbit. Neurosurgery. 2002;51(4
17:1428-1433.
suppl):303-334.
6. DeMonte F, McDermott MW, Al-Mefty O. Al-
Mefty’s Meningiomas. New York: Thieme Medical 22. van Furth WR, Agur AM, Woolridge N,
39. Van Rompaey J, Bush C, Khabbaz E, Vender J,
Publishers, Inc; 2011. Cusimano MD. The orbitozygomatic approach.
Panizza B, Solares CA. What is the best route to
Neurosurgery. 2006;58(1 suppl):103-107.
the Meckel cave? Anatomical comparison between
7. McCulloch P, Altman DG, Campbell WB, et al. No the endoscopic endonasal approach and a lateral
surgical innovation without evaluation: the IDEAL 23. Lehmberg J, Krieg SM, Meyer B. Anterior clinoi-
approach. J Neurol Surg B Skull Base. 2013;74:
recommendations. Lancet. 2009;374:1105-1112. dectomy. Acta Neurochir (Wien). 2014;156:415-419.
331-336.
8. Belotti F, Doglietto F, Schreiber A, et al. Modular 24. Dolenc VV. Frontotemporal epidural approach to
40. Muto J, Kawase T, Yoshida K. Meckel’s cave tu-
classification of endoscopic endonasal trans- trigeminal neurinomas. Acta Neurochir. 1994;130:
mors: relation to the meninges and minimally
sphenoidal approaches to sellar region: anatomic 55-65.
invasive approaches for surgery: anatomic and
quantitative study. World Neurosurg. 2018;109: clinical studies. Neurosurgery. 2010;67(3 Suppl
281-291. 25. Ustun ME, Buyukmumcu M, Ulku CH, Guney O,
Operative):291-298.
Salbacak A. Transzygomatic-subtemporal
9. Doglietto F, Radovanovic I, Ravichandiran M, approach for middle meningeal-to-P2 segment of 41. Figueiredo EG, Deshmukh V, Nakaji P, et al. An
et al. Quantification and comparison of neuro- the posterior cerebral artery bypass: an anatomical anatomical evaluation of the mini-supraorbital
surgical approaches in the preclinical setting: and technical Study. Skull Base. 2006;16:39-44. approach and comparison with standard craniot-
literature review. Neurosurg Rev. 2016;39:357-368. omies. Neurosurgery. 2006;59:212-220.
26. Locatelli D, Pozzi F, Turri-Zanoni M, et al.
10. Doglietto F, Belotti F, Qiu J, et al. Endonasal and Transorbital endoscopic approaches to the skull 42. Tullos HJ, Conner AK, Baker CM, et al. Mini-
transoral approaches to the craniovertebral junc- base: current concepts and future perspectives. pterional craniotomy for resection of parasellar
tion: a quantitative anatomical study. Acta Neurochir J Neurosurg Sci. 2016;60:514-525. meningiomas. World Neurosurg. 2018;117:637-644.
Suppl. 2019;125:37-44.
27. Kassam AB, Prevedello DM, Carrau RL, et al. The 43. Welling LC, Figueiredo EG, Wen HT, et al. Pro-
11. Ferrari M, Schreiber A, Mattavelli D, et al. Surgical front door to Meckel’s cave: an anteromedial spective randomized study comparing clinical,
anatomy of the parapharyngeal space: a multi- corridor via expanded endoscopic endonasal functional, and aesthetic results of minipterional
perspective, quantification-based study. Head Neck. approach—technical considerations and clinical and classic pterional craniotomies. J Neurosurg.
2019;41:642-656. series. Neurosurgery. 2009;64(3 suppl):71-82. 2015;122:1012-1019.
12. Doglietto F, Ferrari M, Mattavelli D, et al. Trans- 28. Truong HQ, Sun X, Celtikci E, et al. Endoscopic 44. Jagersberg M, Brodard J, Qiu J, et al. Quantifica-
nasal endoscopic and lateral approaches to the anterior transmaxillary “transalisphenoid” tion of working volumes, exposure, and
clivus: a quantitative anatomic study. World Neu- approach to Meckel’s cave and the middle cranial target-specific maneuverability of the pterional
rosurg. 2018;113:e659-e671. fossa: an anatomical study and clinical applica- craniotomy and its minimally invasive variants.
tion. J Neurosurg. 2018;130:227-237. World Neurosurg. 2017;101:710-717.e2.
13. Schreiber A, Mattavelli D, Ferrari M, et al. Anterior
superior alveolar nerve injury after extended 29. Rhoton AL Jr. The cavernous sinus, the cavernous 45. Jeon C, Hong C-K, Woo KI, et al. Endoscopic
endoscopic medial maxillectomy: a preclinical venous plexus, and the carotid collar. Neurosurgery. transorbital surgery for Meckel’s cave and middle
study to predict neurological morbidity. Int Forum 2002;51(4 suppl):375-410. cranial fossa tumors: surgical technique and early
Allergy Rhinol. 2017;7:1014-1021. results [e-pub ahead of print]. J Neurosurg. https://doi.
30. Paturet G. Traité d’anatomie Humaine. Paris: Mas- org/10.3171/2018.6.JNS181099, accessed December
14. Schreiber A, Ferrari M, Rampinelli V, et al. son; 1951. 14, 2018.
Modular endoscopic medial maxillectomies:
quantitative analysis of surgical exposure in a 31. Rhoton AL Jr. The temporal bone and trans- 46. Van Rompaey J, Suruliraj A, Carrau R, Panizza B,
preclinical setting. World Neurosurg. 2017;100: temporal approaches. Neurosurgery. 2000;47(3 Solares CA. Meckel’s cave access: anatomic study
44-55. suppl):S211-S265. comparing the endoscopic transantral and
ORIGINAL ARTICLE
endonasal approaches. Eur Arch Otorhinolaryngol. of sphenoorbital meningiomas with predominant commercial or financial relationships that could be construed
2014;271:787-794. hyperostosis: report of 2 cases. J Neurosurg. 2018; as a potential conflict of interest.
128:1885-1895.
Received 7 September 2019; accepted 28 October 2019
47. Cinalli G, Cappabianca P, de Falco R, et al. Cur-
rent state and future development of intracranial 50. Dallan I, Castelnuovo P, Locatelli D, et al. Multi- Citation: World Neurosurg. (2020) 134:e682-e730.
neuroendoscopic surgery. Expert Rev Med Devices. portal combined transorbital transnasal endo- https://doi.org/10.1016/j.wneu.2019.10.178
2005;2:351-373. scopic approach for the management of selected
Journal homepage: www.journals.elsevier.com/world-
skull base lesions: preliminary experience. World
48. Ramakrishna R, Kim LJ, Bly RA, Moe K, neurosurgery
Neurosurg. 2015;84:97-107.
Ferreira M Jr. Transorbital neuroendoscopic sur- Available online: www.sciencedirect.com
gery for the treatment of skull base lesions. J Clin
1878-8750/$ - see front matter ª 2019 Elsevier Inc. All
Neurosci. 2016;24:99-104.
rights reserved.
49. Almeida JP, Omay SB, Shetty SR, et al. Trans- Conflict of interest statement: The authors declare that the
orbital endoscopic eyelid approach for resection article content was composed in the absence of any
ORIGINAL ARTICLE
SUPPLEMENTARY DATA
ORIGINAL ARTICLE
Supplementary Figure 2. Panel documenting quantified crossing lateral analysis) from ApproachViewer. (A) Subtemporal approach. (B)
approaches with screenshots (axial, coronal, sagittal planes and volumetric Subtemporal-transzygomatic approach.
Supplementary Figure 1. Panel documenting quantified crossing anterolateral approaches without anterior clinoidectomy with screenshots (axial, coronal, sagittal
planes and volumetric analysis) from ApproachViewer. (A) Supraorbital approach. (B) Mini-pterional approach. (C) Pterional approach. (D) Pterional-
transzygomatic approach. (E) Fronto-temporal-transzygomatic approach.
ORIGINAL ARTICLE
ORIGINAL ARTICLE
Supplementary Table 1. Comparison of Surgical Exposure for the Lateral Cavernous Sinus Region
Non-crossing Crossing
Mean SE Min. Max Mean SE Min. Max
EET 41.55 4.37 32.99 50.10 54.65 5.14 44.58 64.72

EETI 49.87 5.02 40.03 59.71 67.68 6.77 54.42 80.95
EETI 34.43 4.55 25.50 43.36 66.06 3.94 60.33 75.78
FTOZ 19.94 1.88 16.26 23.63 37.03 2.12 32.89 41.18
FTOZCLIN 26.76 1.63 23.55 29.96 45.25 2.37 40.61 49.90
ILTEA 10.13 2.60 5.03 15.23 37.41 3.78 30.01 44.81
MPT 3.46 0.95 1.59 5.33 13.49 2.03 9.51 17.47
MPTCLIN 7.78 1.53 4.78 10.79 22.27 1.64 19.06 25.49
PT 10.93 1.33 8.33 13.53 25.13 1.99 21.23 29.04
PTCLIN 18.15 1.50 15.21 21.09 30.86 2.21 26.52 35.20
PTTZ 19.14 2.30 14.63 23.65 34.16 3.13 28.02 40.31
PTTZCLIN 22.03 1.87 18.36 25.69 35.74 2.28 31.28 40.20
SEY 0.27 0.70 e1.10 1.64 24.88 4.96 15.16 34.60
SO 0.10 0.68 e1.25 1.44 1.64 1.46 e1.23 4.50
SOCLIN 0.63 0.72 e0.79 2.05 7.23 1.68 3.95 10.51
ST 21.60 4.37 13.03 30.17 44.98 5.32 34.56 55.40
STTZ 27.18 5.00 17.39 36.98 58.17 5.77 46.86 69.48
SE, standard error; EET, endoscopic endonasal transpterygoid approach; EETI, endoscopic endonasal transpterygoid approach to the infratemporal fossa; FTOZ, fronto-temporal-orbito-zygomatic
approach; CLIN, anterior clinoidectomy; ILTEA, inferolateral transorbital approach; MPT, mini-pterional approach; PT, pterional approach; PTTZ, pterional-transzygomatic approach; SEY,
superior eyelid approach; SO, supraorbital approach; ST, subtemporal approach; STTZ, subtemporal-transzygomatic approach.
Supplementary Figure 3. Panel documenting quantified crossing anterior endoscopic approaches with screenshots (axial, coronal, sagittal planes and volumetric
analysis) from ApproachViewer. (A) Superior eyelid approach. (B) Inferolateral transorbital approach. (C) Endoscopic endonasal transpterygoid approach. (D)
Endoscopic endonasal transpterygoid approach to the infratemporal fossa. (E) Endoscopic transmaxillary approach.
ORIGINAL ARTICLE
Supplementary Table 2. Comparison of Surgical Exposure for Gasserian Ganglion

EET 52.10 3.99 44.28 59.93 77.88 3.24 71.53 84.23

EETI 56.49 5.62 45.47 67.52 76.56 6.90 63.02 90.09
EETI 42.56 5.99 30.83 54.30 75.96 5.59 65.00 86.91
FTOZ 14.38 2.55 9.38 19.38 32.22 3.34 25.68 38.76
FTOZCLIN 20.41 2.93 14.67 26.15 41.33 3.23 35.00 47.66
ILTEA 9.64 2.61 4.52 14.76 34.61 4.67 25.47 43.76
MPT 0.07 1.00 e1.90 2.04 4.90 2.43 0.14 9.66
MPTCLIN 2.77 1.19 0.44 5.09 11.65 2.79 6.18 17.12
PT 7.64 2.21 3.31 11.98 13.94 3.16 7.74 20.14
PTCLIN 8.36 2.27 3.90 12.82 22.38 3.56 15.39 29.36
PTTZ 10.06 2.02 6.10 14.03 26.50 3.30 20.04 32.96
PTTZCLIN 13.24 2.50 8.34 18.14 31.91 4.32 23.45 40.38
SEY 3.79 1.47 0.90 6.68 41.47 5.42 30.86 52.09
SO 0.00 0.00 e2.01 2.01 0.00 0.00 e3.39 3.39
SOCLIN 0.90 1.04 e1.14 2.95 4.19 2.22 e0.16 8.53
ST 20.70 5.12 10.68 30.73 39.13 5.64 28.07 50.18
STTZ 25.24 6.06 13.37 37.11 38.89 5.92 27.28 50.50
ORIGINAL ARTICLE
Supplementary Table 3. Comparison of Surgical Exposure for Ophthalmic Nerve—Lateral Part

EET 6.02 3.21 e0.28 12.32 14.41 4.75 5.10 23.72

EETI 7.75 3.59 0.71 14.79 18.74 6.14 6.71 30.77
EETI 2.13 2.92 e3.59 7.84 26.82 6.40 14.27 39.37
FTOZ 79.77 5.92 68.17 91.37 93.47 3.53 86.55 100.38
FTOZCLIN 91.01 3.39 84.36 97.66 95.87 2.48 91.00 100.74
ILTEA 0 0 e7.17 2.61 9.12 4.82 e0.32 18.57
MPT 5.13 3.07 e0.89 11.15 41.82 6.24 29.59 54.05
MPTCLIN 46.03 6.24 33.79 58.26 81.61 5.17 71.48 91.73
PT 41.01 7.00 27.29 54.74 81.11 4.07 73.13 89.09
PTCLIN 70.59 5.56 59.69 81.49 94.14 2.59 89.06 99.22
PTTZ 76.32 5.96 64.65 88.00 96.07 2.34 91.48 100.66
PTTZCLIN 89.51 3.21 83.22 95.80 97.04 2.36 92.41 101.67
SEY 0.00 0 e5.42 5.42 26.25 6.46 13.58 38.91
SO 0.00 0 e5.38 5.38 5.28 3.12 e0.83 11.38
SOCLIN 3.70 2.94 e2.07 9.46 13.92 5.03 4.07 23.78
ST 3.53 3.59 e3.51 10.57 23.63 6.91 10.08 37.18
STTZ 3.81 2.96 e1.99 9.61 28.64 7.37 14.19 43.09
superior eyelid approach; SO, supraorbital; ST, subtemporal approach; STTZ, subtemporal-transzygomatic approach.
ORIGINAL ARTICLE
Supplementary Table 4. Comparison of Surgical Exposure for Ophthalmic Nerve—Medial Part

EET 5.55 3.04 e0.41 11.52 20.93 5.51 10.14 31.73

EETI 10.29 3.65 3.13 17.45 30.15 6.66 17.11 43.20
EETI 0.31 2.58 e4.74 5.36 23.70 5.41 13.08 34.31
FTOZ 68.29 6.17 56.19 80.39 91.01 2.83 85.46 96.56
FTOZCLIN 80.66 5.09 70.69 90.63 95.14 2.57 90.11 100.18
ILTEA 0.00 0.00 e5.13 5.13 10.12 5.37 e0.41 20.65
MPT 0.30 2.57 e4.73 5.33 28.88 5.67 17.78 39.99
MPTCLIN 24.01 5.31 13.61 34.41 76.63 4.14 68.52 84.74
PT 30.29 7.07 16.44 44.14 61.24 6.49 48.51 73.97
PTCLIN 59.57 5.60 48.60 70.53 88.58 2.97 82.75 94.40
PTTZ 46.61 6.18 34.51 58.71 82.96 3.38 76.34 89.58
PTTZCLIN 72.11 4.90 62.51 81.71 94.07 2.38 89.39 98.74
SEY 0.00 0.00 e5.06 5.06 6.85 4.73 e2.43 16.12
SO 0.00 0.00 e5.26 5.26 4.38 3.10 e1.70 10.46
SOCLIN 1.38 2.68 e3.88 6.63 24.46 5.69 13.32 35.60
ST 1.69 2.96 e4.11 7.50 17.17 6.75 3.95 30.40
STTZ 0.53 2.59 e4.55 5.61 19.80 7.16 5.76 33.84
ORIGINAL ARTICLE
Supplementary Table 5. Comparison of Surgical Exposure for Maxillary Nerve—Lateral Part

EET 80.80 5.66 69.71 91.89 90.40 5.05 80.50 100.30

EETI 85.09 5.34 74.62 95.56 89.34 5.80 77.96 100.71
EETI 36.68 8.10 20.81 52.55 85.30 6.91 71.76 98.84
FTOZ 0.00 0.00 e3.80 3.80 7.23 3.63 0.12 14.34
FTOZCLIN 3.69 2.42 e1.06 8.44 14.84 4.78 5.47 24.20
ILTEA 20.46 6.31 8.09 32.83 49.27 8.79 32.04 66.51
MPT 0.00 0.00 e3.78 3.78 0.81 2.79 e4.67 6.29
MPTCLIN 0.00 0.00 e3.65 3.65 0.00 0.00 e5.71 5.71
PT 0.00 0.00 e3.69 3.69 3.23 3.20 e3.04 9.51
PTCLIN 0.00 0.00 e3.80 3.80 0.18 2.96 e5.63 5.98
PTTZ 7.07 3.87 e0.52 14.66 19.41 5.82 8.01 30.81
PTTZCLIN 0.00 0.00 e3.86 3.86 11.12 4.92 1.49 20.76
SEY 10.00 5.13 e0.06 20.06 19.72 7.13 5.74 33.70
SO 0.00 0.00 e3.75 3.75 0.00 0.00 e5.82 5.82
SOCLIN 0.00 0.00 e3.89 3.89 0.00 0.00 e5.80 5.80
ST 9.97 4.87 0.42 19.51 50.22 7.39 35.74 64.71
STTZ 27.41 7.41 12.89 41.93 63.69 7.35 49.29 78.10
ORIGINAL ARTICLE
Supplementary Table 6. Comparison of Surgical Exposure for Maxillary Nerve—Medial Part

EET 81.61 6.02 69.80 93.41 80.61 6.85 67.20 94.03

EETI 83.08 6.00 71.33 94.83 85.63 6.62 72.66 98.60
EETI 47.73 8.59 30.89 64.57 93.79 4.60 84.78 102.80
FTOZ 10.00 5.50 e0.78 20.78 16.44 6.64 3.43 29.44
FTOZCLIN 2.68 1.64 e0.53 5.90 10.82 4.07 2.85 18.80
ILTEA 15.94 5.90 4.36 27.51 26.63 6.91 13.09 40.17
MPT 0.00 0.00 e2.91 2.91 0.00 0.00 e6.13 6.13
MPTCLIN 0.00 0.00 e2.95 2.95 0.00 0.00 e6.20 6.20
PT 0.00 0.00 e2.96 2.96 2.99 2.93 e2.75 8.72
PTCLIN 0.00 0.00 e3.03 3.03 0.00 0.00 e6.24 6.24
PTTZ 2.60 2.05 e1.42 6.62 10.45 4.08 2.46 18.45
PTTZCLIN 0.00 0.00 e3.07 3.07 10.16 4.03 2.26 18.05
SEY 0.00 0.00 e2.94 2.94 12.51 4.38 3.92 21.09
SO 0.00 0.00 e3.00 3.00 0.00 0.00 e6.40 6.40
SOCLIN 0.00 0.00 e3.07 3.07 0.00 0.00 e5.97 5.97
ST 9.33 4.55 0.41 18.25 34.47 7.42 19.93 49.02
STTZ 12.48 5.22 2.26 22.71 34.57 7.82 19.25 49.89
ORIGINAL ARTICLE
Supplementary Table 7. Comparison of Surgical Exposure for Foramen Rotundum—Lateral Part

EET 60.89 7.54 46.12 75.66 74.98 7.98 59.33 90.62

EETI 70.00 7.86 54.60 85.40 71.45 8.06 55.65 87.24
EETI 50.00 8.95 32.46 67.54 63.42 8.17 47.42 79.43
FTOZ 0.79 2.14 e3.41 4.99 9.90 4.66 0.76 19.04
FTOZCLIN 10.00 5.32 e0.42 20.42 14.91 5.05 5.01 24.81
ILTEA 16.13 5.93 4.51 27.76 31.70 7.48 17.04 46.35
MPT 0.00 0.00 e4.19 4.19 0.00 0.00 e7.02 7.02
MPTCLIN 0.00 0.00 e4.27 4.27 0.00 0.00 e7.17 7.17
PT 0.00 0.00 e4.25 4.25 4.30 4.06 e3.67 12.26
PTCLIN 0.00 0.00 e4.40 4.40 1.42 3.93 e6.27 9.11
PTTZ 8.33 4.45 e0.38 17.04 15.18 4.92 5.53 24.83
PTTZCLIN 0.00 0.00 e4.30 4.30 1.46 3.77 e5.92 8.85
SEY 10.00 5.80 e1.36 21.36 30.00 7.47 15.35 44.65
SO 0.00 0.00 e4.31 4.31 0.00 0.00 e7.56 7.56
SOCLIN 0.00 0.00 e4.33 4.33 0.00 0.00 e6.97 6.97
ST 9.15 4.59 0.15 18.16 41.39 8.27 25.19 57.60
STTZ 6.42 3.62 e0.67 13.51 51.27 7.94 35.71 66.84
ORIGINAL ARTICLE
Supplementary Table 8. Comparison of Surgical Exposure for Foramen Rotundum—Medial Part

EET 61.42 7.40 46.92 75.91 81.50 6.56 68.65 94.35

EETI 79.43 6.50 66.69 92.16 80.13 7.90 64.65 95.61
EETI 49.72 9.15 31.80 67.65 72.86 7.05 59.05 86.67
FTOZ 1.50 2.11 e2.63 5.63 8.58 3.94 0.86 16.31
FTOZCLIN 6.94 4.12 e1.13 15.00 8.03 3.88 0.41 15.64
ILTEA 11.16 5.30 0.78 21.55 28.81 7.22 14.66 42.97
MPT 0.00 0.00 e3.50 3.50 0.00 0.00 e4.70 4.70
MPTCLIN 0.00 0.00 e3.43 3.43 0.00 0.00 e4.76 4.76
PT 0.00 0.00 e3.44 3.44 2.71 2.87 e2.92 8.34
PTCLIN 0.00 0.00 e3.52 3.52 0.00 0.00 e4.74 4.74
PTTZ 1.55 2.09 e2.55 5.65 5.05 3.26 e1.34 11.45
PTTZCLIN 0.00 0.00 e3.43 3.43 0.00 0.00 e4.78 4.78
SEY 0.00 0.00 e3.40 3.40 23.85 7.65 8.86 38.84
SO 0.00 0.00 e3.39 3.39 0.00 0.00 e4.69 4.69
SOCLIN 0.00 0.00 e3.66 3.66 0.00 0.00 e4.74 4.74
ST 5.48 3.07 e0.53 11.49 26.87 8.02 11.15 42.60
STTZ 4.46 3.13 e1.66 10.59 28.89 7.41 14.36 43.41
ORIGINAL ARTICLE
Supplementary Table 9. Comparison of Surgical Exposure for Mandibular Nerve—Lateral Part

EET 76.36 6.56 63.50 89.22 83.41 6.03 71.59 95.23

EETI 85.37 5.12 75.33 95.41 88.92 5.35 78.43 99.41
EETI 59.63 7.23 45.45 73.81 87.51 5.74 76.26 98.77
FTOZ 0.00 0.00 e3.06 3.06 0.00 0.00 e1.95 1.95
FTOZCLIN 0.00 0.00 e2.99 2.99 2.66 1.85 e0.97 6.28
ILTEA 19.73 5.67 8.63 30.84 46.44 8.71 29.38 63.50
MPT 0.00 0.00 e2.94 2.94 0.00 0.00 e2.10 2.10
MPTCLIN 0.00 0.00 e2.92 2.92 0.00 0.00 e2.07 2.07
PT 0.00 0.00 e2.88 2.88 0.00 0.00 e2.04 2.04
PTCLIN 0.00 0.00 e3.03 3.03 0.00 0.00 e2.07 2.07
PTTZ 0.00 0.00 e2.94 2.94 0.00 0.00 e2.01 2.01
PTTZCLIN 0.00 0.00 e3.06 3.06 0.00 0.00 e2.01 2.01
SEY 3.54 2.39 e1.15 8.23 27.64 6.72 14.47 40.81
SO 0.00 0.00 e2.97 6.59 0.00 0.00 e2.08 2.08
SOCLIN 0.00 0.00 e3.06 3.06 0.00 0.00 e2.11 2.11
ST 25.37 6.88 11.89 38.86 71.23 6.58 58.33 84.13
STTZ 16.54 5.02 6.70 26.39 77.20 6.03 65.39 89.02
ORIGINAL ARTICLE
Supplementary Table 10. Comparison of Surgical Exposure for Mandibular Nerve—Medial Part
EET 70.00 7.90 54.51 85.49 79.27 6.49 66.54 91.99

EETI 75.65 7.02 61.88 89.42 89.53 5.68 78.41 100.66
EETI 43.97 7.76 28.76 59.17 75.99 7.04 62.19 89.79
FTOZ 0.00 0.00 e2.90 2.90 0.00 0.00 e2.84 2.84
FTOZCLIN 0.00 0.00 e2.94 2.94 3.34 1.95 e0.48 7.16
ILTEA 19.80 5.88 8.27 31.33 36.67 7.64 21.69 51.64
MPT 0.00 0.00 e3.03 3.03 0.00 0.00 e2.94 2.94
MPTCLIN 0.00 0.00 e2.91 2.91 0.00 0.00 e2.81 2.81
PT 0.00 0.00 e2.94 2.94 0.00 0.00 e2.89 2.89
PTCLIN 0.00 0.00 e2.97 2.97 0.00 0.00 e2.82 2.82
PTTZ 0.00 0.00 e2.66 6.32 0.08 1.47 e2.80 2.95
PTTZCLIN 0.00 0.00 e2.91 2.91 0.00 0.00 e2.83 2.83
SEY 10.48 5.69 e0.66 21.63 26.38 6.59 13.45 39.31
SO 0.00 0.00 e2.91 2.91 0.00 0.00 e2.93 2.93
SOCLIN 0.00 0.00 e2.87 2.87 0.00 0.00 e2.92 2.92
ST 17.65 5.18 7.49 27.81 53.84 7.78 38.59 69.08
STTZ 17.17 6.33 4.76 29.57 59.87 6.76 46.62 73.12
ORIGINAL ARTICLE
Supplementary Table 11. Comparison of Surgical Exposure for the Foramen Ovale—Lateral Part
EET 32.91 6.53 20.12 45.71 53.79 7.61 38.87 68.70

EETI 49.15 8.04 33.39 64.90 59.81 7.32 45.47 74.14
EETI 47.34 7.79 32.08 62.60 58.36 7.84 42.99 73.73
FTOZ 0.00 0.00 e5.09 5.09 0.00 0.00 e4.54 4.54
FTOZCLIN 0.00 0.00 e4.82 4.82 0.00 0.00 e4.64 4.64
ILTEA 11.01 4.81 1.58 20.45 11.73 5.14 1.66 21.80
MPT 0.00 0.00 e4.92 4.92 0.00 0.00 e4.65 4.65
MPTCLIN 0.00 0.00 e4.69 4.69 0.00 0.00 e4.88 4.88
PT 0.00 0.00 e4.88 4.88 0.00 0.00 e4.71 4.71
PTCLIN 0.00 0.00 e4.83 4.83 0.00 0.00 e4.55 4.55
PTTZ 0.00 0.00 e4.88 4.88 0.00 0.00 e4.58 4.58
PTTZCLIN 0.00 0.00 e4.96 4.96 0.00 0.00 e4.64 4.64
SEY 10.39 4.80 0.99 19.79 16.36 5.88 4.84 27.87
SO 0.00 0.00 e4.96 4.96 0.00 0.00 e4.84 4.84
SOCLIN 0.00 0.00 e4.84 4.84 0.00 0.00 e4.50 4.50
ST 4.22 2.68 e1.03 9.47 34.26 6.92 20.70 47.82
STTZ 6.76 4.28 e1.64 15.15 46.55 7.98 30.90 62.20
ORIGINAL ARTICLE
Supplementary Table 12. Comparison of Surgical Exposure for the Foramen Ovale—Medial Part
EET 36.62 7.19 22.52 50.72 51.63 7.68 36.57 66.68

EETI 59.15 8.15 43.18 75.13 72.20 6.44 59.58 84.82
EETI 50.77 7.33 36.41 65.14 66.22 8.03 50.49 81.95
FTOZ 0.00 0.00 e3.77 3.77 0.00 0.00 e5.45 5.45
FTOZCLIN 0.00 0.00 e3.96 3.96 0.00 0.00 e5.26 5.26
ILTEA 12.82 5.40 2.24 23.41 13.00 5.58 2.06 23.94
MPT 0.00 0.00 e3.75 3.75 0.00 0.00 e5.22 5.22
MPTCLIN 0.00 0.00 e3.88 3.88 0.00 0.00 e5.57 5.57
PT 0.00 0.00 e3.79 3.79 0.00 0.00 e5.18 5.18
PTCLIN 0.00 0.00 e3.92 3.92 0.00 0.00 e5.36 5.36
PTTZ 1.25 2.31 e3.27 5.76 0.00 0.00 e5.23 5.23
PTTZCLIN 0.00 0.00 e3.78 3.78 0.00 0.00 e5.26 5.26
SEY 10.00 5.07 0.07 19.93 14.71 5.44 4.04 25.38
SO 0.00 0.00 e3.69 3.69 0.00 0.00 e5.17 5.17
SOCLIN 0.00 0.00 e3.93 3.93 0.00 0.00 e5.20 5.20
ST 0.00 0.00 e3.78 3.78 43.32 7.36 28.89 57.76
STTZ 0.00 0.00 e3.75 3.75 45.84 7.08 31.96 59.71
ORIGINAL ARTICLE
Supplementary Table 13. Comparison of Surgical Exposure for the Anteromedial Triangle
EET 58.04 6.75 44.81 71.27 70.57 6.86 57.13 84.02

EETI 63.10 7.01 49.36 76.84 73.13 7.18 59.07 87.20
EETI 28.83 7.40 14.33 43.33 61.83 7.65 46.84 76.83
FTOZ 10.28 3.22 3.98 16.58 35.27 5.17 25.14 45.40
FTOZCLIN 24.72 4.92 15.08 34.36 55.54 5.85 44.08 67.00
ILTEA 6.97 4.26 e1.38 15.32 41.63 6.64 28.62 54.65
MPT 0.00 0.00 e4.69 4.69 4.50 2.63 e0.66 9.65
MPTCLIN 3.79 2.17 e0.47 8.05 10.35 3.24 4.00 16.69
PT 1.01 2.26 e3.41 5.43 12.67 4.28 4.28 21.06
PTCLIN 5.22 3.18 e1.01 11.45 24.01 4.69 14.82 33.19
PTTZ 11.69 4.07 3.72 19.65 35.76 6.55 22.93 48.59
PTTZCLIN 3.70 2.85 e1.87 9.28 32.80 5.82 21.39 44.21
SEY 0.00 0.00 e4.84 4.84 21.29 6.05 9.44 33.14
SO 0.00 0.00 e4.81 4.81 0.00 0.00 e5.58 5.58
SOCLIN 0.00 0.00 e4.81 4.81 0.00 0.00 e5.54 5.54
ST 6.41 3.55 e0.55 13.38 29.10 7.45 14.50 43.69
STTZ 12.07 4.79 2.68 21.46 37.34 7.57 22.51 52.18
ORIGINAL ARTICLE
Supplementary Table 14. Comparison of Surgical Exposure for the Anterolateral Triangle
EET 88.50 5.10 78.51 98.49 92.01 4.72 82.76 101.26

EETI 80.00 7.01 66.27 93.73 80.00 7.50 65.30 94.70
EETI 64.23 8.02 48.52 79.94 99.29 1.84 95.69 102.89
FTOZ 0.00 0.00 e1.59 1.59 4.01 3.09 e2.05 10.08
FTOZCLIN 1.07 0.87 e0.63 2.77 4.01 2.22 e0.35 8.37
ILTEA 20.83 6.46 8.18 33.49 39.51 8.01 23.80 55.22
MPT 0.00 0.00 e1.56 1.56 0.00 0.00 e3.39 3.39
MPTCLIN 0.00 0.00 e1.55 1.55 0.00 0.00 e3.35 3.35
PT 0.00 0.00 e1.52 1.52 0.50 1.64 e2.72 3.71
PTCLIN 0.00 0.00 e1.57 1.57 0.00 0.00 e3.42 3.42
PTTZ 1.92 1.98 e1.96 5.80 7.60 3.40 0.94 14.27
PTTZCLIN 0.00 0.00 e1.60 1.60 0.00 0.00 e3.42 3.42
SEY 10.83 5.47 0.11 21.55 26.72 7.65 11.72 41.72
SO 0.00 0.00 e1.51 1.51 0.00 0.00 e3.36 3.36
SOCLIN 0.00 0.00 e1.56 1.56 0.00 0.00 e3.40 3.40
ST 12.73 3.54 5.79 19.66 79.79 5.38 69.25 90.34
STTZ 31.34 7.84 15.97 46.71 82.66 5.36 72.15 93.17
ORIGINAL ARTICLE
Supplementary Table 15. Comparison of Surgical Exposure for Cavernous Carotid—Lateral Part
EET 26.61 3.08 20.57 32.66 51.41 4.86 41.88 60.94

EETI 29.80 4.45 21.08 38.52 54.80 7.11 40.87 68.73
EETI 11.80 3.91 4.13 19.47 37.18 5.84 25.73 48.63
FTOZ 26.44 3.36 19.86 33.03 53.46 2.89 47.78 59.13
FTOZCLIN 38.78 3.39 32.13 45.43 58.50 4.59 49.49 67.50
ILTEA 2.85 1.96 e0.99 6.69 9.68 2.86 4.07 15.29
MPT 4.00 1.56 0.95 7.06 19.25 2.39 14.57 23.93
MPTCLIN 15.87 2.65 10.67 21.07 34.40 2.26 29.97 38.84
PT 16.97 2.51 12.06 21.89 39.59 2.85 34.00 45.18
PTCLIN 28.40 3.26 22.02 34.78 47.04 3.38 40.43 53.66
PTTZ 21.61 3.35 15.04 28.18 44.36 3.37 37.75 50.96
PTTZCLIN 32.50 3.64 25.37 39.63 54.96 2.40 50.25 59.67
SEY 0.00 0.00 e2.30 2.30 10.63 3.42 3.93 17.34
SO 2.65 1.39 e0.07 5.37 6.96 1.81 3.42 10.51
SOCLIN 4.78 1.52 1.80 7.75 15.21 1.84 11.61 18.81
ST 6.30 2.93 0.55 12.04 15.26 5.08 5.31 25.20
STTZ 8.40 3.81 0.95 15.86 28.65 6.04 16.82 40.48
ORIGINAL ARTICLE
Supplementary Table 16. Comparison of Surgical Exposure for the Cavernous Carotid—Medial Part
EET 11.97 3.09 5.90 18.03 34.97 5.41 24.37 45.57

EETI 15.80 3.37 9.19 22.42 43.98 6.75 30.76 57.20
EETI 6.04 1.77 2.57 9.51 32.20 5.80 20.82 43.58
FTOZ 13.47 2.49 8.58 18.35 35.13 3.60 28.06 42.19
FTOZCLIN 29.84 3.52 22.95 36.74 55.29 3.46 48.51 62.06
ILTEA 1.72 1.61 e1.44 4.88 3.37 2.15 e0.84 7.57
MPT 2.46 1.33 e0.15 5.07 11.02 2.27 6.58 15.46
MPTCLIN 7.25 2.07 3.19 11.31 23.90 2.62 18.76 29.04
PT 7.83 2.35 3.22 12.44 26.43 4.41 17.79 35.08
PTCLIN 19.06 3.25 12.68 25.43 37.30 4.36 28.76 45.85
PTTZ 14.95 2.11 10.81 19.09 24.27 3.18 18.04 30.50
PTTZCLIN 30.42 2.53 25.47 35.37 47.57 3.06 41.58 53.56
SEY 0.00 0.00 e2.44 2.44 2.94 2.38 e1.72 7.61
SO 0.15 1.31 e2.43 2.72 1.83 1.80 e1.70 5.36
SOCLIN 2.59 1.38 e0.10 5.29 12.65 2.09 8.56 16.74
ST 0.64 1.46 e2.22 3.51 2.19 2.42 e2.55 6.93
STTZ 0.33 1.39 e2.40 3.06 13.64 5.62 2.62 24.66
ORIGINAL ARTICLE
Supplementary Table 17. Comparison of Surgical Exposure for the Petrous Carotid—Lateral Part
EET 14.72 4.47 5.97 23.47 28.16 5.63 17.13 39.20

EETI 30.89 6.78 17.61 44.17 38.25 7.34 23.87 52.62
EETI 14.75 3.72 7.46 22.04 33.03 5.41 22.43 43.64
FTOZ 0.00 0.00 e2.05 2.05 0.00 0.00 e3.24 3.24
FTOZCLIN 0.00 0.00 e1.98 1.98 0.00 0.00 e3.42 3.42
ILTEA 0.22 1.02 e1.77 2.22 7.34 2.74 1.97 12.72
MPT 0.00 0.00 e2.00 2.00 0.00 0.00 e3.40 3.40
MPTCLIN 0.00 0.00 e2.02 2.02 0.00 0.00 e3.40 3.40
PT 0.00 0.00 e2.06 2.06 0.00 0.00 e3.36 3.36
PTCLIN 0.00 0.00 e1.97 1.97 0.00 0.00 e3.51 3.51
PTTZ 0.00 0.00 e1.99 1.99 0.00 0.00 e3.48 3.48
PTTZCLIN 0.00 0.00 e2.01 2.01 0.00 0.00 e3.37 3.37
SEY 0.00 0.00 e2.03 2.03 9.06 3.77 1.67 16.46
SO 0.00 0.00 e2.11 2.11 0.00 0.00 e3.49 3.49
SOCLIN 0.00 0.00 e2.08 2.08 0.00 0.00 e3.34 3.34
ST 1.38 1.35 e1.27 4.03 16.69 4.30 8.25 25.12
STTZ 0.36 1.09 e1.77 2.49 13.44 3.71 6.17 20.72
ORIGINAL ARTICLE
Supplementary Table 18. Comparison of Surgical Exposure for the Petrous Carotid—Medial Part
EET 8.89 3.22 2.58 15.20 19.83 4.60 10.82 28.84

EETI 16.76 3.87 9.18 24.34 26.20 5.23 15.95 36.46
EETI 2.85 0.91 1.07 4.64 13.89 3.76 6.52 21.26
FTOZ 0.00 0.00 e1.16 1.16 0.00 0.00 e2.05 2.05
FTOZCLIN 0.00 0.00 e1.15 1.15 0.00 0.00 e2.01 2.01
ILTEA 0.00 0.00 e1.17 1.17 1.09 1.34 e1.54 3.71
MPT 0.00 0.00 e1.11 1.11 0.00 0.00 e2.00 2.00
MPTCLIN 0.00 0.00 e1.16 1.16 0.00 0.00 e2.02 2.02
PT 0.00 0.00 e1.11 1.11 0.00 0.00 e1.97 1.97
PTCLIN 0.00 0.00 e1.17 1.17 0.00 0.00 e1.97 1.97
PTTZ 0.00 0.00 e1.11 1.11 0.00 0.00 e1.91 1.91
PTTZCLIN 0.00 0.00 e1.15 1.15 0.00 0.00 e1.93 1.93
SEY 0.00 0.00 e1.18 1.18 1.36 1.33 e1.25 3.97
SO 0.00 0.00 e1.16 1.16 0.00 0.00 e1.96 1.96
SOCLIN 0.00 0.00 e1.15 1.15 0.00 0.00 e1.98 1.98
ST 0.00 0.00 e1.15 1.15 4.04 2.11 e0.09 8.17
STTZ 0.00 0.00 e1.15 1.15 1.74 1.32 e0.85 4.32
ORIGINAL ARTICLE
Supplementary Table 19. Comparison of Surgical Exposure for the Spheno-Orbital Region
EET 9.31 3.80 1.87 16.76 23.41 5.16 13.30 33.52

EETI 16.26 3.80 8.82 23.70 36.21 5.16 26.10 46.32
EETI 8.93 3.80 1.49 16.38 18.09 5.16 7.97 28.20
FTOZ 20.30 3.80 12.85 27.74 44.70 5.16 34.59 54.82
FTOZCLIN 23.86 3.80 16.41 31.30 46.22 5.16 36.11 56.34
ILTEA 18.95 3.80 11.50 26.39 45.56 5.16 35.45 55.67
MPT 6.06 3.80 e1.39 13.50 17.70 5.16 7.58 27.81
MPTCLIN 12.16 3.80 4.72 19.61 25.32 5.16 15.20 35.43
PT 10.63 3.80 3.18 18.07 25.65 5.19 15.47 35.82
PTCLIN 13.65 3.80 6.21 21.10 30.47 5.16 20.36 40.59
PTTZ 20.48 3.80 13.04 27.92 36.92 5.23 26.68 47.16
PTTZCLIN 20.49 3.80 13.05 27.94 41.49 5.16 31.37 51.60
SEY 21.60 3.80 14.16 29.04 52.00 5.16 41.89 62.12
SO 0.33 3.80 e7.11 7.78 1.55 5.16 e8.56 11.66
SOCLIN 0.71 3.80 e6.74 8.15 3.23 5.16 e6.88 13.35
ST 11.26 3.80 3.82 18.71 49.08 5.16 38.97 59.20
STTZ 12.95 3.80 5.51 20.39 55.71 5.16 45.60 65.82
ORIGINAL ARTICLE
Supplementary Table 20. Comparison of Surgical Exposure for the Superior Orbital Fissure
EET 6.18 2.14 1.98 10.38 15.36 3.94 7.63 23.09

EETI 11.76 3.88 4.17 19.36 23.96 5.44 13.30 34.63
EETI 0.09 1.69 e3.22 3.40 13.68 4.04 5.75 21.60
FTOZ 44.20 6.37 31.72 56.69 76.77 5.30 66.38 87.17
FTOZCLIN 65.03 4.29 56.62 73.43 96.72 1.91 92.97 100.46
ILTEA 0.00 0.00 e3.30 3.30 5.45 2.34 0.87 10.04
MPT 1.75 1.69 e1.56 5.06 30.59 4.48 21.80 39.38
MPTCLIN 30.13 4.59 21.14 39.12 63.56 3.88 55.95 71.16
PT 7.49 3.50 0.62 14.36 64.77 4.51 55.93 73.62
PTCLIN 27.16 5.50 16.37 37.94 78.57 3.61 71.49 85.65
PTTZ 26.46 4.51 17.63 35.30 71.83 5.75 60.56 83.11
PTTZCLIN 42.94 5.32 32.52 53.37 88.60 3.21 82.31 94.90
SEY 0.00 0.00 e3.32 3.32 27.17 5.69 16.01 38.32
SO 0.00 0.00 e3.40 3.40 1.73 1.81 e1.83 5.28
SOCLIN 0.91 1.68 e2.39 4.20 9.38 2.83 3.83 14.92
ST 0.00 0.00 e3.32 3.32 11.62 4.87 2.07 21.17
STTZ 1.62 1.92 e2.14 5.38 18.62 6.49 5.89 31.34
ORIGINAL ARTICLE
Supplementary Table 21. Comparison of Surgical Exposure for the Anterior Clinoid Process—Lateral Part
EET 0.00 0.00 e1.63 1.63 0.38 0.80 e1.18 1.95

EETI 0.00 0.00 e1.68 1.68 3.74 2.14 e0.45 7.93
EETI 0.02 0.00 e1.58 1.62 0.49 0.76 e1.01 1.99
FTOZ 96.91 1.48 94.01 99.81 92.88 4.70 83.67 102.09
FTOZCLIN 98.94 1.08 96.81 101.07 99.44 0.75 97.98 100.90
ILTEA 0.00 0.00 e1.65 1.65 0.00 0.00 e1.33 1.33
MPT 64.43 4.58 55.46 73.40 92.81 1.68 89.52 96.10
MPTCLIN 90.50 1.88 86.82 94.18 99.44 0.76 97.95 100.92
PT 90.40 1.74 86.99 93.81 99.44 0.74 97.99 100.89
PTCLIN 98.20 1.08 96.09 100.31 99.44 0.76 97.95 100.93
PTTZ 95.93 1.73 92.53 99.32 99.41 0.75 97.95 100.88
PTTZCLIN 99.38 0.91 97.59 101.16 99.44 0.76 97.95 100.93
SEY 0.00 0.00 e1.67 1.67 2.07 1.05 0.02 4.12
SO 25.45 3.35 18.88 32.01 52.76 6.55 39.92 65.59
SOCLIN 39.08 6.00 27.31 50.84 65.20 6.43 52.61 77.80
ST 0.00 0.00 e2.16 5.61 0.00 0.00 e1.22 4.48
STTZ 0.00 0.00 e1.68 1.68 5.06 2.78 e0.38 10.51
ORIGINAL ARTICLE
Supplementary Table 22. Comparison of Surgical Exposure for the Anterior Clinoid Process—Medial Part
EET 0.00 0.00 e3.52 3.52 0.00 0.00 e3.00 3.00

EETI 0.00 0.00 e3.62 3.62 2.07 2.53 e2.90 7.04
EETI 0.02 0.00 e3.66 3.66 1.69 2.01 e2.25 5.64
FTOZ 96.91 1.48 79.60 93.80 96.13 1.50 93.18 99.07
FTOZCLIN 98.94 1.08 90.50 98.23 96.85 1.47 93.97 99.73
ILTEA 0.00 0.00 e3.62 3.62 0.00 0.00 e3.02 3.02
MPT 64.43 4.58 42.79 61.79 86.45 3.08 80.41 92.49
MPTCLIN 90.50 1.88 69.79 85.08 93.49 2.25 89.07 97.90
PT 90.40 1.74 74.11 85.62 95.78 1.81 92.23 99.34
PTCLIN 98.20 1.08 91.64 99.99 96.68 1.64 93.47 99.89
PTTZ 95.93 1.73 86.11 97.17 94.32 2.03 90.34 98.31
PTTZCLIN 99.38 0.91 90.16 100.28 96.36 1.78 92.88 99.84
SEY 0.00 0.00 e3.68 3.68 0.31 1.52 e2.66 3.29
SO 25.45 3.35 14.67 30.17 44.32 6.11 32.35 56.29
SOCLIN 39.08 6.00 33.35 59.55 67.11 5.67 55.99 78.22
ST 0.00 0.00 e3.53 3.63 0.00 0.00 e3.07 3.12
STTZ 0.00 0.00 e3.68 3.68 0.00 0.00 e2.86 3.87
ORIGINAL ARTICLE
Supplementary Table 23. Comparison of Surgical Exposure for the Sphenoid Ridge
EET 0.00 0.00 e3.96 3.96 0.00 0.00 e2.39 2.39

EETI 0.00 0.00 e3.89 3.89 0.00 0.00 e2.35 2.35
EETI 0.00 0.00 e4.06 4.06 0.00 0.00 e2.29 2.29
FTOZ 56.05 3.64 48.91 63.19 90.76 2.85 85.18 96.35
FTOZCLIN 50.20 5.60 39.23 61.17 94.53 2.19 90.24 98.83
ILTEA 0.00 0.00 e3.91 3.91 0.00 0.00 e2.36 2.36
MPT 32.08 3.27 25.67 38.49 72.80 3.75 65.45 80.14
MPTCLIN 42.33 2.40 37.63 47.03 81.45 4.04 73.53 89.36
PT 55.33 4.48 46.54 64.12 84.86 4.06 76.89 92.82
PTCLIN 60.60 4.51 51.75 69.45 87.26 3.27 80.85 93.66
PTTZ 68.91 5.14 58.84 78.97 87.82 5.33 77.38 98.26
PTTZCLIN 71.66 4.74 62.37 80.95 93.94 2.02 89.98 97.90
SEY 2.19 2.55 e2.82 7.19 11.88 4.54 2.98 20.79
SO 2.05 1.76 e1.40 5.50 10.51 1.72 7.14 13.89
SOCLIN 4.90 1.90 1.18 8.63 19.10 2.25 14.69 23.51
ST 6.22 4.41 e2.42 14.87 15.97 6.23 3.76 28.18
STTZ 3.15 3.13 e2.99 9.28 16.94 6.57 4.06 29.83
ORIGINAL ARTICLE
Supplementary Table 24. Comparison of Surgical Exposure for the Greater Wing of the Sphenoid Bone
EET 2.47 1.19 9.63 23.77 16.70 3.61 9.63 23.77

EETI 11.18 2.04 21.86 37.24 29.55 3.92 21.86 37.24
EETI 2.64 1.23 8.56 18.34 13.45 2.50 8.56 18.34
FTOZ 19.87 2.17 40.30 55.80 48.05 3.96 40.30 55.80
FTOZCLIN 26.92 2.80 41.83 56.17 49.00 3.66 41.83 56.17
ILTEA 23.96 2.41 47.89 62.87 55.38 3.82 47.89 62.87
MPT 1.12 1.03 4.32 12.38 8.35 2.06 4.32 12.38
MPTCLIN 6.45 1.43 14.21 22.22 18.21 2.04 14.21 22.22
PT 4.08 1.20 13.97 24.46 19.22 2.67 13.97 24.46
PTCLIN 9.16 1.75 20.43 31.89 26.16 2.92 20.43 31.89
PTTZ 16.89 2.28 35.53 54.80 45.16 4.92 35.53 54.80
PTTZCLIN 14.81 1.99 34.75 47.08 40.91 3.15 34.75 47.08
SEY 25.50 2.61 58.09 73.88 65.98 4.03 58.09 73.88
SO 0.00 0.00 e3.81 63.81 0.00 0.00 e3.81 3.81
SOCLIN 0.08 1.04 e3.79 63.98 0.09 1.98 e3.79 3.98
ST 7.17 3.11 50.35 69.48 59.92 4.88 50.35 69.48
STTZ 7.07 2.67 52.60 71.34 61.97 4.78 52.60 71.34
ORIGINAL ARTICLE
Supplementary Table 25. Comparison of Surgical Exposure for the Petrous Region
EET 19.99 2.14 15.80 24.18 12.27 2.12 8.12 16.42

EETI 25.39 2.14 21.20 29.58 15.63 2.12 11.47 19.78
EETI 15.95 2.14 11.76 20.14 9.82 2.12 5.67 13.97
FTOZ 0.00 0.00 e4.19 4.19 0.00 0.00 e4.15 4.15
FTOZCLIN 0.00 0.00 e4.19 4.19 0.00 0.00 e4.15 4.15
ILTEA 26.18 2.14 21.99 30.37 11.98 2.12 7.82 16.13
MPT 0.00 0.00 e4.19 4.19 0.00 0.00 e4.15 4.15
MPTCLIN 0.00 0.00 e4.19 4.19 0.00 0.00 e4.15 4.15
PT 0.00 0.00 e4.19 4.19 0.00 0.00 e4.15 4.15
PTCLIN 0.00 0.00 e4.19 4.19 0.00 0.00 e4.15 4.15
PTTZ 0.00 0.00 e4.19 4.19 0.00 0.00 e4.15 4.15
PTTZCLIN 0.00 0.00 e4.19 4.19 0.00 0.00 e4.15 4.15
SEY 15.15 2.14 10.96 19.34 8.94 2.12 4.78 13.09
SO 0.00 0.00 e4.15 4.23 0.00 0.00 e4.07 4.24
SOCLIN 0.00 0.00 e4.19 4.19 0.00 0.00 e4.15 4.15
ST 40.11 2.14 35.92 44.30 22.00 2.12 17.84 26.15
STTZ 47.41 2.14 43.22 51.60 29.61 2.12 25.46 33.76
ORIGINAL ARTICLE
Supplementary Table 26. Comparison of Surgical Exposure for the Petrous Apex
EET 41.66 6.76 28.42 54.90 66.18 6.04 54.34 78.03

EETI 40.36 6.73 27.17 53.54 63.52 6.77 50.26 76.79
EETI 32.02 5.76 20.74 43.31 55.71 5.99 43.97 67.44
FTOZ 0.00 0.00 e2.05 2.05 0.00 0.00 e2.14 2.14
FTOZCLIN 0.00 0.00 e2.06 2.06 0.00 0.00 e2.18 2.18
ILTEA 8.26 2.42 3.52 13.01 36.55 5.83 25.11 47.98
MPT 0.00 0.00 e1.98 1.98 0.00 0.00 e2.26 2.26
MPTCLIN 0.00 0.00 e2.06 2.06 0.00 0.00 e2.15 2.15
PT 0.00 0.00 e2.08 2.08 0.00 0.00 e2.15 2.15
PTCLIN 0.00 0.00 e2.02 2.02 0.00 0.00 e2.09 2.09
PTTZ 0.00 0.00 e2.01 2.01 0.00 0.00 e2.23 2.23
PTTZCLIN 0.00 0.00 e2.07 2.07 0.00 0.00 e2.20 2.20
SEY 4.33 1.98 0.45 8.21 23.15 5.73 11.93 34.38
SO 0.00 0.00 e2.06 2.06 0.00 0.00 e2.24 2.24
SOCLIN 0.00 0.00 e2.03 2.03 0.00 0.00 e2.21 2.21
ST 23.72 5.85 12.25 35.19 40.73 5.92 29.14 52.32
STTZ 28.72 5.77 17.41 40.04 55.23 6.06 43.35 67.11
ORIGINAL ARTICLE
Supplementary Table 27. Comparison of Surgical Exposure for the Trigeminal Impression
EET 32.83 5.26 22.53 43.14 69.31 6.86 55.87 82.75

EETI 32.24 7.22 18.10 46.38 60.85 8.22 44.73 76.97
EETI 30.86 6.57 17.99 43.73 61.96 7.24 47.77 76.16
FTOZ 0.00 0.00 e2.41 2.41 0.00 0.00 e3.40 3.40
FTOZCLIN 0.00 0.00 e2.39 2.39 0.00 0.00 e3.37 3.37
ILTEA 10.82 4.70 1.60 20.03 37.42 6.35 24.98 49.87
MPT 0.00 0.00 e2.35 2.35 0.00 0.00 e3.37 3.37
MPTCLIN 0.00 0.00 e2.51 2.51 0.00 0.00 e3.41 3.41
PT 0.00 0.00 e2.47 2.47 0.00 0.00 e3.35 3.35
PTCLIN 0.00 0.00 e2.45 2.45 0.00 0.00 e3.51 3.51
PTTZ 0.00 0.00 e2.58 2.58 0.00 0.00 e3.45 3.45
PTTZCLIN 0.00 0.00 e2.49 2.49 0.00 0.00 e3.45 3.45
SEY 6.67 2.73 1.31 12.02 27.90 7.36 13.48 42.32
SO 0.00 0.00 e2.33 2.33 0.00 0.00 e3.46 3.46
SOCLIN 0.00 0.00 e2.50 2.50 0.00 0.00 e3.49 3.49
ST 15.46 5.03 5.61 25.32 17.22 5.46 6.52 27.92
STTZ 17.10 5.40 6.52 27.69 35.49 6.60 22.55 48.43
ORIGINAL ARTICLE
Supplementary Table 28. Comparison of Surgical Exposure for the Kawase Triangle
Mean SD Min. Max Mean SD Min. Max
EET 36.91 5.85 25.45 48.37 68.36 5.75 57.08 79.64

EETI 40.57 6.61 27.62 53.52 64.55 8.18 48.50 80.59
EETI 31.15 4.85 21.64 40.66 69.59 7.78 54.36 84.83
FTOZ 0.00 0.00 e2.26 2.26 0.00 0.00 e1.86 1.86
FTOZCLIN 0.00 0.00 e2.27 2.27 0.00 0.00 e1.92 1.92
ILTEA 33.10 5.77 21.79 44.40 72.21 6.44 59.58 84.83
MPT 0.00 0.00 e2.34 2.34 0.00 0.00 e1.84 1.84
MPTCLIN 0.00 0.00 e2.26 2.26 0.00 0.00 e1.95 1.95
PT 0.00 0.00 e2.36 2.36 0.00 0.00 e1.91 1.91
PTCLIN 0.00 0.00 e2.28 2.28 0.00 0.00 e1.95 1.95
PTTZ 0.00 0.00 e2.27 2.27 0.00 0.00 e1.96 1.96
PTTZCLIN 0.00 0.00 e2.22 2.22 0.00 0.00 e1.92 1.92
SEY 32.25 6.90 18.73 45.78 50.54 8.37 34.14 66.94
SO 0.00 0.00 e2.30 2.30 0.00 0.00 e1.87 1.87
SOCLIN 0.00 0.00 e2.30 2.30 0.00 0.00 e1.87 1.87
ST 36.69 6.97 23.03 50.35 72.19 5.47 61.47 82.92
STTZ 46.52 6.88 33.04 60.00 89.26 2.91 83.57 94.96
ORIGINAL ARTICLE
Supplementary Table 29. Comparison of Surgical Exposure for the Glasscock Triangle
EET 26.00 6.27 13.72 38.29 50.84 7.59 35.98 65.71

EETI 47.36 7.01 33.63 61.09 69.10 7.16 55.06 83.14
EETI 39.19 6.78 25.90 52.48 60.52 7.43 45.95 75.08
FTOZ 0.00 0.00 e2.18 2.18 0.00 0.00 e2.95 2.95
FTOZCLIN 0.00 0.00 e2.10 2.10 0.00 0.00 e2.97 2.97
ILTEA 7.00 3.47 0.19 13.80 29.21 7.56 14.39 44.03
MPT 0.00 0.00 e2.10 2.10 0.00 0.00 e3.05 3.05
MPTCLIN 0.00 0.00 e2.13 2.13 0.00 0.00 e2.96 2.96
PT 0.00 0.00 e2.11 2.11 0.00 0.00 e2.90 2.90
PTCLIN 0.00 0.00 e2.11 2.11 0.00 0.00 e2.95 2.95
PTTZ 0.00 0.00 e2.06 2.06 0.00 0.00 e2.88 2.88
PTTZCLIN 0.00 0.00 e2.21 2.21 0.00 0.00 e2.90 2.90
SEY 3.80 2.29 e0.69 8.29 26.04 7.24 11.85 40.23
SO 0.00 0.00 e2.19 2.19 0.00 0.00 e2.80 2.80
SOCLIN 0.00 0.00 e2.14 2.14 0.00 0.00 e3.05 3.05
ST 6.21 2.54 1.22 11.19 68.20 6.72 55.03 81.36
STTZ 31.04 7.46 16.42 45.67 76.10 6.35 63.65 88.56
ORIGINAL ARTICLE
Supplementary Table 30. Comparison of Surgical Exposure for the Arcuate Eminence
EET 10.49 4.75 1.18 19.81 27.74 5.07 17.79 37.69

EETI 14.49 4.75 5.18 23.81 47.48 5.07 37.53 57.43
EETI 10.00 4.75 0.68 19.32 18.23 5.07 8.28 28.18
FTOZ 0.00 0.00 e9.32 9.32 0.00 0.00 e9.95 9.95
FTOZCLIN 0.00 0.00 e9.32 9.32 0.00 0.00 e9.95 9.95
ILTEA 19.63 4.75 10.31 28.94 57.33 5.07 47.39 67.28
MPT 0.00 0.00 e9.32 9.32 0.00 0.00 e9.95 9.95
MPTCLIN 0.00 0.00 e9.32 9.32 0.00 0.00 e9.95 9.95
PT 0.00 0.00 e9.32 9.32 0.00 0.00 e9.95 9.95
PTCLIN 0.00 0.00 e9.32 9.32 0.00 0.00 e9.95 9.95
PTTZ 0.00 0.00 e9.32 9.32 0.00 0.00 e9.95 9.95
PTTZCLIN 0.00 0.00 e9.32 9.32 0.00 0.00 e9.95 9.95
SEY 13.43 4.75 4.12 22.75 24.20 5.07 14.25 34.15
SO 0.00 0.00 e9.32 9.32 0.00 0.00 e9.95 9.95
SOCLIN 0.00 0.00 e9.32 9.32 0.00 0.00 e9.95 9.95
ST 32.86 4.75 23.54 42.18 59.62 5.07 49.67 69.57
STTZ 37.66 4.75 28.34 46.98 65.37 5.07 55.42 75.32
ORIGINAL ARTICLE
Supplementary Table 31. Comparison of Surgical Exposure for the Anterior Surface of the Petrous Bone
EET 8.15 3.08 2.12 14.18 29.96 7.48 15.30 44.62

EETI 16.86 5.93 5.23 28.48 53.33 8.28 37.09 69.56
EETI 0.48 1.27 e2.01 2.96 6.82 3.22 0.51 13.14
FTOZ 0.00 0.00 e2.35 2.35 0.00 0.00 e3.51 3.51
FTOZCLIN 0.00 0.00 e2.19 2.19 0.00 0.00 e3.47 3.47
ILTEA 17.09 4.07 9.11 25.06 49.09 7.51 34.36 63.81
MPT 0.00 0.00 e2.29 2.29 0.00 0.00 e3.49 3.49
MPTCLIN 0.00 0.00 e2.30 2.30 0.00 0.00 e3.35 3.35
PT 0.00 0.00 e2.23 2.23 0.00 0.00 e3.41 3.41
PTCLIN 0.00 0.00 e2.36 2.36 0.00 0.00 e3.30 3.30
PTTZ 0.00 0.00 e2.24 2.24 0.00 0.00 e3.62 3.62
PTTZCLIN 0.00 0.00 e2.26 2.26 0.00 0.00 e3.51 3.51
SEY 8.14 3.21 1.85 14.42 49.21 6.30 36.85 61.56
SO 1.77 1.93 e2.01 5.56 0.00 0.00 e3.48 3.48
SOCLIN 0.00 0.00 e2.31 2.31 0.00 0.00 e3.38 3.38
ST 25.68 5.57 14.75 36.60 75.54 5.33 65.10 85.99
STTZ 26.88 5.44 16.22 37.53 75.01 5.35 64.53 85.49
ORIGINAL ARTICLE
Supplementary Table 32. Comparison of Surgical Exposure for the Tegmen

EET 0.11 0.48 e0.83 1.05 4.04 1.36 1.38 6.69

EETI 1.55 1.05 e0.51 3.60 10.06 3.13 3.92 16.20
EETI 0.00 0.46 e0.89 0.89 1.90 1.70 e1.43 5.22
FTOZ 0.00 0.00 e0.91 0.91 0.00 0.00 e2.50 2.50
FTOZCLIN 0.00 0.00 e0.90 0.90 0.00 0.00 e2.44 2.44
ILTEA 3.68 1.00 1.72 5.63 24.82 3.72 17.53 32.11
MPT 0.00 0.00 e0.90 0.90 0.00 0.00 e2.44 2.44
MPTCLIN 0.00 0.00 e0.93 0.93 0.00 0.00 e2.44 2.44
PT 0.00 0.00 e0.90 0.90 0.00 0.00 e2.36 2.36
PTCLIN 0.00 0.00 e0.94 0.94 0.00 0.00 e2.40 2.40
PTTZ 0.00 0.00 e0.91 0.91 0.00 0.00 e2.48 2.48
PTTZCLIN 0.00 0.00 e0.91 0.91 0.00 0.00 e2.59 2.59
SEY 0.57 0.56 e0.52 1.66 5.88 1.59 2.77 8.99
SO 0.00 0.00 e0.91 0.91 0.00 0.00 e2.42 2.42
SOCLIN 0.00 0.00 e0.95 0.95 0.00 0.00 e2.41 2.41
ST 17.01 3.12 10.90 23.12 56.19 4.24 47.88 64.51
STTZ 22.83 3.93 15.13 30.54 58.25 4.57 49.30 67.20
ORIGINAL ARTICLE
Supplementary Table 33. Comparison of Surgical Exposure for the Roof of the Cavernous Sinus
EET 0.00 0.00 e6.16 6.16 0.00 0.00 e7.97 7.97

EETI 0.00 0.00 e6.36 6.36 0.00 0.00 e8.16 8.16
EETI 3.29 3.29 e6.45 6.45 1.18 4.05 e6.76 9.12
FTOZ 40.83 3.96 33.07 48.59 60.92 4.81 51.50 70.34
FTOZCLIN 48.75 4.30 40.32 57.17 68.70 5.01 58.89 78.51
ILTEA 0.00 0.00 e6.22 6.22 0.03 0.00 e7.90 7.96
MPT 21.75 3.14 15.60 27.90 34.79 4.12 26.71 42.87
MPTCLIN 31.08 3.21 24.78 37.38 44.43 4.41 35.79 53.07
PT 35.08 3.80 27.63 42.52 52.56 4.89 42.97 62.16
PTCLIN 43.75 4.13 35.65 51.85 57.84 5.05 47.94 67.74
PTTZ 39.44 5.25 29.16 49.72 49.78 6.37 37.30 62.26
PTTZCLIN 52.20 4.77 42.85 61.55 62.54 5.62 51.51 73.56
SEY 0.00 0.00 e6.43 6.43 0.30 4.16 e7.86 8.46
SO 12.48 2.89 6.82 18.15 27.92 3.72 20.63 35.21
SOCLIN 18.38 2.64 13.21 23.54 36.49 4.40 27.87 45.11
ST 1.04 3.31 e5.45 7.54 1.29 4.32 e7.18 9.76
STTZ 0.60 3.36 e5.99 7.18 4.89 4.92 e4.76 14.55
ORIGINAL ARTICLE
Supplementary Table 34. Comparison of Surgical Exposure for the Squamous Region
EET 0.42 0.95 e1.45 2.29 4.56 1.44 1.74 7.38

EETI 3.50 1.86 e0.15 7.15 18.46 4.55 9.55 27.37
EETI 4.81 1.59 1.70 7.92 18.58 2.15 14.37 22.79
FTOZ 0.00 0.00 e1.90 1.90 1.24 1.16 e1.04 3.52
FTOZCLIN 0.00 0.00 e1.94 1.94 2.25 1.58 e0.85 5.36
ILTEA 12.68 2.12 8.54 16.83 43.92 4.19 35.72 52.13
MPT 0.00 0.00 e1.86 1.86 0.00 0.00 e1.95 1.95
MPTCLIN 0.00 0.00 e1.92 1.92 0.00 0.00 e1.89 1.89
PT 0.00 0.00 e1.80 1.80 0.00 0.00 e1.92 1.92
PTCLIN 0.00 0.00 e1.91 1.91 0.00 0.00 e1.92 1.92
PTTZ 0.50 0.96 e1.38 2.38 3.38 1.43 0.58 6.17
PTTZCLIN 0.00 0.00 e1.89 1.89 2.86 1.45 0.01 5.70
SEY 9.35 2.36 4.72 13.97 28.42 5.12 18.38 38.45
SO 0.00 0.00 e1.91 1.91 0.00 0.00 e1.92 1.92
SOCLIN 0.00 0.00 e1.81 1.81 0.00 0.00 e1.98 1.98
ST 38.30 5.23 28.05 48.55 95.03 1.78 91.55 98.52
STTZ 42.12 5.09 32.14 52.10 98.11 1.68 94.82 101.41

Quantitative Anatomical Comparison of Anterior, Anterolateral and Lateral, Microsurgical and Endoscopic Approaches To The Middle Cranial Fossa

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Quantitative Anatomical Comparison of Anterior, Anterolateral and Lateral, Microsurgical and Endoscopic Approaches To The Middle Cranial Fossa

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Quantitative Anatomical Comparison of Anterior, Anterolateral and Lateral, Microsurgical

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Table 1. Principal Findings of This Study

Figure 3. Radar diagrams documenting percentage of exposed macroregions by each

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Spheno-Orbital Region Squamous Region

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approaches provide a clear advantage and zygoma resection might CONCLUSIONS

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Mean SE Min. Max Mean SE Min. Max

EET 41.55 4.37 32.99 50.10 54.65 5.14 44.58 64.72

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Supplementary Table 2. Comparison of Surgical Exposure for Gasserian Ganglion

Mean SE Min. Max Mean SE Min. Max

EET 52.10 3.99 44.28 59.93 77.88 3.24 71.53 84.23

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Supplementary Table 3. Comparison of Surgical Exposure for Ophthalmic Nerve—Lateral Part

Mean SE Min. Max Mean SE Min. Max

EET 6.02 3.21 e0.28 12.32 14.41 4.75 5.10 23.72

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Supplementary Table 4. Comparison of Surgical Exposure for Ophthalmic Nerve—Medial Part

Mean SE Min. Max Mean SE Min. Max

EET 5.55 3.04 e0.41 11.52 20.93 5.51 10.14 31.73

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Supplementary Table 5. Comparison of Surgical Exposure for Maxillary Nerve—Lateral Part

Mean SE Min. Max Mean SE Min. Max

EET 80.80 5.66 69.71 91.89 90.40 5.05 80.50 100.30

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Supplementary Table 6. Comparison of Surgical Exposure for Maxillary Nerve—Medial Part

Mean SE Min. Max Mean SE Min. Max

EET 81.61 6.02 69.80 93.41 80.61 6.85 67.20 94.03

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Supplementary Table 7. Comparison of Surgical Exposure for Foramen Rotundum—Lateral Part

Mean SE Min. Max Mean SE Min. Max

EET 60.89 7.54 46.12 75.66 74.98 7.98 59.33 90.62

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Supplementary Table 8. Comparison of Surgical Exposure for Foramen Rotundum—Medial Part

Mean SE Min. Max Mean SE Min. Max

EET 61.42 7.40 46.92 75.91 81.50 6.56 68.65 94.35

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Supplementary Table 9. Comparison of Surgical Exposure for Mandibular Nerve—Lateral Part

Mean SE Min. Max Mean SE Min. Max

EET 76.36 6.56 63.50 89.22 83.41 6.03 71.59 95.23

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Mean SE Min. Max Mean SE Min. Max

EET 70.00 7.90 54.51 85.49 79.27 6.49 66.54 91.99

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Mean SE Min. Max Mean SE Min. Max

EET 32.91 6.53 20.12 45.71 53.79 7.61 38.87 68.70

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Mean SE Min. Max Mean SE Min. Max