Comparison between olfactory bulb and olfactory tract implantations through an endoscopic supraorbital keyhole approach: a cadaveric study - Scorecard - MDSpire
Clinical Scorecard: A Cadaveric Study on the Endoscopic Supraorbital Keyhole Approach for Implantation of the Olfactory Bulb versus the Olfactory Tract
At a Glance
Category
Detail
Condition
Olfactory loss (anosmia) often post-viral or post-traumatic
Key Mechanisms
Electrical stimulation of olfactory pathways via implants targeting olfactory mucosa, bulb, or central olfactory networks
Target Population
Patients with olfactory loss, especially post-COVID-19 anosmia
Care Setting
Surgical implantation via endoscopic supraorbital keyhole approach in specialized neurosurgical or otolaryngology centers
Key Highlights
Olfactory loss significantly impairs quality of life and increases depression risk.
Olfactory implants involve gas sensors and electrode arrays targeting olfactory mucosa, bulb, or tract.
Supraorbital keyhole approach allows minimally invasive access to olfactory bulb and tract for electrode implantation.
Guideline-Based Recommendations
Diagnosis
Identify olfactory loss etiology including post-viral or post-traumatic causes.
Consider anatomical variability of olfactory bulb and tract via imaging prior to implantation.
Management
Electrical stimulation via olfactory implants targeting dorsal olfactory bulb or ventral olfactory tract.
Prefer non-lesional, reversible electrode placement on dorsal olfactory bulb to preserve residual function.
Consider ventral olfactory tract implantation for easier, more stable electrode placement without orbital roof drilling.
Monitoring & Follow-up
Monitor electrode stability intraoperatively and postoperatively to prevent displacement.
Assess olfactory function and patient safety post-implantation.
Evaluate for potential complications related to surgical approach and electrode placement.
Risks
Potential electrode displacement due to cerebrospinal fluid flow in olfactory cistern.
Surgical risks related to orbital roof drilling when accessing olfactory bulb.
Possible damage to olfactory structures if electrode placement is invasive or requires detachment.
Patient & Prescribing Data
Individuals with olfactory loss, particularly post-COVID-19 anosmia or traumatic anosmia
Olfactory implants using a 12-contact electrode array can be placed via supraorbital keyhole approach; ventral olfactory tract implantation may offer improved stability and less invasive access compared to dorsal olfactory bulb implantation.
Clinical Best Practices
Use a supraorbital keyhole approach with a 2 × 3 cm craniotomy above the orbital roof for electrode implantation.
Avoid orbital roof drilling when targeting the olfactory tract to reduce operative time and invasiveness.
Place electrodes on the dorsal olfactory bulb to preserve residual olfactory function and allow reversibility.
Consider anatomical variations and vascular structures to optimize electrode placement and minimize complications.
Employ endoscopic visualization and angled instruments for precise electrode positioning.
