Comparative Analysis of the Exposure and Surgical Freedom of the Endoscopic Extended Minipterional Craniotomy and the Transorbital Endoscopic Approach to the Anterior and Middle Cranial Fossae

Noiphithak, Raywat; Yanez‐Siller, Juan C.; Barbero, J. Manuel Revuelta; Cho, Raymond I.; Otto, Bradley A.; Carrau, Ricardo L.; Prevedello, Daniel M.

doi:10.1093/ons/opy309

Cited by 30 publications

(30 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The technique of eTOA has already been described in detail in the previous literature. 4,[10][11][12] Briefly, under general anesthesia, the patient was placed in the supine position with either a slight flexion of the head or the head in the neutral position. A skin incision was made along the superior eyelid crease after the induction of local anesthesia.…”

Section: Surgical Techniquementioning

confidence: 99%

Optimal indications and limitations of endoscopic transorbital superior eyelid surgery for spheno-orbital meningiomas

Kong

Kim

Hong

2021

Journal of Neurosurgery

View full text Add to dashboard Cite

OBJECTIVESpheno-orbital meningiomas (SOMs) are complicated tumors that involve multiple structures at initial presentation, such as the orbit, temporalis muscle, sphenoidal bone, cavernous sinus, and temporal or infratemporal fossa. The infiltrative growth and complexity of this type of meningioma make total resection impossible. In this study, the authors evaluated the surgical outcome of the endoscopic transorbital approach (eTOA) for SOM. In addition, they identified optimal indications for the use of eTOA and analyzed the feasibility of this approach as a minimally invasive surgery for SOMs of varying types and locations at presentation.METHODSBetween September 2016 and December 2019, the authors performed eTOA in 41 patients with SOM with or without orbital involvement at 3 independent tertiary institutions. The authors evaluated the surgical outcomes of eTOA for SOM and investigated several factors that affect the outcome, such as tumor volume, tumor location, and the presence of lateral orbitotomy. Gross-total resection (GTR) was defined as complete resection of the tumor or intended subtotal resection except the cavernous sinus. This study was undertaken as a multicenter project (006) of the Korean Society of Endoscopic Neurosurgery (KOSEN-006).RESULTSThere were 41 patients (5 men and 36 women) with a median age of 52.0 years (range 24–73 years). Twenty-one patients had tumors that involved the orbital structure, while 14 patients had tumors that presented at the sphenoidal bone along with other structures, such as the cavernous sinus, temporal fossa, and infratemporal fossa. Fifteen patients had the globulous type of tumor and 26 patients had the en plaque type. Overall, GTR was achieved in 21 of 41 patients (51.2%), and complications included CSF leaks in 2 patients and wound complications in 2 patients. Multiple logistic regression analysis showed that the en plaque type of tumor, absence of lateral orbital rim osteotomy, involvement of the temporal floor or infratemporal fossa, and involvement of the orbit and medial one-third of the greater sphenoidal wing were closely associated with lower GTR rates (p < 0.05). Multivariate analysis revealed that the en plaque type of tumor and the absence of lateral orbital rim osteotomy were significant predictors for lower GTR rate.CONCLUSIONSThe en plaque type of SOM remains a challenge despite advances in technique such as minimally invasive surgery. Overall, clinical outcome of eTOA for SOM was comparable to the transcranial surgery. To achieve GTR, eTOA is recommended, with additional lateral orbital rim osteotomy for globulous-type tumors, without involving the floor of the temporal and infratemporal fossa.

show abstract

Section: Surgical Techniquementioning

confidence: 99%

Optimal indications and limitations of endoscopic transorbital superior eyelid surgery for spheno-orbital meningiomas

Kong

Kim

Hong

2021

Journal of Neurosurgery

View full text Add to dashboard Cite

show abstract

“…If needed, removal of the superior orbital wall is possible, exposing the entire ACF from the midline to its most lateral point. Suchlike, the removal of the lateral orbital wall may help for an adequate view of MCF, from the lateral wall of the cavernous sinus to the lateral aspect of the temporal lobe [51].…”

Section: Discussionmentioning

confidence: 99%

“…This may also result in cardiac arrhythmias, thus, frequent monitoring of pupil size and blood pressure, along with electrocardiography, is required [29]. Intermittent relaxation of the eyeball every 20-30 min during the procedure and keeping tissues dislocation less than 10 mm is recommended [5,48,51].…”

Section: Discussionmentioning

confidence: 99%

“…3, 4, 5, 6, 7, 8, and 9) [47]. Several variants of these pillar approaches have been described over the last decade in clinical and anatomical studies, each aiming to facilitate surgical goals [8,9,20,24,25,29,33,44,[50][51][52]59]. A thorough understanding of the anatomy of the eyelid is essential in each approach, and possible need for a reconstruction and additional corridors (i.e., multiportal approach) must also be precisely planned before surgery.…”

Section: Surgical Techniquesmentioning

confidence: 99%

See 1 more Smart Citation

Transorbital endoscopic approaches to the skull base: a systematic literature review and anatomical description

et al. 2021

View full text Add to dashboard Cite

Transorbital endoscopic approaches are increasing in popularity as they provide corridors to reach various areas of the ventral skull base through the orbit. They can be used either alone or in combination with different approaches when dealing with the pathologies of the skull base. The objective of the current study is to evaluate the surgical anatomy of transorbital endoscopic approaches by cadaver dissections as well as providing objective clinical data on their actual employment and morbidity through a systematic review of the current literature. Four cadaveric specimens were dissected, and step-by-step dissection of each endoscopic transorbital approach was performed to identify the main anatomic landmarks and corridors. A systematic review with pooled analysis of the current literature from January 2000 to April 2020 was performed and the related studies were analyzed. Main anatomical landmarks are presented based on the anatomical study and systematic review of the literature. With emphasis on the specific transorbital approach used, indications, surgical technique, and complications are reviewed through the systematic review of 42 studies (19 in vivo and 23 anatomical dissections) including 193 patients. In conclusion, transorbital endoscopic approaches are promising and appear as feasible techniques for the surgical treatment of skull base lesions. Surgical anatomy of transorbital endoscopic approaches can be mastered through knowledge of a number of anatomical landmarks. Based on data available in the literature, transorbital endoscopic approaches represent an important complementary that should be included in the armamentarium of a skull base team.

show abstract

“…Some authors have suggested that vascular lesions and aneurysms cannot be safely treated using MIAs without endoscopic assistance. 22,26,30 However, all dissections in our study were carried out using only microsurgical techniques, and adequate exposure and freedom were obtained without undue difficulty.…”

Section: Discussionmentioning

confidence: 99%

Comparative anatomical analysis between the minipterional and supraorbital approaches

Martínez-Pérez¹,

Albonette-Felicio²,

Hardesty

et al. 2021

Journal of Neurosurgery

View full text Add to dashboard Cite

OBJECTIVEKeyhole approaches, namely the minipterional approach (MPTa) and the supraorbital approach (SOa), are alternatives to the standard pterional approach to treat lesions located in the anterior and middle cranial fossae. Despite their increasing popularity and acceptance, the indications and limitations of these approaches require further assessment. The purpose of the present study was to determine the differences in the area of surgical exposure and surgical maneuverability provided by the MPTa and SOa.METHODSThe areas of surgical exposure afforded by the MPTa and SOa were analyzed in 12 sides of cadaver heads by using a microscope and a neuronavigation system. The area of exposure of the region of interest and surgical freedom (maneuverability) of each approach were calculated.RESULTSThe area of exposure was significantly larger in the MPTa than in the SOa (1250 ± 223 mm2 vs 939 ± 139 mm2, p = 0.002). The MPTa provided larger areas of exposure in the ipsilateral and midline compartments, whereas there was no significant difference in the area of exposure in the contralateral compartment. All targets in the anterior circulation had significantly larger areas of surgical freedom when treated via the MPTa versus the SOa.CONCLUSIONSThe MPTa provides greater surgical exposure and better maneuverability than that offered by the SOa. The SOa may be advantageous as a direct corridor for treating lesions located in the contralateral side or in the anterior cranial fossa, but the surgical exposure provided in the midline region is inferior to that exposed by the MPTa.

show abstract

Comparative Analysis of the Exposure and Surgical Freedom of the Endoscopic Extended Minipterional Craniotomy and the Transorbital Endoscopic Approach to the Anterior and Middle Cranial Fossae

Cited by 30 publications

References 24 publications

Optimal indications and limitations of endoscopic transorbital superior eyelid surgery for spheno-orbital meningiomas

Optimal indications and limitations of endoscopic transorbital superior eyelid surgery for spheno-orbital meningiomas

Transorbital endoscopic approaches to the skull base: a systematic literature review and anatomical description

Comparative anatomical analysis between the minipterional and supraorbital approaches

Contact Info

Product

Resources

About