Endoscopic extradural supraorbital approach to the temporal pole and adjacent area: technical note

Abstract

The authors' initial experience with the endoscopic extradural supraorbital approach to the temporal pole and adjacent area is reported. Fully endoscopic surgery using the extradural space via a supraorbital keyhole was performed for tumors in or around the temporal pole, including temporal pole cavernous angioma, sphenoid ridge meningioma, and cavernous sinus pituitary adenoma, mainly using 4-mm, 0° and 30° endoscopes and single-shaft instruments. After making a supraorbital keyhole, a 4-mm, 30° endoscope was advanced into the extradural space of the anterior cranial fossa during lifting of the dura mater. Following identification of the sphenoid ridge, orbital roof, and anterior clinoid process, the bone lateral to the orbital roof was drilled off until the dura mater of the anterior aspect of the temporal lobe was exposed. The dura mater of the temporal lobe was incised and opened, exposing the temporal pole under a 4-mm, 0° endoscope. Tumors in or around the temporal pole were safely removed under a superb view through the extradural corridor. The endoscopic extradural supraorbital approach was technically feasible and safe. The anterior trajectory to the temporal pole using the extradural space under endoscopy provided excellent visibility, allowing minimally invasive surgery. Further surgical experience and development of specialized instruments would promote this approach as an alternative surgical option.

Minimally Invasive Subfrontal Approach: How to Make it Safe and Effective from the Olfactory Groove to the Mesial Temporal Lobe

“…We identified three major subfrontal corridors accessible through an MISFA: extended medial, medial, and lateral corridors. The latter is less analyzed in the literature, 4,40,41 but it carries an interesting peculiarity. In fact, through a straight subfrontal route, resection of mesial temporal lesions (gliomas, cavernomas) can be accomplished without any damage to the temporal stem, which notably incorporates the uncinate fasciculus and the inferior fronto-occipital fasciculus.…”

Extradural anterior clinoidectomy and aneurysm clipping using transcranial neuroendoscopic approach

“…To date, only 1 clinical case of extradural anterior clinoidectomy has been performed by neuroendoscopy to resect a cavernous sinus pituitary adenoma; the anterior clinoid process was easily removed because of bone erosion to the optic strut by the tumor. [6] But this case involved a pathological anterior clinoid process which was corroded by pituitary adenoma. So there was requirement for normal anterior clinoid process removal by neuroendoscopy.…”