Endoscopic transorbital surgery for Meckel’s cave and middle cranial fossa tumors: surgical technique and early results

Jeon, Chanhyung; Hong, Chang-Ki; Woo, Kyung In; Hong, Sang Duk; Nam, Do‐Hyun; Lee, Jung-Il; Choi, Jung Won; Seol, Ho Jun; Kong, Doo‐Sik

doi:10.3171/2018.6.jns181099

Cited by 63 publications

(65 citation statements)

References 41 publications

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“…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%

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

et al. 2021

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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.

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Section: Surgical Techniquesmentioning

confidence: 99%

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

et al. 2021

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“…First, duplicates (n = 89) and non-English abstracts (n = 25) were removed; thereafter, 157 abstracts were screened for relevance resulting in the full-text evaluation of 112 articles. Subsequently, 75 articles were identified for our qualitative synthesis and included case reports (n = 21) , cadaveric studies (n = 32) [3,6,7,10,13,, clinical articles (n = 16) [2,5,8,9,16,[61][62][63][64][65][66][67][68][69][70][71], review of the literatures (n = 3) [72][73][74], as well as technical notes (n = 2) [75,76] and a radiological manuscript (n = 1) [77]. These outlined articles were published between February 1978 and November 2018.…”

Section: Resultsmentioning

confidence: 99%

“…This approach targets the anterolateral and superior region of Meckel's cave. Jeon et al demonstrated in a recent series of nine patients, seven of them with diseases involving Meckel's cave, the feasibility of this novel technique [65]. Even though the sample size is small and the follow-up time was short, the authors reported low morbidity with a single patient suffering of ptosis, which eventually recovered after 6 months.…”

Section: Transorbitalmentioning

confidence: 98%

Access to Meckel’s cave for biopsies of indeterminate lesions: a systematic review

et al. 2020

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Accessing Meckel's cave (MC) is surgically challenging. Open approaches are complex and often correlated with high morbidity. Endoscopic approaches emerged in the last decade as feasible alternatives to open approaches, especially for sampling indeterminate lesions. This article first analyses available routes to approach Meckel's cave and presents furthermore an illustrative case. We conducted a systematic review and reported according to the guidelines for preferred reporting items for systematic reviews and meta-analyses (PRISMA). Various surgical approaches identified through the search are evaluated and discussed in detail. Additionally, we report on a case of woman with a lesion in MC, which was accessed through an endoscopic transpterygoid approach subsequently diagnosed as a diffuse large B cell lymphoma. Our search delivered 75 articles that included case reports (n = 21), cadaveric studies (n = 32), clinical articles (n = 16), review of the literatures (n = 3), as well as technical notes (n = 2) and a radiological manuscript (n = 1). Open routes included lateral approaches with many variations, mainly intra-and extradural pterional approaches and anterior petrosal, as well as a retrosigmoid intradural suprameatal and a lateral transorbital approach. Endoscopically, MC was reached via approaches that included transpterygoid, transorbital or infraorbital fissure routes. Percutaneous approaches, e.g. through the foramen ovale, were also described. Multiple surgical approaches to MC are currently available. Their different characteristics as well as individual patient factors, such as clinical history and the localization of the disease, have to be considered when choosing a surgical corridor. Studies included in this review highlight the endonasal endoscopic transpterygoidal technique as an excellent corridor for biopsies in the ventral MC.

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“…6,7 Their potential for damaging the temporalis muscle and the need for retraction of the temporal lobe have fostered the development of other minimally invasive techniques. 8 During the past decade, other minimal access techniques (ie, transorbital approach, 9 transantral, and modified EEA techniques 10,11 ) to the floor of MCF have emerged.…”

Section: Introductionmentioning

confidence: 99%

The Anterolateral Triangle: Implications for a Transnasal Prelacrimal Approach to the Floor of the Middle Cranial Fossa

London

Prevedello

et al. 2020

Am J Rhinol�Allergy

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Background The anterolateral triangle enclosed by the foramen rotundum and foramen ovale constitutes part of the floor of the middle cranial fossa (MCF). Objective To assess the feasibility of a transnasal prelacrimal approach for accessing the floor of MCF via an anterolateral triangle corridor and to determine the extent of maximal exposure while safeguarding neurovascular structures. Methods A transnasal prelacrimal approach was performed in 5 cadaveric specimens (10 sides). Following the identification of foramen rotundum and foramen ovale, the bony ridge between 2 was drilled to expose the MCF. The temporal lobe dura was then elevated laterally, and the distances from foramen ovale to the respective borders of the area of the MCF window were measured using a surgical navigation device. Results The MCF was exposed with a 0° scope in all specimens also exposing significant landmarks including the middle meningeal artery, greater superficial petrosal nerve, superior petrous sinus, and arcuate eminence. Average distances from foramen ovale to the anterior, posterior, and lateral exposed borders were 22.86 ± 1.87 mm, 27.24 ± 0.94 mm, and 24.23 ± 1.61 mm, respectively. The average area of exposed MCF window was 554.12 ± 60.22 mm2. Preservation of vidian nerve, greater palatine nerve, lateral nasal wall, and nasolacrimal duct was possible in all 10 sides. Conclusion It is feasible to access the floor of MCF via an endoscopic transnasal prelacrimal approach with seemingly low risk.

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Endoscopic transorbital surgery for Meckel’s cave and middle cranial fossa tumors: surgical technique and early results

Cited by 63 publications

References 41 publications

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

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

Access to Meckel’s cave for biopsies of indeterminate lesions: a systematic review

The Anterolateral Triangle: Implications for a Transnasal Prelacrimal Approach to the Floor of the Middle Cranial Fossa

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