Endoscopic transorbital transtentorial approach to middle incisural space: preclinical cadaveric study

Lin, Benjamin C.; Hong, Kun-Ting; Chung, Tzu-Tsao; Liu, Wei-Hsiu; Hueng, Dueng‐Yuan; Chen, Yuan-Hao; Ju, Da‐Tong; Ma, Hsin‐I; Liu, Mingying; Hung, Hung-Chang; Tang, Chi‐Tun

doi:10.1007/s00701-019-03831-6

Cited by 17 publications

(15 citation statements)

References 22 publications

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“…Although eTOA is a minimally invasive technique for deep-seated orbital and skull base lesions, surgical maneuverability in a narrow surgical corridor remains a challenge. 1,12,[16][17][18][19][20][21][22][23][24][25][26][27][28] To gain surgical freedom during eTOA, a limited lateral orbital rim osteotomy may be helpful. 16,29 A and B) and postoperative (C and D) axial and coronal MR images after GTR (cases 1, 2, and 3).…”

Section: Study Limitations: Surgical Maneuverabilitymentioning

confidence: 99%

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

Kong

Kim

Hong

2021

Journal of Neurosurgery

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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.

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Section: Study Limitations: Surgical Maneuverabilitymentioning

confidence: 99%

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

Kong

Kim

Hong

2021

Journal of Neurosurgery

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“…If a more lateral corridor is needed, detachment of lateral canthal ligament can be done [26]. Diamond burr or a chisel is used to perform the craniectomy, which is sized and located depending on the targeted area [16,37,56]. The dura of the ACF and MCF can be elevated and/or incised based on the situation of the disease.…”

Section: Superior Eyelid Crease Approachmentioning

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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“…Additionally, the endoscopic sublabial transmaxillary approach was introduced as another choice of minimally invasive access to the anterolateral skull base 5,6 . Accompanying with introduction of endoscopic transorbital route as a novel and minimally invasive access to the skull base, significant interest has been invested in the extensive application to different area of interest 7‐13 . In a cadaveric study, Lin et al described that the endoscopic transorbital approach through inferior orbital fissure was feasible to access the anterolateral skull base without sacrificing any critical neurovascular structure 13 …”

Section: Introductionmentioning

confidence: 99%

“…5,6 Accompanying with introduction of endoscopic transorbital route as a novel and minimally invasive access to the skull base, significant interest has been invested in the extensive application to different area of interest. [7][8][9][10][11][12][13] In a cadaveric study, Lin et al described that the endoscopic transorbital approach through inferior orbital fissure was feasible to access the anterolateral skull base without sacrificing any critical neurovascular structure. 13 Being newly developed approach to the anterolateral skull base, the superiority of endoscopic transorbital route is unknown.…”

Section: Introductionmentioning

confidence: 99%

Quantitative comparison of endoscopically assisted endonasal, sublabial and transorbital transmaxillary approaches to the anterolateral skull base

Lin

Hsu

et al. 2020

Clinical Otolaryngology

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Objectives: The aim of this anatomical study is to make quantitative comparison among three endoscopic approaches, encompassing contralateral endonasal transseptal transmaxillary transpterygoid approach (contralateral EEA), endoscopic sublabial transmaxillary transalisphenoid (Caldwell-Luc) approach and endoscopic transorbital transmaxillary approach through inferior orbital fissure (ETOA), to the anterolateral skull base for assisting preoperative planning. Design & Participants: Anatomical dissections were performed in four adult cadaveric heads bilaterally using three endoscopic transmaxillary approaches described above.

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Endoscopic transorbital transtentorial approach to middle incisural space: preclinical cadaveric study

Cited by 17 publications

References 22 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

Quantitative comparison of endoscopically assisted endonasal, sublabial and transorbital transmaxillary approaches to the anterolateral skull base

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