Lateral Transorbital Endoscopic Access to the Hippocampus, Amygdala, and Entorhinal Cortex: Initial Clinical Experience

Abstract

Background/Aims: Transorbital approaches traditionally have focused on skull base and cavernous sinus lesions medial to the globe. Lateral orbital approaches to the temporal lobe have not been widely explored despite several theoretical advantages compared to open craniotomy. Recently, we demonstrated the feasibility of the lateral transorbital technique in cadaveric specimens with endoscopic visualization. We describe our initial clinical experience with the endoscope-assisted lateral transorbital approach to lesions in the temporal lobe. Methods: Two patients with mesial temporal lobe pathology presenting with seizures underwent surgery. The use of a transpalpebral or Stallard-Wright eyebrow incision enabled access to the intraorbital compartment, and a lateral orbital wall 'keyhole' opening permitted visualization of the anterior temporal pole. Results: This approach afforded adequate access to the surgical target and surrounding structures and was well tolerated by the patients. To the best of our knowledge, this report constitutes the first case series describing the endoscope-assisted lateral transorbital approach to the temporal lobe. We discuss the limits of exposure, the nuances of opening and closing, and comparisons to open craniotomy. Conclusion: Further prospective investigation of this approach is warranted for comparison to traditional approaches to the mesial temporal lobe.

Surgery around the Orbit: How to Select an Approach

“…Otherwise, several possibilities of skull base transorbital reconstructions exist (see above), with very low risk of postoperative CSF leak, given the critical support offered by the orbit to the skull base reconstruction. 10,37…”

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

“…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.…”

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

“…Compared with different endoscopic approaches to the temporal pole, the endoscopic extradural supraorbital approach has the ability to expand the accessible area. 4,14 The applicable area of exposure is similar to that in the conventional extradural frontotemporal approach by craniotomy. Depending on the target pathology, bone removal in the extradural space would be modified, and the optimal corridor could be prepared.…”