Multilayered macular hemorrhages as an unusual complication of transorbital neuroendoscopic surgery

Foulsham, William; North, Victoria S.; Botsford, Benjamin; Dinkin, Marc; Henderson, Fraser; Godfrey, Kyle J.; D’Amico, Donald J.; Schwartz, Theodore H.; Orlin, Anton

doi:10.1016/j.ajoc.2022.101556

Cited by 7 publications

(4 citation statements)

References 20 publications

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“…17 However, to date, our case is the only one reported in the literature after eLTOA, so we believe that this outcome was an exception, rather than common. 22 Our second complication was a pseudomeningocele, which resolved with lumbar drainage. In this case, we had a large dural opening, and we failed to place abdominal fat in the cavity.…”

Section: Discussionmentioning

confidence: 84%

The Endoscopic Lateral Transorbital Approach for the Removal of Select Sphenoid Wing and Middle Fossa Meningiomas. Surgical Technique and Short-Term Outcomes

Carnevale,

Rosen,

Chae

et al. 2023

Operative Neurosurgery

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BACKGROUND AND OBJECTIVE: The endoscopic lateral transorbital approach (eLTOA) is a relatively new approach to the skull base that has only recently been applied in vivo in the management of complex skull base pathology. Most meningiomas removed with this approach have been in the spheno-orbital location. We present a series of select purely sphenoid wing and middle fossa meningiomas removed through eLTOA. The objective here was to describe the selection criteria and results of eLTOA for a subset of sphenoid wing and middle fossa meningiomas. METHODS: This is a retrospective study based on a prospectively maintained database of consecutive cases of eLTOA operated on at our institution by the lead author. The cohort's clinical and radiographic characteristics and outcome are presented. RESULTS: Five patients underwent eLTOA to remove 3 sphenoid wing and 2 middle fossa meningiomas. The mean tumor volume was 11.9 cm3. Gross total resection was achieved in all cases. There were no intraoperative complications. Postoperatively, there was one case of subretinal hemorrhage, which was corrected by open vitrectomy repair, and one case of cerebrospinal fluid leak, which resolved with lumbar drainage. Three patients presented with visual impairment, 1 improved, 1 remained stable, and 1 worsened, but returned to stable after vitrectomy repair. All patients have been free of disease at a median follow-up of 8.9 months. CONCLUSION: eLTOA provides a direct minimal access corridor to certain well-selected sphenoid wing and middle fossa meningiomas. eLTOA minimizes brain retraction and provides a high rate of gross total resection. Meningiomas appropriately selected based on size, type, and location of dural attachment, and the eLTOA is a safe, rapid, and highly effective procedure with acceptable morbidity.

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Section: Discussionmentioning

confidence: 84%

The Endoscopic Lateral Transorbital Approach for the Removal of Select Sphenoid Wing and Middle Fossa Meningiomas. Surgical Technique and Short-Term Outcomes

Carnevale,

Rosen,

Chae

et al. 2023

Operative Neurosurgery

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“…This nally led to the appearance and publication of several series of cases around 2018-2019, which is the last key moment identi ed in our analyses, causing a new increase in the number of publications. In 2019, 92 publications related to the transorbital approach were identi ed, being the year with the highest annual number of publications in our analysis 7,9,11,[15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34] (see Fig. 1).…”

Section: Annual Absolute Number Of Publicationsmentioning

confidence: 99%

Transorbital Approach Scientific Trend: Analysis of Publications and Citations Over Years

Codes,

Somma,

Ferrés

et al. 2023

Preprint

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Background: Transorbital approach has gained significant consideration over the last few years, as evidenced by the growing number of publications. The present study aims to describe and quantify the number of publications and citations over the years in order to identify key moments in its history. Methods: Data from annual publications and citations of the transorbital approach between 1950 and 2022 have been extracted from the Web of Science and later uploaded to Microsoft Excel. Three parameters were analyzed: 1) absolute number of publications; 2) annual absolute growth of citations; 3) trend of publications. Results: Results showed an average number of publications of 18.6 with 266 citations per year. Regarding the number of publications, the analysis showed four key moments in history: 1985, 2001, 2010-2011, and 2018-2019. Around 1985, related to studies on transorbital lobotomy. Around 2001, due to experimental studies in vascular pathology. During 2010-2011, when the concept of transorbital neuroendoscopic surgery was introduced. Around 2018-2019, when different case series were published. However, analyzing the annual absolute growth of citations, one key moment was detected: 2019, achieving a significant positive annual growth of +522 citations. The analysis of the publication trend shows a positive trend line, forecasting 60-63 publications per year in the next 3-5 years. Conclusions: Despite the inherent limitation of this study, this analysis showed that the recent 2019 is a turning point for transorbital surgery being the year with the most citations and publications. The following years will determine the exact place of this technique in the skull base armamentarium.

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“…Undoubtedly, the recognition of complications is a fundamental step to guarantee the safety of a new surgical approach. 12…”

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confidence: 99%

“…Undoubtedly, the recognition of complications is a fundamental step to guarantee the safety of a new surgical approach. 12 The aim of this study is to analyze any surgical complication that occurred in our preliminary experience with this technique. Specific focus was driven to the orbital outcomes and subjective patient's satisfaction.…”

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confidence: 99%

Complications of the Superior Eyelid Endoscopic Transorbital Approach to the Skull Base: Preliminary Experience With Specific Focus on Orbital Outcome

Somma¹,

Guizzardi²,

España³

et al. 2023

Journal of Neuro-Ophthalmology

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Background: The endoscopic superior eyelid approach is a relatively novel mini-invasive technique that is currently investigating for skull base cancers. However, questions remain regarding specific approach-related complications when treating different skull base tumors. This study aims to analyze any surgical complications that occurred in our preliminary consecutive experience, with specific focus on orbital outcome. Methods: A retrospective and consecutive cohort of patients treated via a superior eyelid endoscopic transorbital approach at the Division of Neurosurgery of the Hospital Clinic in Barcelona was analyzed. Patients features were described in detail. Complications were divided into 2 groups to analyze separately the approach-related complications, and those resulting from tumor removal. The ocular complications were subdivided into early ocular status (<3 weeks), late ocular status (3–8 weeks), and persistent ocular complications. The “Park questionnaire” was used to determine patient's satisfaction related to the transorbital approach. Results: A total of 20 patients (5 spheno-orbital meningiomas, 1 intradiploic Meningioma, 2 intraconal lesions, 1 temporal pole lesion, 2 trigeminal schwannoma, 3 cavernous sinus lesions, and 6 petroclival lesions) were included in the period 2017–2022. Regarding early ocular status, upper eyelid edema was detected in all cases (100%) associated with diplopia in the lateral gaze in 30% of cases, and periorbital edema in 15% of cases. These aspects tend to resolve at late ocular follow-up (3–8 weeks) in most cases. Regarding persistent ocular complications, in one case of intraconal lesion, a limitation of eye abduction was detected (5%). In another patient with intraconal lesion, an ocular neuropathic pain was reported (5%). In 2 cases of petroclival menigioma, who were also treated with a ventriculo-peritoneal shunt, slight enophthalmus was observed as a persistent complication (10%). According to the Park questionnaire, no cosmetic complaints, no head pain, no palpable cranial irregularities, and no limited mouth opening were reported, and an average of 89% of general satisfaction was encountered. Conclusions: The superior eyelid endoscopic transorbital approach is a safe and satisfactory technique for a diversity of skull base tumors. At late follow-up, upper eyelid edema, diplopia, and periorbital edema tend to resolve. Persistent ocular complications are more frequent after treating intraconal lesions. Enophthalmus may occur in patients with associated ventriculo-peritoneal shunt. According to patient's satisfaction, fairly acceptable results are attained.

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Multilayered macular hemorrhages as an unusual complication of transorbital neuroendoscopic surgery

Cited by 7 publications

References 20 publications

The Endoscopic Lateral Transorbital Approach for the Removal of Select Sphenoid Wing and Middle Fossa Meningiomas. Surgical Technique and Short-Term Outcomes

The Endoscopic Lateral Transorbital Approach for the Removal of Select Sphenoid Wing and Middle Fossa Meningiomas. Surgical Technique and Short-Term Outcomes

Transorbital Approach Scientific Trend: Analysis of Publications and Citations Over Years

Complications of the Superior Eyelid Endoscopic Transorbital Approach to the Skull Base: Preliminary Experience With Specific Focus on Orbital Outcome

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