Transcranial Approaches to the Orbit

Gardner, Paul A.; Zenonos, Georgios A.; Formentin, Cleiton; Pichugin, Arseniy

doi:10.1055/s-0040-1713855

Cited by 5 publications

(9 citation statements)

References 10 publications

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“…These techniques remain valuable for lesions with intracranial extension as they provide visualization of the superolateral aspect of the orbit. 1,16,17 They can also be modified to gain access to the superomedial and inferolateral orbit. External approaches are also useful when dural or orbital reconstruction is needed.…”

Section: Discussionmentioning

confidence: 99%

“…External approaches are also useful when dural or orbital reconstruction is needed. 1 The surgical exposure and maneuverability provid-ed by transcranial approaches are uncontested; however, they may require retraction of the brain or globe, placing patients at risk of associated complications. 1 Conversely, the EEA is generally limited in ability to address tumors extending beyond the medial orbit but avoids retraction of the brain or globe.…”

Section: Discussionmentioning

confidence: 99%

“…1 The surgical exposure and maneuverability provid-ed by transcranial approaches are uncontested; however, they may require retraction of the brain or globe, placing patients at risk of associated complications. 1 Conversely, the EEA is generally limited in ability to address tumors extending beyond the medial orbit but avoids retraction of the brain or globe. Surgical approaches to the medial orbit and the ethmoid cavity have also been described utilizing the orbit as a corridor.…”

Section: Discussionmentioning

confidence: 99%

“…Transcranial approaches provide access for invasive tumors involving the posterior third of the orbit and those extending to other cranial compartments. [1][2][3] Transorbital approaches have also been successfully used for the management of intrinsic orbital pathology. 4 Endoscopic approaches allow access to medially based lesions within the orbit through a natural corridor and minimize manipulation of the globe and intraconal neurovascular structures.…”

Section: Introductionmentioning

confidence: 99%

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The Role of the Transeptal Window in Endoscopic Endonasal Access to the Contralateral Orbit

Revuelta-Barbero,

Rodas,

Porto

et al. 2023

J Neurol Surg B Skull Base

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Objective This study aimed to objectively compare maneuverability at the contralateral medial orbit when approached through the traditional endoscopic endonasal approach (EEA) and EEA with transeptal window (TW). Study Design Anatomic dissections were performed bilaterally on three latex-injected cadaveric heads.  Approaches were performed sequentially; initially, an EEA was fashioned. Binostril access was achieved through a 2-cm posterior septectomy. The second stage pertained to the TW dissection. Area of exposure (AoE), surgical freedom (SF), and angles of attack (AoA) were measured along the contralateral medial orbital wall and compared for each approach. Additionally, the study presents an illustrative case describing the application of the EEA + TW for resection of an intraorbital schwannoma. Results Compared with EEA, EEA + TW yielded a significantly greater AoE along the contralateral medial orbital wall (39.45 vs. 48.45 cm2, respectively; p = 0.002). SF was statistically different between the EEA and EEA + TW (1153.25 vs. 2256.33 cm2, respectively; p = 0.002). AoA in the horizontal plane were significantly broader with the EEA + TW (6.36 vs. 4.9 degrees by EEA; p = 0.015).A 50-year-old male with a right medial extraconal orbital tumor was successfully treated through an EEA using the transeptal corridor to access the medial orbital region. No long-term complications were encountered after 31 months of follow-up. Conclusions EEA + TW is a minimally invasive technique that maximizes exposure and maneuverability within the medial orbital wall, allowing resection of lesions that extend anteriorly. EEA + TW limits disruption of the nasal septum and overcomes the obstacle that intranasal anatomy represents for instrumentation.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

The Role of the Transeptal Window in Endoscopic Endonasal Access to the Contralateral Orbit

Revuelta-Barbero,

Rodas,

Porto

et al. 2023

J Neurol Surg B Skull Base

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“…Generally, removal of the orbital bar is not necessary to access the anterior superior lateral orbit. 24 However, it makes it easier to access the orbit with less retraction of the brain that is needed to be considered, particularly in young and middle-aged patients.…”

Section: Discussionmentioning

confidence: 99%

Pilocytic astrocytoma of the optic nerve with intracystic hemorrhage in an adult: illustrative case

Kuramitsu¹,

Suzaki²,

Takahashi³

et al. 2022

Journal of Neurosurgery: Case Lessons

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BACKGROUND Optic pathway gliomas are uncommon, accounting for 3–5% of childhood brain tumors, and are mostly classified as pilocytic astrocytomas (PAs). PAs of the optic nerve are particularly rare in adults. OBSERVATIONS The authors presented the case of PA of the left optic nerve in a 49-year-old woman along with detailed pathological and molecular analyses and sequential magnetic resonance imaging. The tumor had progressed during 5 years of follow-up along with cyst formation and intracystic hemorrhage; it had a thick capsule and contained xanthochromic fluid. The boundary between tumor and optic nerve was unclear. B-type Raf kinase (BRAF) V600E point mutations or translocations, IDH1-R132H mutations, loss of alpha-thalassemia/mental retardation X-linked, and 1p/19q codeletion were negative. LESSONS BRAF alterations in pediatric PAs of the optic nerve are less frequent than those observed in PAs in other lesions; the same molecular pattern was observed in the adult case, without changes in BRAF. Surgical management should be indicated only in cases with severely impaired vision or disfigurement because there is no clear border between the tumor and optic nerve. Further discussion is needed to optimize the treatment for adult optic pathway gliomas, including radiotherapy, chemotherapy, and molecular-targeted therapies, in addition to surgical intervention.

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