Transorbital endoscopic assisted management of intraorbital lesions: lessons learned from our first 9 cases

Dallan, Iacopo; Castelnuovo, Paolo; Turri‐Zanoni, Mario; Fiacchini, Giacomo; Locatelli, Davide; Battaglia, Paolo; Sellari–Franceschini, Stefano

doi:10.4193/rhin15.237

Cited by 25 publications

(25 citation statements)

References 15 publications

(20 reference statements)

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“…A promising option for such tumors, which has been recently proposed, is represented by the transpalpebral approach. It gives a direct and straightforward access to lateral quadrants of the orbit through a centimetric skin incision in the eyelid, which has not esthetic consequences (Dallan et al, 2016). Moreover, it allows to resect the lesion with the standard bimanual microsurgical technique with minimal manipulation of the orbital structures (Dallan et al, 2016).…”

Section: :50 Discussion On Possible Surgical Managementmentioning

confidence: 99%

Endoscopic transpalpebral approach for resection of an intraorbital intraconal cavernous angioma

Zoli

Sollini

Asioli

et al. 2019

Neurosurgical Focus: Video

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VIDEO Transcript 0:20 Case presentationThis video represents the surgical management of an intraorbital intraconal cavernous angioma, located laterally to the optic nerve, in the left side.A 47-year-old man presented with a 6-month history or progressive left exophthalmus. An MRI was performed, showing a spotting enhancing lesion mainly located in the superoexternal quadrant of the orbit, medially displacing the optic nerve, compatible for a cavernous angioma. Correspondence

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Section: :50 Discussion On Possible Surgical Managementmentioning

confidence: 99%

Endoscopic transpalpebral approach for resection of an intraorbital intraconal cavernous angioma

Zoli

Sollini

Asioli

et al. 2019

Neurosurgical Focus: Video

View full text Add to dashboard Cite

show abstract

“…Finally, regarding the issue of the transorbital route for intracranial pathology, it should be stressed that at present this kind of approach is still in its infancy, so we have to await further developments, in terms of both surgical technique and surgical tools, to reach proper conclusions. [10][11][12] Above all, the present work has been designed to provide useful anatomical details with regard to the transorbital approach. A peer understanding of the anatomy represents the backbone of any surgical procedure; we aimed to detail the main features of the MOB as the key landmark in identification of the cavernous sinus.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic transorbital route to the cavernous sinus through the meningo-orbital band: a descriptive anatomical study

Dallan

Somma

Prats-Galino

et al. 2017

Journal of Neurosurgery

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OBJECTIVE Exposure of the cavernous sinus is technically challenging. The most common surgical approaches use well-known variations of the standard frontotemporal craniotomy. In this paper the authors describe a novel ventral route that enters the lateral wall of the cavernous sinus through an interdural corridor that includes the removal of the greater sphenoid wing via a purely endoscopic transorbital pathway. METHODS Five human cadaveric heads (10 sides) were dissected at the Laboratory of Surgical NeuroAnatomy of the University of Barcelona. To expose the lateral wall of the cavernous sinus, a superior eyelid endoscopic transorbital approach was performed and the anterior portion of the greater sphenoid wing was removed. The meningo-orbital band was exposed as the key starting point for revealing the cavernous sinus and its contents in a minimally invasive interdural fashion. RESULTS This endoscopic transorbital approach, with partial removal of the greater sphenoid wing followed by a "natural" ventral interdural dissection of the meningo-orbital band, allowed exposure of the entire lateral wall of the cavernous sinus up to the plexiform portion of the trigeminal root and the petrous bone posteriorly and the foramen spinosum, with the middle meningeal artery, laterally. CONCLUSIONS The purely endoscopic transorbital approach through the meningo-orbital band provides a direct view of the cavernous sinus through a simple and rapid means of access. Indeed, this interdural pathway lies in the same sagittal plane as the lateral wall of the cavernous sinus. Advantages include a favorable angle of attack, minimal brain retraction, and the possibility for dissection through the interdural space without entering the neurovascular compartment of the cavernous sinus. Surgical series are needed to demonstrate any clinical advantages and disadvantages of this novel route.

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“…For aggressive tumors, biopsy may be indicated to confirm diagnosis prior to commencing adjuvant therapy [18, 19]. The treatment of ONA is highly individualized, and clinicians should be aware of the benefits and disadvantages of the various treatment options [20]. …”

Section: Discussionmentioning

confidence: 99%

Surgical Management of Pilocytic Astrocytoma of the Optic Nerve: A Case Report and Review of the Literature

Apanisile

Karosi

2017

Case Reports in Oncological Medicine

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Optic nerve astrocytomas (ONAs) are frequent types of optic nerve gliomas (ONGs), which can affect the visual pathway. An 18-year-old male patient was admitted to our department with right-sided intraorbital/retrobulbar swelling, which progressively grew over several months. Clinical examination showed right-sided diplopia, mydriasis, low visual acuity (0.4), exophthalmus (3 cm), epiphora, and severe retrobulbar pain. There was a family history of high-grade (IV) astrocytomas in which two of the family members died due to the disease. Preoperative MRI scan revealed a soft tissue mass around the retrobulbar area of the right eye with intact orbital bony walls. Surgery was performed whereby it was dissected freely from the muscles and was separated from the optic nerve and the globe. Histopathologic analysis confirmed a benign astrocytoma. The follow-up examination revealed no recurrent or residual tumor. A systemic review of the literature indicates that early diagnosis and experienced multidisciplinary management are required in case of unilateral, resectable forms of ONAs with no distant metastasis, in order to provide a long-time survival of patients. Surgical intervention of unilateral ONAs is a relatively safe procedure, allowing complete or partial tumor removal with minimal morbidity and low recurrence rate.

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Transorbital endoscopic assisted management of intraorbital lesions: lessons learned from our first 9 cases

Abstract: Our preliminary results are promising with successful functional and cosmetic outcomes and reduced morbidity for the patient. This approach should be considered as an option for selected intraorbital lesions.

Cited by 25 publications

References 15 publications

Endoscopic transpalpebral approach for resection of an intraorbital intraconal cavernous angioma

Endoscopic transpalpebral approach for resection of an intraorbital intraconal cavernous angioma

Endoscopic transorbital route to the cavernous sinus through the meningo-orbital band: a descriptive anatomical study

Surgical Management of Pilocytic Astrocytoma of the Optic Nerve: A Case Report and Review of the Literature

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