Orbital decompressive effect of endoscopic transorbital surgery for sphenoorbital meningioma

OBJECTIVECranioorbital tumors are complex lesions that involve the deep orbit, floor of the frontal bone, and lesser and greater wing of the sphenoid bone. The purpose of this study was to describe the clinical and ophthalmological outcomes with an endoscopic transorbital approach (TOA) in the management of cranioorbital tumors involving the deep orbit and intracranial compartment.METHODSThe authors performed endoscopic TOAs via the superior eyelid crease incision in 18 patients (16 TOA alone and 2 TOA combined with a simultaneous endonasal endoscopic resection) with cranioorbital tumors from September 2016 to November 2017. There were 12 patients with sphenoorbital meningiomas. Other lesions included osteosarcoma, plasmacytoma, sebaceous gland carcinoma, intraconal schwannoma, cystic teratoma, and fibrous dysplasia. Ten patients had primary lesions and 8 patients had recurrent tumors. Thirteen patients had intradural lesions, while 5 had only extradural lesions.RESULTSOf 18 patients, 7 patients underwent gross-total resection of the tumor and 7 patients underwent planned near-total resection of the tumor, leaving the cavernous sinus lesion. Subtotal resection was performed in 4 patients with recurrent tumors. There was no postoperative CSF leak requiring reconstruction surgery. Fourteen of 18 patients (77.8%) had preoperative proptosis on the ipsilateral side, and all 14 patients had improvement in exophthalmos; the mean proptosis reduced from 5.7 ± 2.7 mm to 1.5 ± 1.4 mm. However, some residual proptosis was evident in 9 of the 14 (64%). Ten of 18 patients (55.6%) had preoperative optic neuropathy, and 6 of them (60.0%) had improvement; the median best-corrected visual acuity improved from 20/100 to 20/40. Thirteen of 18 patients showed mild ptosis at an immediate postoperative examination, all of whom had a spontaneous and complete recovery of their ptosis during the follow-up period. Three of 7 patients showed improvement in extraocular motility after surgery.CONCLUSIONSEndoscopic TOA can be considered as an option in the management of cranioorbital tumors involving complex anatomical areas, with acceptable sequelae and morbidity.

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Endoscopic Transorbital Surgery for Middle Cranial Fossa Tumors

10.1055/s-0039-1679429 ◽

2019 ◽

Author(s):

Sanghun Lee ◽

Chang-Ki Hong

Keyword(s):

Middle Cranial Fossa ◽

Endoscopic Transorbital ◽

Cranial Fossa ◽

Endoscopic Transorbital Surgery

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Endoscopic transorbital surgery for spheno-orbital lesions: how I do it

Acta Neurochirurgica ◽

10.1007/s00701-018-3529-5 ◽

2018 ◽

Vol 160 (6) ◽

pp. 1231-1233 ◽

Cited By ~ 4

Author(s):

Cesare Zoia ◽

Daniele Bongetta ◽

Paolo Gaetani

Keyword(s):

Endoscopic Transorbital ◽

Endoscopic Transorbital Surgery ◽

Orbital Lesions

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Sphenoorbital Meningioma: Surgical Series and Design of Intraoperative Management Paradigm

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0036-1579820 ◽

2016 ◽

Vol 77 (S 01) ◽

Author(s):

Lior Gonen ◽

Eytan Nov ◽

Nir Shimony ◽

Ben Shofty ◽

Georgios Klironomos ◽

...

Keyword(s):

Intraoperative Management ◽

Sphenoorbital Meningioma

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Use of endoscopic transorbital and endonasal approaches for 360° circumferential access to orbital tumors

Journal of Neurosurgery ◽

10.3171/2020.6.jns20890 ◽

2020 ◽

pp. 1-10

Author(s):

Chiman Jeon ◽

Sang Duk Hong ◽

Kyung In Woo ◽

Ho Jun Seol ◽

Do-Hyun Nam ◽

...

Keyword(s):

Optic Nerve ◽

Minimally Invasive ◽

Surgical Techniques ◽

Cystic Teratoma ◽

Subtotal Resection ◽

Zone Model ◽

Team Approach ◽

Orbital Tumors ◽

Total Resection ◽

Endoscopic Transorbital

OBJECTIVEOrbital tumors are often surgically challenging because they require an extensive fronto-temporo-orbital zygomatic approach (FTOZ) and a multidisciplinary team approach to provide the best outcomes. Recently, minimally invasive endoscopic techniques via a transorbital superior eyelid approach (ETOA) or endoscopic endonasal approach (EEA) have been proposed as viable alternatives to transcranial approaches for orbital tumors. In this study, the authors investigated the feasibility of 360° circumferential access to orbital tumors via both ETOA and EEA.METHODSBetween April 2014 and June 2019, 16 patients with orbital tumors underwent either ETOA or EEA at the authors’ institution. Based on the neuro-topographic “four-zone model” of the orbit with its tumor epicenter around the optic nerve in the coronal plane, ETOA (n = 10, 62.5%) was performed for tumors located predominantly superolateral to the nerve and EEA (n = 6, 37.5%) for those located predominantly inferomedial to the nerve. Eight patients (50%) presented with intraconal tumors and 8 (50%) with extraconal ones. The orbital tumors included orbital schwannoma (n = 6), cavernous hemangioma (n = 2), olfactory groove meningioma (n = 1), sphenoorbital meningioma (n = 1), chondrosarcoma (n = 1), trigeminal schwannoma (n = 1), metastatic osteosarcoma (n = 1), mature cystic teratoma (n = 1), sebaceous carcinoma (n = 1), and ethmoid sinus osteoma (n = 1). The clinical outcomes and details of surgical techniques were reviewed.RESULTSGross-total resection was achieved in 12 patients (75%), near-total resection in 3 (18.8%), and subtotal resection in 1 (6.2%). Eight (88.9%) of the 9 patients with preoperative proptosis showed improvement after surgery, and 4 (66.7%) of the 6 patients with visual symptoms demonstrated improvement. Four (40%) of the 10 patients treated with ETOA experienced partial third nerve palsy immediately after surgery (3 transient and 1 persistent). There have been no postoperative CSF leaks or infections in this series.CONCLUSIONSWithout transcranial approaches requiring temporalis muscle dissection and orbitozygomatic osteotomy, the selection of ETOA or EEA based on a concept of a four-zone model with its epicenter around the optic nerve successfully provides a minimally invasive 360° circumferential access to the entire orbit with acceptable morbidity.

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Use of the O-arm® for skull base resection in a sphenoorbital meningioma

Journal of Clinical Neuroscience ◽

10.1016/j.jocn.2012.08.016 ◽

2013 ◽

Vol 20 (8) ◽

pp. 1149-1151

Author(s):

Edward E. Kerr ◽

Kiarash Shahlaie ◽

Rudolph J. Schrot

Keyword(s):

Skull Base ◽

Sphenoorbital Meningioma

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Extended endoscopic transorbital approach with superior-lateral orbital rim osteotomy: cadaveric feasibility study and clinical implications (SevEN-007)

Journal of Neurosurgery ◽

10.3171/2021.7.jns21996 ◽

2021 ◽

pp. 1-14

Author(s):

*Jaejoon Lim ◽

Kyoung Su Sung ◽

Woohyun Kim ◽

Jihwan Yoo ◽

In-Ho Jung ◽

...

Keyword(s):

Skull Base ◽

Complete Removal ◽

Vertical Movement ◽

Anterior Skull Base ◽

Cadaveric Study ◽

Surgical Instruments ◽

Anterior Clinoidectomy ◽

Endoscopic Transorbital ◽

Surgical Corridor ◽

Orbital Rim

OBJECTIVE The endoscopic transorbital approach (ETOA) has been developed, permitting a new surgical corridor. Due to the vertical limitation of the ETOA, some lesions of the anterior cranial fossa are difficult to access. The ETOA with superior-lateral orbital rim (SLOR) osteotomy can achieve surgical freedom of vertical as well as horizontal movement. The purpose of this study was to confirm the feasibility of the ETOA with SLOR osteotomy. METHODS Anatomical dissections were performed in 5 cadaveric heads with a neuroendoscope and neuronavigation system. ETOA with SLOR osteotomy was performed on one side of the head, and ETOA with lateral orbital rim (LOR) osteotomy was performed on the other side. After analysis of the results of the cadaveric study, the ETOA with SLOR osteotomy was applied in 6 clinical cases. RESULTS The horizontal and vertical movement range through ETOA with SLOR osteotomy (43.8° ± 7.49° and 36.1° ± 3.32°, respectively) was improved over ETOA with LOR osteotomy (31.8° ± 5.49° and 23.3° ± 1.34°, respectively) (p < 0.01). Surgical freedom through ETOA with SLOR osteotomy (6025.1 ± 220.1 mm3) was increased relative to ETOA with LOR osteotomy (4191.3 ± 57.2 mm3) (p < 0.01); these values are expressed as the mean ± SD. Access levels of ETOA with SLOR osteotomy were comfortable, including anterior skull base lesion and superior orbital area. The view range of the endoscope for anterior skull base lesions was increased through ETOA with SLOR osteotomy. After SLOR osteotomy, the space for moving surgical instruments and the endoscope was widened. Anterior clinoidectomy could be achieved successfully using ETOA with SLOR osteotomy. The authors performed ETOA with SLOR osteotomy in 6 cases of brain tumor. In all 6 cases, complete removal of the tumor was successfully accomplished. In the 3 cases of anterior clinoidal meningioma, anterior clinoidectomy was performed easily and safely, and manipulation of the extended dural margin and origin dura mater was possible. There was no complication related to this approach. CONCLUSIONS The authors evaluated the clinical feasibility of ETOA with SLOR osteotomy based on a cadaveric study. ETOA with SLOR osteotomy could be applied to more diverse disease groups that do not permit conventional ETOA or to cases in which surgical application is challenging. ETOA with SLOR osteotomy might serve as an opportunity to broaden the indication for the ETOA.

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Endoscopic transorbital approach to the infratemporal fossa and parapharyngeal space: a cadaveric study

Journal of Neurosurgery ◽

10.3171/2019.7.jns191743 ◽

2020 ◽

Vol 133 (6) ◽

pp. 1948-1959 ◽

Cited By ~ 2

Author(s):

Mina M. Gerges ◽

Saniya S. Godil ◽

Iyan Younus ◽

Michael Rezk ◽

Theodore H. Schwartz

Keyword(s):

Carotid Artery ◽

Parapharyngeal Space ◽

Infratemporal Fossa ◽

Middle Meningeal Artery ◽

Endoscopic Approach ◽

Surgical Approaches ◽

Maxillary Artery ◽

Lateral Pterygoid Muscle ◽

Endoscopic Techniques ◽

Endoscopic Transorbital

OBJECTIVEThe infratemporal fossa (ITF) and parapharyngeal space are anatomical regions that can be challenging to access without the use of complex, cosmetically disfiguring approaches. With advances in endoscopic techniques, a new group of surgical approaches to access the intracranial space through the orbit has been recently referred to as transorbital neuroendoscopic surgery (TONES). The objective of this study was to establish a transorbital endoscopic approach utilizing the inferior orbital fissure (IOF) to gain access to the ITF and parapharyngeal space and provide a detailed endoscopic anatomical description of this approach.METHODSFour cadaveric heads (8 sides) were dissected using a TONES approach through the IOF to reach the ITF and parapharyngeal space, providing stepwise dissection with detailed anatomical findings and a description of each step.RESULTSAn inferior eyelid approach was made with subperiosteal periorbital dissection to the IOF. The zygomatic and greater wing of the sphenoid were drilled, forming the boundaries of the IOF. The upper head of the lateral pterygoid muscle in the ITF and parapharyngeal space was removed, and 7 distinct planes were described, each with its own anatomical contents. The second part of the maxillary artery was mainly found in plane 1 between the temporalis laterally and the lateral pterygoid muscle in plane 2. The branches of the mandibular nerve (V3) and middle meningeal artery (MMA) were identified in plane 3. Plane 4 was formed by the fascia of the medial pterygoid muscle (MTM) and the tensor veli palatini muscle. The prestyloid segment, found in plane 5, was composed mainly of fat and lymph nodes. The parapharyngeal carotid artery in the poststyloid segment, found in plane 7, was identified after laterally dissecting the styloid diaphragm, found in plane 6. V3 and the origin of the levator and tensor veli palatini muscles serve as landmarks for identification of the parapharyngeal carotid artery.CONCLUSIONSThe transorbital endoscopic approach provides excellent access to the ITF and parapharyngeal space compared to previously described complex and morbid transfacial or transcranial approaches. Using the IOF is an important and useful landmark that permits a wide exposure.

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