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

Abstract

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.

Surgical Anatomy of the Microscopic and Endoscopic Transorbital Approach to the Middle Fossa and Cavernous Sinus: Anatomo-Radiological Study with Clinical Applications

“…Since TOAs are minimally invasive approaches, in-depth anatomical knowledge is required to recognize the main landmarks despite the unusual surgical perspective, especially for young trainees. This corridor is indicated in the cases of proptosis and lesions located lateral to the CN II [ 8 , 13 , 17 , 19 , 20 , 23 , 24 , 31 , 39 , 53 , 54 , 57 ]. The TOAs offer a good exposure to the anterolateral skull base through small craniectomies, avoiding excessive brain retraction injury and complications associated with long hospitalization [ 8 , 11 , 12 , 13 , 15 , 17 , 20 , 22 , 23 , 24 , 39 ].…”

Endoscopic transorbital resection of the temporal lobe: anatomic qualitative and quantitative study

“…The endoscopic transorbital approach has now entered the skull base neurosurgeon's armamentarium for the management of selected skull base lesions (Somma et al, 2021 ; Yoo et al, 2021 ; Han et al, 2023 ). Starting from anatomic studies that demonstrated the feasibility of exploring via the transorbital route, the anterior (Di Somma et al, 2018 ; Nannavecchia et al, 2021 ; Lim et al, 2022 ), middle (Chibbaro et al, 2021 ; Guizzardi et al, 2022 ; Corvino et al, 2023 ), and posterior cranial fossae (De Rosa et al, 2022 ), many applications of this approach in the management of extradural lesions have been published (Dallan et al, 2018b ; Zoia et al, 2018 ; Park et al, 2020a ; Corvino et al, 2022 ; Lee et al, 2022 ; Lim et al, 2022 ; Noiphithak et al, 2022 ; Di Somma et al, 2023a ; Zoli et al, 2023 ), demonstrating the possibility of overcoming many concerns attributed to this approach in terms of poor maneuverability and intraoperative complications' management (Kim W. et al, 2021 ; Di Somma et al, 2023b ).…”

A novel classification for guiding the surgical approach for cranio-orbital lesions: A single institution case series of 45 cases and a literature review.

“…Some studies have also suggested the endoscopic transorbital approach (ETOA) to be considered for COLs. [20][21][22][23] In detail, the Joseph et al's study illustrated that ETOA could be used to remove selected spheno-orbital and medial sphenoid wing meningiomas. [23] Besides, Alberto et al [22] illustrated that the superior eyelid transorbital approach supraorbital approach can be used for spheno-orbital and intraconal meningiomas.…”

“…[20][21][22][23] In detail, the Joseph et al's study illustrated that ETOA could be used to remove selected spheno-orbital and medial sphenoid wing meningiomas. [23] Besides, Alberto et al [22] illustrated that the superior eyelid transorbital approach supraorbital approach can be used for spheno-orbital and intraconal meningiomas. Their studies thought ETOA should reduce the need for temporal lobe retraction and the extensive mobilization and reconstruction of the temporalis muscle.…”

“…Their studies thought ETOA should reduce the need for temporal lobe retraction and the extensive mobilization and reconstruction of the temporalis muscle. [22,23] Tumor exposure in the CS For removal of lesions in the CS area are challenging for surgeons; the common associated pathologies are schwannomas and meningiomas. In our series, ve cases of meningiomas involving the CS had residual lesions.…”