Endoscopic approach to the orbital apex and periorbital skull base

Murchison, Ann P.; Rosen, Marc; Evans, James J.; Bilyk, Jurij R.

doi:10.1002/lary.21357

Cited by 80 publications

(81 citation statements)

References 19 publications

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“…4,16,19,[30][31][32][33][34]38,44,60 The approach is very similar to that used for pituitary surgery; 6,9 therefore, most skull base surgeons are familiar with it. 49 With the patient under general anesthesia and orotracheal intubation, his or her head is secured in a 3-pin head holder, and neuronavigation is calibrated with a fusion of CT and MRI data.…”

Section: Surgical Techniquementioning

confidence: 99%

Endoscopic endonasal optic nerve and orbital apex decompression for nontraumatic optic neuropathy: surgical nuances and review of the literature

Berhouma

Jacquesson

Abouaf³

et al. 2014

FOC

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Object While several approaches have been described for optic nerve decompression, the endoscopic endonasal route is gaining favor because it provides excellent exposure of the optic canal and the orbital apex in a minimally invasive manner. Very few studies have detailed the experience with nontraumatic optic nerve decompressions, whereas traumatic cases have been widely documented. Herein, the authors describe their preliminary experience with endoscopic endonasal decompression for nontraumatic optic neuropathies (NONs) to determine the procedure’s efficacy and delineate its potential indications and limits. Methods The medical reports of patients who had undergone endoscopic endonasal optic nerve and orbital apex decompression for NONs at the Lyon University Neurosurgical Hospital in the period from January 2012 to March 2014 were reviewed. For all cases, clinical and imaging data on the underlying pathology and the patient, including demographics, preoperative and 6-month postoperative ophthalmological assessment results, symptom duration, operative details with video debriefing, as well as the immediate and delayed postoperative course, were collected from the medical records. Results Eleven patients underwent endoscopic endonasal decompression for NON in the multidisciplinary skull base surgery unit of the Lyon University Neurosurgical Hospital during the 27-month study period. The mean patient age was 53.4 years, and there was a clear female predominance (8 females and 3 males). Among the underlying pathologies were 4 sphenoorbital meningiomas (36%), 3 optic nerve meningiomas (27%), and 1 each of trigeminal neuroma (9%), orbital apex meningioma (9%), ossifying fibroma (9%), and inflammatory pseudotumor of the orbit (9%). Fifty-four percent of the patients had improved visual acuity at the 6-month follow-up. Only 1 patient whose sphenoorbital meningioma had been treated at the optic nerve atrophy stage continued to worsen despite surgical decompression. The 2 patients presenting with preoperative papilledema totally recovered. One case of postoperative epistaxis was successfully treated using balloon inflation, and 1 case of air swelling of the orbit spontaneously resolved. Conclusions Endoscopic endonasal optic nerve decompression is a safe, effective, and minimally invasive technique affording the restoration of visual function in patients with nontraumatic compressive processes of the orbital apex and optic nerve. The timing of decompression remains crucial, and patients should undergo such a procedure early in the disease course before optic atrophy.

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Section: Surgical Techniquementioning

confidence: 99%

Endoscopic endonasal optic nerve and orbital apex decompression for nontraumatic optic neuropathy: surgical nuances and review of the literature

Berhouma

Jacquesson

Abouaf³

et al. 2014

FOC

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show abstract

“…[12][13][14][15][16][17] Reports of orbital tumors that have been biopsied, resected, or decompressed through an EEA have increased in the last few years. [18][19][20][21] The EEA is now a widely accepted approach for the resection of skull base tumors including anterior, middle, and posterior fossae intradural tumors. [22][23][24][25][26] Recognized advantages are the increased illumination and magnification, the improved cosmesis resulting from the absence of external scars, and shorter hospitalization.…”

Section: Discussionmentioning

confidence: 99%

“Round-the-Clock” Surgical Access to the Orbit

Paluzzi¹,

Koutourousiou²,

Tormenti³

et al. 2012

J Neurol Surg B

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“…Image guidance and the use of a Doppler probe is useful to detect, monitor, and avoid injury to the carotid artery [32]. Optic nerve and orbital apex decompressions are increasingly being performed with the endonasal endoscopic technique [33].…”

Section: Transnasal Endoscopic Approaches To the Skull Base And Orbitmentioning

confidence: 99%