Endoscopic-assisted transorbital surgery: Where do we stand on the scott’s parabola? personal considerations after a 10-year experience

Abstract

Transorbital approaches are genuinely versatile surgical routes which show interesting potentials in skull base surgery. Given their “new” trajectory, they can be a very useful adjunct to traditional routes, even being a valid alternative to them in some cases, and add valuable opportunities in selected patients. Indications are constantly expanding, and currently include selected intraorbital, skull base and even intra-axial lesions, both benign and malignant. Given their relatively recent development and thus unfamiliarity among the skull base community, achieving adequate proficiency needs not only a personalized training and knowledge but also, above all, an adequate case volume and a dedicated setting. Current, but mostly future, applications should be selected by genetic, omics and biological features and applied in the context of a truly multidisciplinary environment.

Endoscopic transorbital approach bone pillars: a comprehensive stepwise anatomical appraisal

“…An extensive number of anatomical studies demonstrating its safeness and feasibility have allowed its progressive growth, leading to an increasing number of indications for its use and clinical reports. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18]29,30,32,38,[41][42][43][44][45][46][47][48][49][50][51][52][53] Utilization of consistent anatomical landmarks in relation to the orbital contents facilitates a comprehensive systematization of the approach. This systematic framework allows for more effective treatment of diverse surgical pathologies within the confines of the operating room.…”

Through the orbit and beyond: Current state and future perspectives in endoscopic orbital surgery on behalf of the EANS frontiers committee in orbital tumors and the EANS skull base section

“…Still, transorbital surgery is currently performed in a few highly specialized centers, limiting the possibility of spreading skills and knowledge among new-generation surgeons. In this proposal, Dallan et al proposed that to gain confidence with endoscopic transorbital procedures, at least 50 cases are required, with at least 20 cases/year to maintain it ( Dallan et al, 2022 ). As with every other technique, also trans-orbital surgery has different levels of complexity ( Di Somma et al, 2022b ), and an adequate training program should progressively encompass all of it.…”

The Transorbital Approach: A Comprehensive Review of Targets, Surgical Techniques, and Multiportal Variants

“…However, there are some limitations. One of the most significant constraints of the endoscopic transorbital route is its steep learning curve, a factor not yet thoroughly studied in the literature [76]. Unlike more conventional surgical approaches, the complexity of this technique demands not only the surgeon's expertise but also a high level of proficiency from the entire surgical team.…”