Endoscopic Transorbital Approach for the Management of Spheno-Orbital Meningiomas: Literature Review and Preliminary Experience

Somma, Alberto Di; Rosa, Andrea De; Ferrés, Abel; Mosteiro, Alejandra; Guizzardi, Giulia; Fassi, Jessica Matas; Topczewski, Thomaz E.; Reyes, Luís; Roldán, Pedro; Torné, Ramón; Alobid, Isam; Enseñat, Joaquim

doi:10.1016/j.wneu.2023.03.126

Cited by 16 publications

(12 citation statements)

References 38 publications

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“…Reconstruction can be accomplished with the use of free fat tissue from the abdomen for filling both latero-orbital spaces and the space created after lesion removal. Dural closure can be performed either with fascia lata or with dural substitutes combined with dural sealants ( Balakrishnan and Moe, 2011 ; Yoo et al, 2021 ; Di Somma et al, 2023 ; Han et al ).…”

Section: Discussionmentioning

confidence: 99%

Transorbital and supraorbital uniportal multicorridor approach to the orbit, anterior, middle and posterior cranial fossa: Anatomic study

Zoia,

Mastantuoni,

Solari

et al. 2024

Brain and Spine

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Section: Discussionmentioning

confidence: 99%

Transorbital and supraorbital uniportal multicorridor approach to the orbit, anterior, middle and posterior cranial fossa: Anatomic study

Zoia,

Mastantuoni,

Solari

et al. 2024

Brain and Spine

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“…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 ]. In selected cases, TOAs are valid alternatives to traditional transcranial surgery if the patient is unable to sustain an overly invasive treatment or has comorbidities that would imply greater risks than benefits, allowing for histological diagnosis and the decompression of the main structures involved in the pathology [ 15 , 17 , 22 , 23 , 39 ].…”

Section: Discussionmentioning

confidence: 99%

“…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 ]. In selected cases, TOAs are valid alternatives to traditional transcranial surgery if the patient is unable to sustain an overly invasive treatment or has comorbidities that would imply greater risks than benefits, allowing for histological diagnosis and the decompression of the main structures involved in the pathology [ 15 , 17 , 22 , 23 , 39 ]. The small surgical incision, hidden by the palpebral skinfold, offers an optimal aesthetic result with minimal impact on the patient’s self-perception [ 8 , 20 ].…”

Section: Discussionmentioning

confidence: 99%

“…The application of TOAs has been subsequently extended to the lesions of the anterolateral skull base such as meningiomas, schwannomas, dermoid cysts, CSF leak, and infections [ 8 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 ], using the orbital cavity as a corridor to offer several trajectories [ 8 , 13 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 ]. Moreover, recent anatomical and initial clinical studies have also highlighted the potential versatility of these approaches, to the tentorial area [ 41 , 42 ], petrous apex [ 43 , 44 , 45 ], and the insular region [ 46 , 47 ].…”

Section: Introductionmentioning

confidence: 99%

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

Serioli,

Nizzola,

Plou

et al. 2023

Cancers

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Background: The transorbital approaches (TOAs) have acquired growing notoriety, thanks to their ability to offer alternative corridors to the skull base. However, the limited access and the unfamiliarity with this surgical perspective make recognition of key landmarks difficult, especially for less experienced surgeons. The study wants to offer a detailed description of the anatomy to comprehend the potential and limitations of TOAs. Methods: Measurements of the orbit region and the surrounding areas were performed on two hundred high-resolution CT scans and thirty-nine dry skulls. Five specimens were dissected to illustrate the TOA, and one was used to perform the extradural clinoidectomy. Three clinical cases highlighted the surgical applications. Results: A step-by-step description of the key steps of the TOA was proposed and a comparison with the transcranial anterior clinoidectomy was discussed. The mean work distance was 6.1 ± 0.4 cm, and the lateral working angle increased 20 ± 5.4° after removing the lateral orbital rim. Conclusions: TOAs are indicated in selected cases when tumor involves the lateral portion of the cavernous sinus or the middle skull base, obtaining a direct decompression of the optic nerve and avoiding excessive manipulation of the neurovascular structures. Comprehension of surgical anatomy of the orbit and its surrounding structures is essential to safely perform these approaches.

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“…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 ).…”

Section: Discussionmentioning

confidence: 99%

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

De Rosa,

Mosteiro,

Guizzardi

et al. 2023

Front. Neuroanat.

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ObjectiveStarting from an anatomic study describing the possibility of reaching the temporal region through an endoscopic transorbital approach, many clinical reports have now demonstrated the applicability of this strategy when dealing with intra-axial lesions. The study aimed to provide both a qualitative anatomic description of the temporal region, as seen through a transorbital perspective, and a quantitative analysis of the amount of temporal lobe resection achievable via this route.Material and methodsA total of four cadaveric heads (eight sides) were dissected at the Laboratory of Surgical Neuroanatomy (LSNA) of the University of Barcelona, Spain. A stepwise description of the resection of the temporal lobe through a transorbital perspective is provided. Qualitative anatomical descriptions and quantitative analysis of the amount of the resection were evaluated by means of pre- and post-dissection CT and MRI scans, and three-dimensional reconstructions were made by means of BrainLab®Software.ResultsThe transorbital route gives easy access to the temporal region, without the need for extensive bone removal. The resection of the temporal lobe proceeded in a subpial fashion, mimicking what happens in a surgical scenario. According to our quantitative analysis, the mean volume removed was 51.26%, with the most superior and lateral portion of the temporal lobe being the most difficult to reach.ConclusionThis anatomic study provides qualitative and quantitative details about the resection of the temporal lobe via an endoscopic transorbital approach. Our results showed that the resection of more than half of the temporal lobe is possible through this surgical corridor. While the anterior, inferior, and mesial portions of the temporal lobe were easily accessible, the most superior and lateral segment was more difficult to reach and resect. Our study serves as an integration to the current anatomic knowledge and clinical practice knowledge highlighting and also as a starting point for further anatomic studies addressing more selected segments of the temporal lobe, i.e., the mesial temporal region.

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Endoscopic Transorbital Approach for the Management of Spheno-Orbital Meningiomas: Literature Review and Preliminary Experience

Cited by 16 publications

References 38 publications

Transorbital and supraorbital uniportal multicorridor approach to the orbit, anterior, middle and posterior cranial fossa: Anatomic study

Transorbital and supraorbital uniportal multicorridor approach to the orbit, anterior, middle and posterior cranial fossa: Anatomic study

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

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

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