Multiportal Combined Transorbital and Transnasal Endoscopic Resection of Fibrous Dysplasia

Abstract

Introduction Historically, access to the anterior skull base was achieved with open procedures. The paradigms to this approach were challenged with the advent of minimally disruptive endoscopic surgical techniques and supporting technology. The next step in the evolution of minimally disruptive surgery was the combination of multiportal endoscopic surgery. Results The patient was an 18-year-old man who presented with right-sided proptosis. Further diagnostic tests revealed a fibrous dysplasia (FD) occupying the skull base and orbit. The lesion was successfully resected. Conclusions The location of the tumor in this case was challenging, in which surgeons at some centers would have opted to have performed as an open procedure instead of endoscopically. The combined transnasal/transorbital approach is an uncommonly used technique that we have used to remove this tumor successfully. The patient also had a unique disease (FD) in a unique location that was treated without complications. This case report highlights how surgeons may use an expanded armamentarium in dealing with complex pathologies.

Transuncal Selective Amygdalohippocampectomy by an Inferolateral Preseptal Endoscopic Approach Through Inferior Eyelid Conjunctival Incision: An Anatomic Study

“…42 These results encouraged neurosurgeons to expand these corridors to intracranial lesions [43][44][45][46][47][48] such as spheno-orbital meningiomas, [49][50][51][52] middle fossa lesions, [53][54][55][56][57][58] and temporal gliomas 46,59 to overcome the lateral limitation of the transnasal approaches to the anterior and middle fossae or to explore the multiportal routes. [60][61][62][63][64][65][66][67][68] In this context, the mesial temporal region became a new target, subject of laboratory investigations, considering that the transorbital corridor provides a direct pathway that avoids the temporal neocortex and the white fiber fascicles. 24,25,60 Despite current discussions comparing seizure control and neuropsychological outcomes after anterior temporal lobectomy vs selective amygdalohippocampectomy, [69][70][71][72][73] the aim of this innovative technique is to access the entire length of the mesial temporal lobe without disrupting or retracting the temporal neocortex.…”

“…42 These results encouraged neurosurgeons to expand these corridors to intracranial lesions 43-48 such as spheno-orbital meningiomas, 49-52 middle fossa lesions, 53-58 and temporal gliomas 46,59 to overcome the lateral limitation of the transnasal approaches to the anterior and middle fossae or to explore the multiportal routes. 60-68…”

Multiportal Retrograde Endoscopy to Enhance Surgical Target Visualization: A Pilot Study

“…Multiportal surgical approaches have allowed for multiple views of the target lesion, increased depth perception, and visualization of instrument location to optimize the completeness and efficiency of resection. [3][4][5] In this study, we highlighted the utility of transoral endoscopy to provide a retrograde view of the sinuses to enhance sinus surgery. In our maxillary antrostomies, the full extent of the extent of the uncinate was not only visualized but we were able to see the exact tissue engaged by the backbiter.…”

Intraorbital space-occupying lesions: the evaluation of clinical, radiological and pathological results

“…Bu yöntemin intrakonal cerrahilerde başarılı bir yaklaşım olduğunu düşünmekteyiz. Yine medial yerleşimli kitlelere endonazal endoskopik yolla klinikler arası multidisipliner cerrahi uygulamanın mümkün olduğunu da akılda tutmak gerekir (22,23).…”