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

Zoia, C.; Mantovani, G.; Müther, M.; Suero Molina, E.; Scerrati, A.; De Bonis, P.; Cornelius, J.F.; Roche, P.H.; Tatagiba, M.; Jouanneau, E.; Manet, R.; Schroeder, H.W.S.; Cavallo, L.M.; Kasper, E.M.; Meling, T.R.; Mazzatenta, D.; Daniel, R.T.; Messerer, M.; Visocchi, M.; Froelich, S.; Bruneau, M.; Spena, G.

doi:10.1016/j.bas.2023.102669

Cited by 8 publications

(8 citation statements)

References 68 publications

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“…Over the last few years, endoscopic techniques have been used more frequently to treat both orbital and skull base pathologies with EEA and ETA, in a continuously evolving landscape ( Zoia et al, 2023 ).…”

Section: Discussionmentioning

confidence: 99%

Endoscopic approaches to the orbit: Transnasal and transorbital, a retrospective case series

Zoia,

Maiorano,

Borromeo

et al. 2024

Brain and Spine

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Section: Discussionmentioning

confidence: 99%

Endoscopic approaches to the orbit: Transnasal and transorbital, a retrospective case series

Zoia,

Maiorano,

Borromeo

et al. 2024

Brain and Spine

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“…However, this limitation could be reduced by transient the removal of the orbital rim. Alternatively or additionally, the use of a multi-portal strategy where two or three surgical corridors are exploited simultaneously may improve the visualization and range of motion in deep-seated areas of the skull base ( Corvino et al, 2023 ; Zoia et al, 2023 ).…”

Section: Discussionmentioning

confidence: 99%

“…Indeed, the composite anatomy of the CS and the proximity to crucial neural and vascular structures have generated great controversy over the optimal surgical approach to this area, with many lesions considered unresectable and prone to non-surgical management ( Fariselli et al, 2016 ; Corniola et al, 2022 ). Even when conventional transcranial approaches are, thus far, the gold standard ( Dolenc, 1985 ; Al-Mefty and Anand, 1990 ; Dolenc, 1997 ; Heth and Al-Mefty, 2003 ; Matsuo et al, 2016 ), the direct pathway afforded by ventral routes like the transorbital (TO) and the minimally disruptive manipulation granted by the endoscopic techniques have rekindled surgical attention to this area ( Cappabianca et al, 1998 ; de Divitiis, 2003 ; Cavallo et al, 2005 ; Doglietto et al, 2009 ; Altay et al, 2012 ; Bly et al, 2014 ; Dallan et al, 2017 ; Di Somma et al, 2018b ; Zoia et al, 2023 ). Still, it is only through an extensive anatomical expertise that this region becomes a scrutable surgical site.…”

Section: Introductionmentioning

confidence: 99%

Transorbital approach to the cavernous sinus: an anatomical study of the related cranial nerves

Mosteiro,

Codes,

Tafuto

et al. 2024

Front. Neuroanat.

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BackgroundThe cavernous sinus (CS) is a demanding surgical territory, given its deep location and the involvement of multiple neurovascular structures. Subjected to recurrent discussion on the optimal surgical access, the endoscopic transorbital approach has been recently proposed as a feasible route for selected lesions in the lateral CS. Still, for this technique to safely evolve and consolidate, a comprehensive anatomical description of involved cranial nerves, dural ligaments, and arterial relations is needed.ObjectiveDetailed anatomical description of the CS, the course of III, IV, VI, and V cranial nerves, and C3-C7 segments of the carotid artery, all described from the ventrolateral endoscopic transorbital perspective.MethodsFive embalmed human cadaveric heads (10 sides) were dissected. An endoscopic transorbital approach with lateral orbital rim removal, anterior clinoidectomy, and petrosectomy was performed. The course of the upper cranial nerves was followed from their apparent origin in the brainstem, through the middle fossa or cavernous sinus, and up to their entrance to the orbit. Neuronavigation was used to follow the course of the nerves and to measure their length of surgical exposure.ResultsThe transorbital approach allowed us to visualize the lateral wall of the CS, with cranial nerves III, IV, V1-3, and VI. Anterior clinoidectomy and opening of the frontal dura and the oculomotor triangle revealed the complete course of the III nerve, an average of 37 (±2) mm in length. Opening the trigeminal pore and cutting the tentorium permitted to follow the IV nerve from its course around the cerebral peduncle up to the orbit, an average of 54 (±4) mm. Opening the infratrochlear triangle revealed the VI nerve intracavernously and under Gruber’s ligament, and the extended petrosectomy allowed us to see its cisternal portion (27 ± 6 mm). The trigeminal root was completely visible and so were its three branches (46 ± 2, 34 ± 3, and 31 ± 1 mm, respectively).ConclusionComprehensive anatomic knowledge and extensive surgical expertise are required when addressing the CS. The transorbital corridor exposes most of the cisternal and the complete cavernous course of involved cranial nerves. This anatomical article helps understanding relations of neural, vascular, and dural structures involved in the CS approach, essential to culminating the learning process of transorbital surgery.

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“…A critical consequence of reduced neurosurgeon involvement in certain specialty areas is the potential detrimental effect on patient care. In multidisciplinary team settings focusing on these subspecialties, the input of experienced neurosurgeons is indispensable ( Abussuud et al, 2020 ; Peck et al, 2020 ; Rasulić, 2017 ; Robinson et al, 2022 ; Staudt, 2022 ; Zoia et al, 2023 ). Neurosurgical solutions or insights are often paramount for optimal treatment, and the absence of neurosurgical participation may lead to missed opportunities for ideal patient care, potentially resulting in suboptimal outcomes and patient dissatisfaction.…”

Section: Introductionmentioning

confidence: 99%

Revitalizing neurosurgical frontiers: The EANS frontiers in neurosurgery committee's strategic framework

Lawson McLean,

Vetrano,

Lawson McLean

et al. 2024

Brain and Spine

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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

Cited by 8 publications

References 68 publications

Endoscopic approaches to the orbit: Transnasal and transorbital, a retrospective case series

Endoscopic approaches to the orbit: Transnasal and transorbital, a retrospective case series

Transorbital approach to the cavernous sinus: an anatomical study of the related cranial nerves

Revitalizing neurosurgical frontiers: The EANS frontiers in neurosurgery committee's strategic framework

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