Transorbital Approaches: Minimally Invasive Access to the Anterior Skull Base

Gassner, Holger G.; Schwan, Franziska; Schebesch, Karl‐Michael

doi:10.5005/jp/books/12758_7

Cited by 7 publications

(8 citation statements)

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“…[3,9,17,20] e superior incision of a cosmetic blepharoplasty encouraged Gassner et al to further modify the incision and used an incision about 7-12 mm above the supratarsal fold, which makes the corridor to the anterior skull base larger, due to the more superior placement of the incision, and stated even better cosmetic outcome. [6] A wide variety of pathologies were managed during the 10 years' experience, which clearly reflected the advantages of the offered surgical corridor. In general, a gross total resection was achieved in 72.2% of the cases.…”

Section: Discussionmentioning

confidence: 96%

The transpalpebral approach “eyelid incision” for surgical management of intracranial tumors: A 10-years’ experience

Elnokaly

Mao

Aziz

2020

Surgical Neurology International

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Background: The minimally invasive approaches to the anterior skull base region through fronto-orbital craniotomy remain a highly accepted option that gains countenance and predilection over time. The transpalpebral “eyelid” incision is an under-utilized and more recent technique that offers a safe efficient corridor to manage a wide variety of lesions. Methods: We carried a retrospective study of 44 patients operated on by the fronto-orbital craniotomy through transpalpebral “eyelid” incision for intracranial tumors, in the time period from March 2007 to July 2016. The results from surgeries were analyzed; extent of tumor resection, length of hospital stay, cosmetic outcome, and complications. Results: Out of the 44 intracranial tumor cases, we had 16 male and 28 female patients with median age 54 years. We had 19 anterior skull base lesions, 8 middle skull base lesions and 8 parasellar lesions. We also operated on four frontal intraparenchymal lesions and four other various lesions. Total resection was achieved in 32 cases (72.7%), with excellent cosmetic outcome in 43 cases (97.7%). Average hospital stay was 6 days. No major complications recorded. Three cases (6.8%) had complications that varied between pseudomeningocele, wound infections, and facial pain. Follow-up average period was 23.6 months. Conclusion: The fronto-orbital approach through eyelid incision remains a reliable approach to the skull base. It provides natural anatomical dissection planes through the eyelid incision and a fronto-orbital craniotomy, creating a wide surgical corridor to manage specific lesions with consistent surgical and cosmetic outcome.

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Section: Discussionmentioning

confidence: 96%

The transpalpebral approach “eyelid incision” for surgical management of intracranial tumors: A 10-years’ experience

Elnokaly

Mao

Aziz

2020

Surgical Neurology International

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“…Illustrative steps of the transpalpebral orbitofrontal craniotomy have been detailed in previous publications. [17][18][19][20][21] Supporting Video S1 demonstrates the surgical technique and highlights key steps of the procedure.…”

Section: Surgical Techniquementioning

confidence: 99%

Combined endonasal and eyelid approach for management of extensive frontal sinus inverting papilloma

et al. 2017

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“…The latter may be considered complementary to the midline endonasal route, hence providing an additional corridor to the skull base, in a lateral-to-medial direction. 10-17 A recent systematic literature review analyzes the data of all the clinical articles and case series published regarding this topic, 18 with interesting and encouraging data.…”

mentioning

confidence: 99%

Multiportal Combined Endoscopic Endonasal and Transorbital Pathways: Qualitative and Quantitative Anatomic Studies of the “Connection” Skull Base Areas

Guizzardi

Prats‐Galino

Mosteiro

et al. 2023

Operative Neurosurgery

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BACKGROUND: Combined endonasal and transorbital multiportal surgery has been recently described for selected skull base pathologies. Nevertheless, a detailed anatomic description and a quantitative comprehensive anatomic study of the skull base areas where these 2 endoscopic routes converge, a so-called connection areas, are missing in the scientific literature. OBJECTIVE: To identify all the skull base areas and anatomic structures where endonasal and transorbital endoscopic avenues could be connected and combined. METHODS: Five cadaveric specimens (10 sides) were used for dissection. Qualitative description and quantitative analysis of each connection areas were performed. RESULTS: At the anterior cranial fossa, the connection area was found at the level of the sphenoid planum; in the middle cranial fossa, it was at the Mullan triangle; finally, in the posterior cranial fossa, the connection area was just behind the medial portion of the petrous apex. The average extradural working areas through the transorbital approach were 4.93, 12.93, and 1.93 cm 2 and from the endonasal corridor were 7.75, 10.45, and 7.48 cm 2 at the level of anterior, middle, and posterior cranial fossae, respectively. CONCLUSION: The combined endonasal and transorbital endoscopic approach is an innovative entity of skull base neurosurgery. From the anatomic point of view, our study demonstrated the feasibility of this combined approach to access the entire skull base, by both corridors, identifying a working connection area in each cranial fossa. These data could be extremely useful during the surgical planning to predict which portion of a lesion could be removed through each route and to optimize patients' care.

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Transorbital Approaches: Minimally Invasive Access to the Anterior Skull Base

Cited by 7 publications

References 0 publications

The transpalpebral approach “eyelid incision” for surgical management of intracranial tumors: A 10-years’ experience

The transpalpebral approach “eyelid incision” for surgical management of intracranial tumors: A 10-years’ experience

Combined endonasal and eyelid approach for management of extensive frontal sinus inverting papilloma

Multiportal Combined Endoscopic Endonasal and Transorbital Pathways: Qualitative and Quantitative Anatomic Studies of the “Connection” Skull Base Areas

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