Transorbital Endoscopic Surgery for Sphenoid Wing Meningioma: Long-Term Outcomes and Surgical Technique

Abstract

Sphenoid wing meningiomas are benign tumors that can result in proptosis, visual impairment, and pain. Traditional open surgical approaches are associated with significant morbidity. Transorbital endoscopic surgery has been developed as a minimally invasive approach to gain access to these tumors and address the main presenting symptoms. Case series reporting transorbital endoscopic resection of sphenoid wing meningiomas using combined endonasal, pre-caruncular, and extended superior eyelid approaches have demonstrated stable and/or improved short- and medium-term visual outcomes. Earlier medial optic nerve decompression appears to result in more favorable long-term visual outcomes. Transorbital endoscopic surgery therefore represents an emerging minimally invasive alternative to deal with these challenging lesions.

Endoscopy-assisted resection of a sphenoid-wing meningioma using a 3D-printed patient-specific pointer in a dog: A case report

“…NN has also been used to obtain diagnostic brain biopsy samples ( 8 , 30 ). However, the relatively small size and thickness of the canine skull compared to humans makes it difficult for neurosurgeons to apply NN accurately in dogs ( 22 , 23 , 31 ); attempting NN in the presence of a large volume of temporal muscle and zygomatic bone could result in longer access times and narrower surgical fields. These limitations make it difficult for veterinary neurosurgeons to apply NN to sphenoid-wing meningioma resection.…”

“…The relationships between the vascular and bone morphology and the anatomic landmarks have been clarified in human medicine, but little information of this kind is available to assist sphenoid-wing meningioma surgery in veterinary medicine ( 7 ). Dogs have relatively massive temporal muscles and different sizes, locations, and morphologies of neurovascular structures and structures such as the zygomatic arch and the coronoid process of the mandibular bone ( 20 – 23 ). Therefore, for accurate and safe delineation of the surgical site, we decided to employ a 3D-printing technique similar to the use of a 3D-printed biopsy guide, since we lacked NN capability and sufficient experience with traditional in-silico planning and in-vivo measuring techniques.…”

“…The craniectomy line was made along the outer boundary of the pointer using a surgical pen and electrocautery. The bone was resected using a 2.0 mm bone burr (2.0 mm burr/drill; Stryker Corp., Kalamazoo, MI, USA) along a tool path indicated by the 3D PSP, following which the tumor could be immediately identified ( 20 , 23 ).…”

“…After exposing the tumor using the pointer, we maximized visualization of the surgical site using an endoscope. Under endoscopic visualization, durotomy was performed using a #11 scalpel and micro-scissors, and the ventrolateral aspect of the lateral temporal lobe was exposed under an enhanced surgical field ( 20 , 22 , 23 ). To magnify the surgical site, a 10-mm, 0° rigid telescope was connected to a high-definition camera system (Stryker Endoscopy, Stryker Corp., Kalamazoo, MI, USA).…”

Transorbital Endoscopic Eyelid Approach for Resection of Spheno-Orbital Meningioma: 2-Dimensional Operative Video

“…The periosteum was incised with monopolar cautery, and a periosteal elevator was used to reflect the periorbita off the lateral orbital wall. 4 A silastic sheet protected the orbital contents beneath a malleable retractor. A 4-mm 30-cm 0° endoscope was held by an assistant, and the lateral orbital wall was drilled exposing the temporalis.…”