1
|
Li W, Li M, Luo L, Hu Y, Liu X, Yang H, Guo Y, He H. Prechiasmatic Transection of the Unilateral Dodge Class Ⅰ Optic Pathway Glioma without Neurofibromatosis Type 1: Technical Description and Clinical Prognosis. World Neurosurg 2024; 181:e648-e654. [PMID: 37898272 DOI: 10.1016/j.wneu.2023.10.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 10/22/2023] [Accepted: 10/22/2023] [Indexed: 10/30/2023]
Abstract
OBJECTIVE For unilateral Dodge Class Ⅰ optic pathway glioma (OPG-uDCⅠ) without neurofibromatosis type 1, unilateral isolated optic nerve gliomas before the optic chiasm have been confirmed to possibly cause visual deterioration and poor prognosis. For this type of highly selective localized tumor, we explored surgery as the only treatment method. This article retrospectively analyzed and summarized the clinical data of this case series, with the aim of exploring the main technical details and clinical prognosis. METHODS Included were patients with OPG-uDCⅠ without neurofibromatosis type 1 and experiencing vision loss on the affected side. The fronto-orbital approach was used, which was mainly divided into 3 parts: intraorbital, optic canal, and intracranial. All patients underwent prechiasmatic resection without any adjuvant treatments. The follow-up period was 3 months after surgery, and magnetic resonance imaging and contralateral visual acuity were reviewed annually after surgery. RESULTS All OPG-uDCⅠ cases were completely removed without any adjuvant treatments, and there was no recurrence during the follow-up period. Pathological results showed that, except for 1 adult patient with pilomyxoid astrocytoma (World Health Organization grade Ⅱ), the others all had pilocytic astrocytoma (World Health Organization grade Ⅰ). Five patients experienced transient ptosis, and all recovered 3 months after surgery. CONCLUSIONS For OPG-uDCⅠ without neurofibromatosis type 1, radical prechiasmatic resection of the tumor is possible, without the need for postoperative radiotherapy and chemotherapy.
Collapse
Affiliation(s)
- Wensheng Li
- Department of Neurosurgery, The Third Afliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Manting Li
- Department of Neurosurgery, The Third Afliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Lun Luo
- Department of Neurosurgery, The Third Afliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Yuanjun Hu
- Department of Neurosurgery, The Third Afliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Xuanxin Liu
- Department of Neurosurgery, The Third Afliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Huasheng Yang
- Department of Eye Tumor and Orbital Disease, Zhongshan Ophthalmic Center (ZOC) of Sun Yat-Sen University, Guangzhou, China
| | - Ying Guo
- Department of Neurosurgery, The Third Afliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Haiyong He
- Department of Neurosurgery, The Third Afliated Hospital of Sun Yat-Sen University, Guangzhou, China.
| |
Collapse
|
2
|
Robinow ZM, Peterson C, Riestenberg R, Waldau B, Yu N, Shahlaie K. Cosmetic Outcomes of Supraorbital Keyhole Craniotomy Via Eyebrow Incision: A Systematic Review and Meta-Analysis. J Neurol Surg B Skull Base 2023; 84:470-498. [PMID: 37671300 PMCID: PMC10477017 DOI: 10.1055/s-0042-1755575] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 07/08/2022] [Indexed: 10/14/2022] Open
Abstract
Background Supraorbital eyebrow craniotomy is a minimally invasive alternative to a frontotemporal craniotomy and is often used for tumor and vascular pathologies. The purpose of this study was to investigate how patient cosmetic outcomes are affected by technique variations of this approach. Methods PubMed, Embase, and Scopus databases were systematically searched, and results were reported according to PRISMA guidelines. For the meta-analysis portion, the DerSimonian-Laird random effects model was used, and the primary end points were patient satisfaction and percentage of permanent cosmetic complications. Results A total of 2,629 manuscripts were identified. Of those, 124 studies (8,241 surgical cases) met the inclusion criteria. Overall, 93.04 ± 11.93% of patients reported favorable cosmetic outcome following supraorbital craniotomy, and mean number of cases with permanent cosmetic complications was 6.62 ± 12.53%. We found that vascular cases are associated with more favorable cosmetic outcomes than tumor cases ( p = 0.0001). Addition of orbital osteotomy or use of a drain is associated with adverse cosmetic outcomes ( p = 0.001 and p = 0.0001, respectively). The location of incision, size of craniotomy, utilization of an endoscope, method of cranial reconstruction, skin closure, use of antibiotics, and addition of pressure dressing did not significantly impact cosmetic outcomes ( p > 0.05 for all). Conclusions Supraorbital craniotomy is a minimally invasive technique associated with generally high favorable cosmetic outcomes. While certain techniques used in supraorbital keyhole approach do not pose significant cosmetic risks, utilization of an orbital osteotomy and the addition of a drain correlate with unfavorable cosmetic outcomes.
Collapse
Affiliation(s)
- Zoe M. Robinow
- California Northstate University College of Medicine, Elk Grove, California, United States
| | - Catherine Peterson
- Department of Neurological Surgery, University of California Davis, Sacramento, California, United States
| | - Robert Riestenberg
- Department of Neurological Surgery, University of California Davis, Sacramento, California, United States
| | - Ben Waldau
- Department of Neurological Surgery, University of California Davis, Sacramento, California, United States
| | - Nina Yu
- Department of Neurological Surgery, University of California Davis, Sacramento, California, United States
| | - Kiarash Shahlaie
- Department of Neurological Surgery, University of California Davis, Sacramento, California, United States
| |
Collapse
|
3
|
Supraorbital Keyhole Craniotomy via Eyebrow Incision: A Systematic Review and Meta-Analysis. World Neurosurg 2022; 158:e509-e542. [PMID: 34775096 DOI: 10.1016/j.wneu.2021.11.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 11/02/2021] [Accepted: 11/03/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Supraorbital eyebrow keyhole craniotomy is a minimally invasive alternative to a frontotemporal craniotomy and is often used for tumor resection and aneurysm clipping. The purpose of this study is to provide a contemporary review on the outcomes related to this approach and to determine whether they vary with the type of pathology and the addition of an endoscope. METHODS PubMed, Embase, and Scopus databases were systematically searched, and results were reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. For the meta-analysis portion, the DerSimonian-Laird random effects model was used. RESULTS A total of 2629 manuscripts were identified. of those, 124 studies (8241 surgical cases) met the inclusion criteria. Mean total complication rate was 26.7 ± 25.7% and the mean approach-related mortality rate was 1.3 ± 2.8%. Technical success, defined as gross total tumor resection or complete aneurysm clipping, was achieved in 83.6 ± 21.5% of the cases. Vascular pathologies were associated with greater technical success, lower total complications, and longer length of hospital stay compared with tumor cases (P < 0.05 for all). For vascular cases, addition of the endoscope yielded lower technical success (P = 0.001) and lower complication rate (P = 0.041). The use of the endoscope for tumor pathologies did not affect technical success, complications, mortality, length of hospital stay, operative time, or reoperation rate (P > 0.05). CONCLUSIONS The supraorbital craniotomy via an eyebrow incision is a feasible minimally invasive approach with an overall high technical success rate for both vascular and tumor pathologies.
Collapse
|
4
|
The Treatment Strategy for Skull Base Reconstruction for Anterior Cranial Fossa Intra- and Extracranial Tumors. J Craniofac Surg 2021; 32:1673-1678. [PMID: 33208698 DOI: 10.1097/scs.0000000000007244] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
ABSTRACT Anterior cranial fossa intra- and extracranial tumors arise from the anterior cranial fossa and invade the orbit and nose. Anterior cranial fossa tumor resection and skull base reconstruction are challenging for neurosurgeons due to the complex anatomy, leakage of cerebrospinal fluid, and critical neurovasculature involvement. The authors report a case series of cranio-orbital communicating tumors and cranionasal-orbital communicating tumors. All patients underwent a modified Derome approach or transfrontal basal approach, and all tumor resections were satisfactory. Skull base reconstruction for small defects (<1.5 cm) can be performed with autogenous fascia, muscle, and fat. Large defects (≥1.5 cm) require autogenous fascia, muscle, and fat combined with osseous reconstruction (autogenous bone, titanium mesh, and polyetheretherketone). The techniques and treatments were successful, and only 1 patient experienced mild cerebrospinal fluid leak but no intracranial infection, pneumocrania or intracranial hemorrhage. Additionally, long-term follow-up demonstrated that the outcomes remain favorable. According to a literature review, this technique might be an alternative strategy for treating anterior cranial fossa intra- and extracranial tumors, and better skull base reconstruction can prevent many postoperative complications.
Collapse
|
5
|
Zamanipoor Najafabadi AH, Genders SW, van Furth WR. Visual outcomes endorse surgery of patients with spheno-orbital meningioma with minimal visual impairment or hyperostosis. Acta Neurochir (Wien) 2021; 163:73-82. [PMID: 32888075 PMCID: PMC7778613 DOI: 10.1007/s00701-020-04554-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 08/24/2020] [Indexed: 12/23/2022]
Abstract
ABTRACT BACKGROUND: Most spheno-orbital meningioma series span multiple decades, and predictors of visual outcomes have not yet been systemically assessed. We describe visual outcomes in a recent cohort and assess predictors of postoperative visual outcomes. METHODS Consecutive case series operated by a team of a neurosurgeon and orbital surgeon between May 2015 and January 2019. Best corrected visual acuity (BCVA), visual fields (static perimetry), and relative proptosis were measured preoperatively and postoperatively at 3/6/12 months after which it was assessed yearly. Predictors were assessed with linear regression analysis. RESULTS Nineteen patients (all WHO grade I) were operated by the pterional approach (median follow-up 2.4 years). Preoperative visual acuity deficits (n = 10) normalized in 70% and improved in 10% (median preoperative: 0.8, postoperative: 1.2, p = 0.021). Preoperative visual field deficits (n = 8) normalized in all patients (preoperative: - 6.5 dB, postoperative: - 1.5 dB, p = 0.008). Preoperative proptosis (n = 16) normalized in 44% and improved in 56% (preoperative: 5 mm, postoperative: 2 mm, p < 0.001). BCVA and visual fields remained stable at longer follow-up in 95% of patients, while 21% showed progression of proptosis. Predictors for worse longer-term (> 12 months) BCVA were worse preoperative BCVA (p = 0.002) and diagnosis of multiple meningioma (p = 0.021). Predictors for worse longer-term visual fields were higher diameter of hyperostosis (p = 0.009) and higher Simpson grade (p = 0.032). Predictor for short-term (3 months) proptosis was preoperative proptosis (p = 0.006). CONCLUSION We recommend surgery, even of patients with minimal visual impairment or hyperostosis, as patients who present with deteriorated visual function or extensive hyperostosis are less likely to have postoperative visual outcomes restored to normal.
Collapse
Affiliation(s)
| | - Stijn W Genders
- University Neurosurgical Centre Holland, Leiden University Medical Centre, Haaglanden Medical Centre and Haga Teaching Hospital, Leiden and The Hague, The Netherlands
- Orbital Center, Department of Ophthalmology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Wouter R van Furth
- Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands
| |
Collapse
|
6
|
Donofrio CA, Capitanio JF, Riccio L, Herur-Raman A, Caputy AJ, Mortini P. Mini Fronto-Orbital Approach: "Window Opening" Towards the Superomedial Orbit - A Virtual Reality-Planned Anatomic Study. Oper Neurosurg (Hagerstown) 2020; 19:330-340. [PMID: 31960061 DOI: 10.1093/ons/opz420] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 12/01/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Surgical approaches to the orbit are challenging and require combined multispecialist skills. Considering its increasing relevance in neurosurgical practice, keyhole surgery could be also applied to this field. However, mastering a minimally invasive approach necessitates an extended learning curve. For this reason, virtual reality (VR) can be effectively used for planning and training in this demanding surgical technique. OBJECTIVE To validate the mini fronto-orbital (mFO) approach to the superomedial orbit, using VR planning and specimen dissections, conjugating the principles of skull base and keyhole neurosurgery. METHODS Three-dimensional measurements were performed thanks to Surgical Theater (Surgical Theater© LLC), and then, simulated craniotomies were implemented on cadaver specimens. RESULTS The mFO approach affords optimal exposure and operability in the target area and reduced risks of surrounding normal tissue injuries. The eyebrow skin incision, the minimal soft-tissue retraction, the limited temporalis muscle dissection and the single-piece craniotomy, as planned with VR, are the key elements of this minimally invasive approach. Furthermore, the "window-opening" cotton-tip intraorbital dissection technique, based on widening surgical corridors between neuromuscular bundles, provides a safe orientation and a deep access inside the orbit, thereby significantly limiting the risk of jeopardizing neurovascular structures. CONCLUSION The mFO approach associated to the window-opening dissection technique can be considered safe, effective, suitable, and convenient for treating lesions located in the superomedial orbital aspect, up to the orbital apex.
Collapse
Affiliation(s)
- Carmine Antonio Donofrio
- Department of Neurosurgery and Gamma Knife Radiosurgery, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Jody Filippo Capitanio
- Department of Neurosurgery and Gamma Knife Radiosurgery, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Lucia Riccio
- Department of Neurosurgery and Gamma Knife Radiosurgery, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | | | - Anthony J Caputy
- Department of Neurosurgery, George Washington Hospital, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Pietro Mortini
- Department of Neurosurgery and Gamma Knife Radiosurgery, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| |
Collapse
|
7
|
He H, Cai M, Li M, Wei L, Luo L, Chen Z, Yang H, Guo Y, Li W. Surgical Techniques and the Choice of Operative Approach for Cranioorbital Lesions. J Neurol Surg B Skull Base 2019; 81:686-693. [PMID: 33381374 DOI: 10.1055/s-0039-1696684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 07/28/2019] [Indexed: 10/26/2022] Open
Abstract
Objectives Cranioorbital lesions present a great challenge for neurosurgeons and ophthalmologists. There is no consensus on the choice of surgical approach. The aims of this study were to investigate 49 cases of cranioorbital lesions and evaluate surgical approaches and outcomes. Patients and Methods A retrospective study was done on 49 patients (51 operations) from 2009 to 2018. Information about the lesion was used to decide whether the supraorbital eyebrow approach (SEA) or pterional approach (PA) was performed. Results Twenty-eight patients had surgical resection using SEA, 21 patients received PA, each group included one case of recurrence, who underwent reoperation via the same approach. SEA provided better cosmetic satisfaction, and a shorter incision than PA ( p < 0.05). There was no significant difference in total resection rates, visual outcomes, recovery of ptosis, and other new surgical-related complications between SEA group and PA group ( p > 0.05). Forty-nine cases of proptosis (94.1%, 49/51) were improved. Thirty-three patients (33/37, 89.2%) who underwent follow-up for longer than 12 weeks had a modified Rankin Scale (mRS) score ≤ 3. Conclusion Surgery is the preferred treatment for cranioorbital lesions, but total resection is difficult. SEA may be a more minimally invasive option for some more limited lesions superior to optic nerve. PA may be more reasonable for the lesion with obvious hyperostosis and more extensive lesions.
Collapse
Affiliation(s)
- Haiyong He
- Department of Neurosurgery, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Meiqin Cai
- Department of Neurosurgery, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Manting Li
- Department of Neurosurgery, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Lei Wei
- Department of Neurology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510060, People's Republic of China
| | - Lun Luo
- Department of Neurosurgery, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Zhuopeng Chen
- Department of Neurosurgery, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Huasheng Yang
- Department of Eye Tumor and Orbital Disease, Zhongshan Ophthalmic Center (ZOC) of Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Ying Guo
- Department of Neurosurgery, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Wensheng Li
- Department of Neurosurgery, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People's Republic of China
| |
Collapse
|
8
|
He H, Li W, Cai M, Luo L, Li M, Ling C, Huang T, Yang H, Guo Y. Outcomes After Pterional and Supraorbital Eyebrow Approach for Cranio-Orbital Lesions Communicated via the Supraorbital Fissure—A Retrospective Comparison. World Neurosurg 2019; 129:e279-e285. [DOI: 10.1016/j.wneu.2019.05.128] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 05/14/2019] [Accepted: 05/15/2019] [Indexed: 11/29/2022]
|