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Tariciotti L, Rodas A, Patel B, Zohdy YM, De Andrade EJ, Revuelta Barbero M, Porto E, Vuncannon J, Maldonado J, Vergara SM, Lohana S, Solares CA, DiMeco F, Garzon-Muvdi T, Pradilla G. Biportal Endoscopic TransOrbital and transMaxillary Approach to the Cranio-Orbital Region and Middle Cranial Fossa: A Preliminary Analysis of Maneuverability. Oper Neurosurg (Hagerstown) 2024:01787389-990000000-01256. [PMID: 39012138 DOI: 10.1227/ons.0000000000001259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 05/08/2024] [Indexed: 07/17/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Traditional and well-established transcranial approaches to the spheno-orbital region and middle cranial fossa guarantee optimal intracranial exposure, and additional orbital and zygomatic osteotomies provide further control over extracranial components to be resected; however, these techniques come at the cost of additional morbidity. The introduction of minimally invasive endoscopic approaches and the conceptualization of the so-called "multiportal" paradigm might provide an alternative route. This preliminary study investigates the feasibility of the combined Biportal Endoscopic TransOrbital and transMaxillary Approach (bETOMA) approach to the spheno-orbital and middle cranial fossa regions. METHODS Using 4 silicon-injected adult cadaver heads (8 sides; 16 approaches), we systematically dissected through superior eyelid ETOA and endoscopic TMA approaches. The analysis focused on pterygopalatine, infratemporal, anterior and middle cranial fossae, Meckel cave, and cavernous sinus access. We evaluated the feasibility of bETOMA using linear distances, angles of attack, and exposure areas. We also introduced volume of operative maneuverability, its standardized derivative (sVOM), target distance, visuo-operative angle, and working zone volume as novel metrics. RESULTS The analysis revealed comparable angles of attack between approaches. ETOA and TMA exposure areas were 918.38 ± 223.93 mm2 and 257.07 ± 86.07 mm2, respectively. TMA showed a larger VOM in the greater sphenoid wing, but ETOA offered superior distal maneuverability (sVOM: 5.39 ± 1.94 vs 2.54 ± 0.79 cm3) and closer intracranial space access (27.45 vs 50.83 mm). The combined approaches yielded a mean working zone volume of 13.75 ± 3.73 cm3 in the spheno-orbital interface. CONCLUSION The bETOMA approach provides adequate neurovascular exposure and maneuverability to the spheno-orbital region, infratemporal, and anterior and middle cranial fossae, addressing significant limitations of previously investigated monoportal techniques (ie, optic nerve decompression, hyperostotic bone resection, and infratemporal exposure). This combined minimally invasive approach might help manage lesions harbored within the cranio-orbital interface region invading the extracranial space.
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Affiliation(s)
- Leonardo Tariciotti
- Department of Neurosurgery, Emory University, Atlanta, Georgia, USA
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Alejandra Rodas
- Department of Otorhinolaryngology-Head and Neck Surgery, Emory University, Atlanta, Georgia, USA
| | - Biren Patel
- Department of Neurosurgery, Emory University, Atlanta, Georgia, USA
| | - Youssef M Zohdy
- Department of Neurosurgery, Emory University, Atlanta, Georgia, USA
| | | | | | - Edoardo Porto
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Jackson Vuncannon
- Department of Otorhinolaryngology-Head and Neck Surgery, Emory University, Atlanta, Georgia, USA
| | - Justin Maldonado
- Department of Neurosurgery, Emory University, Atlanta, Georgia, USA
| | - Silvia M Vergara
- Department of Neurosurgery, Emory University, Atlanta, Georgia, USA
| | - Samir Lohana
- Department of Neurosurgery, Emory University, Atlanta, Georgia, USA
| | - C Arturo Solares
- Department of Otorhinolaryngology-Head and Neck Surgery, Emory University, Atlanta, Georgia, USA
| | - Francesco DiMeco
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
- Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Gustavo Pradilla
- Department of Neurosurgery, Emory University, Atlanta, Georgia, USA
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Al-Shalchy A, Al-Taie RH, Algburi HA, Ismail M. Neuroanatomical perspectives on transorbital approaches: A meta-analysis. Surg Neurol Int 2024; 15:202. [PMID: 38974567 PMCID: PMC11225392 DOI: 10.25259/sni_351_2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Accepted: 05/29/2024] [Indexed: 07/09/2024] Open
Abstract
Background Transorbital approaches represent a paradigm shift in skull base surgery, focusing on minimally invasive techniques that prioritize patient outcomes and surgical precision. The scientific community, recognizing the significance of these advances, necessitates a possible review and meta-analysis to encapsulate the collective efficacy, safety, and developmental trajectory of these approaches. Methods This was a literature review targeting literature in the past 10 years to present evidence for studies on surgical approaches transorbital. The included articles were analyzed. In addition, the references list of the included papers was searched for further articles. Results Studies based on the endoscopic endonasal and transorbital approach have emphasized that it is minimally invasive; on the other hand, it offers an advantage to maximal resection success in the case of skull base tumors with advanced endoscopic skills. Transorbital neuroendoscopic surgery was criticized for being highly technical and narrow in its scope, with reduced morbidity. Superior Eyelid Approach involves a direct access with hidden incisions, potential for eyelid complications. Lateral orbitotomy entailed some inherent risks, such as muscle and nerve injury, but it gave excellent exposure to lesions that are lateral in the orbit. The transorbital endoscopic intraconal approach and the transconjunctival approach give direct advantages but are, however, limited to the type of lesion and location. Conclusion The main technique focused on in this overview is the approaches through orbits, which greatly contribute to further innovation brought into the surgical panorama of skull base interventions. All such techniques do have their characteristics and applications, keeping them moving toward less invasiveness.
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Affiliation(s)
- Ali Al-Shalchy
- Department of Surgery, Univeristy of Baghdad, College of Medicine, Baghdad, Iraq
| | - Rania H. Al-Taie
- Department of Surgery, Univeristy of Mustansiriyah, College of Medicine, Baghdad, Iraq
| | - Hagar A. Algburi
- Department of Surgery, Univeristy of Baghdad, College of Medicine, Baghdad, Iraq
| | - Mustafa Ismail
- Department of Neurosurgery, Neurosurgery Teaching Hospital, Baghdad, Iraq
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De Simone M, Zoia C, Choucha A, Kong DS, De Maria L. The Transorbital Approach: A Comprehensive Review of Targets, Surgical Techniques, and Multiportal Variants. J Clin Med 2024; 13:2712. [PMID: 38731240 PMCID: PMC11084817 DOI: 10.3390/jcm13092712] [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: 04/05/2024] [Revised: 04/24/2024] [Accepted: 05/02/2024] [Indexed: 05/13/2024] Open
Abstract
The transorbital approach (TOA) is gaining popularity in skull base surgery scenarios. This approach represents a valuable surgical corridor to access various compartments and safely address several intracranial pathologies, both intradurally and extradurally, including tumors of the olfactory groove in the anterior cranial fossa (ACF), cavernous sinus in the middle cranial fossa (MCF), and the cerebellopontine angle in the posterior cranial fossa (PCF). The TOA exists in many variants, both from the point of view of invasiveness and from that of the entry point to the orbit, corresponding to the four orbital quadrants: the superior eyelid crease (SLC), the precaruncular (PC), the lateral retrocanthal (LRC), and the preseptal lower eyelid (PS). Moreover, multiportal variants, consisting of the combination of the transorbital approach with others, exist and are relevant to reach peculiar surgical territories. The significance of the TOA in neurosurgery, coupled with the dearth of thorough studies assessing its various applications and adaptations, underscores the necessity for this research. This extensive review delineates the multitude of target lesions reachable through the transorbital route, categorizing them based on surgical complexity. Furthermore, it provides an overview of the different transorbital variations, both standalone and in conjunction with other techniques. By offering a comprehensive understanding, this study aims to enhance awareness and knowledge regarding the current utility of the transorbital approach in neurosurgery. Additionally, it aims to steer future investigations toward deeper exploration, refinement, and exploration of additional perspectives concerning this surgical method.
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Affiliation(s)
- Matteo De Simone
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, Via S. Allende, 84081 Baronissi, Italy
| | - Cesare Zoia
- UOC of Neurosurgery, Ospedale Moriggia Pelascini, Gravedona e Uniti, 22015 Gravedona, Italy;
| | - Anis Choucha
- Department of Neurosurgery, Aix Marseille University, APHM, UH Timone, 13005 Marseille, France;
- Laboratory of Biomechanics and Application, UMRT24, Gustave Eiffel University, Aix Marseille University, 13005 Marseille, France
| | - Doo-Sik Kong
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Republic of Korea;
| | - Lucio De Maria
- Division of Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Piazza Spedali Civili 1, 25123 Brescia, Italy;
- Division of Neurosurgery, Department of Clinical Neurosciences, Geneva University Hospitals (HUG), Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland
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Locatelli D, Veiceschi P, Arosio AD, Agosti E, Peris-Celda M, Castelnuovo P. 360 Degrees Endoscopic Access to and Through the Orbit. Adv Tech Stand Neurosurg 2024; 50:231-275. [PMID: 38592533 DOI: 10.1007/978-3-031-53578-9_8] [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] [Indexed: 04/10/2024]
Abstract
The treatment of pathologies located within and surrounding the orbit poses considerable surgical challenges, due to the intricate presence of critical neurovascular structures in such deep, confined spaces. Historically, transcranial and craniofacial approaches have been widely employed to deal with orbital pathologies. However, recent decades have witnessed the emergence of minimally invasive techniques aimed at reducing morbidity. Among these techniques are the endoscopic endonasal approach and the subsequently developed endoscopic transorbital approach (ETOA), encompassing both endonasal and transpalpebral approaches. These innovative methods not only facilitate the management of intraorbital lesions but also offer access to deep-seated lesions within the anterior, middle, and posterior cranial fossa via specific transorbital and endonasal corridors. Contemporary research indicates that ETOAs have demonstrated exceptional outcomes in terms of morbidity rates, cosmetic results, and complication rates. This study aims to provide a comprehensive description of endoscopic-assisted techniques that enable a 360° access to the orbit and its surrounding regions. The investigation will delve into indications, advantages, and limitations associated with different approaches, while also drawing comparisons between endoscopic approaches and traditional microsurgical transcranial approaches.
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Affiliation(s)
- Davide Locatelli
- Division of Neurosurgery, Department of Biotechnology and Life Sciences, "Ospedale di Circolo e Fondazione Macchi", University of Insubria, Varese, Italy
- Head and Neck and Forensic Dissection Research Center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
- Research Center for Pituitary Adenoma and Sellar Pathology, University of Insubria, Varese, Italy
| | - Pierlorenzo Veiceschi
- Division of Neurosurgery, Department of Biotechnology and Life Sciences, "Ospedale di Circolo e Fondazione Macchi", University of Insubria, Varese, Italy
| | - Alberto Daniele Arosio
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, "Ospedale di Circolo e Fondazione Macchi", University of Insubria, Varese, Italy
| | - Edoardo Agosti
- Division of Neurosurgery, Department of Biotechnology and Life Sciences, "Ospedale di Circolo e Fondazione Macchi", University of Insubria, Varese, Italy
- Unit of Neurosurgery, Spedali Civili Hospital, Brescia, Italy
| | - Maria Peris-Celda
- Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, MN, USA
- Department of Neurological Surgery, Mayo Clinic, Rochester, MN, USA
| | - Paolo Castelnuovo
- Head and Neck and Forensic Dissection Research Center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
- Research Center for Pituitary Adenoma and Sellar Pathology, University of Insubria, Varese, Italy
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, "Ospedale di Circolo e Fondazione Macchi", University of Insubria, Varese, Italy
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Di Somma A, Codes M, Guizzardi G, Mosteiro A, Tafuto R, Ferres A, Matas J, Prats-Galino A, Enseñat J, Cavallo LM. Transorbital Route to Intracranial Space. Adv Tech Stand Neurosurg 2024; 52:183-205. [PMID: 39017795 DOI: 10.1007/978-3-031-61925-0_14] [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] [Indexed: 07/18/2024]
Abstract
The endoscopic superior eyelid transorbital approach has emerged as a notable and increasingly utilized surgical technique in recent years. This chapter presents an overview of the approach, tracing its historical development and highlighting its growing acceptance within the skull base community.Beginning with an introduction and historical perspective, the chapter outlines the evolution of the transorbital approach, shedding light on its origins and the factors driving its adoption. Subsequently, a comprehensive exploration of the anatomic bone pillars and intracranial spaces accessible via this approach is provided. Hence, five bone pillars of the transorbital approach were identified, namely the lesser sphenoid wing, the anterior clinoid, the sagittal crest, the middle cranial fossa, and the petrous apex. A detailed correlation of those bone targets with respective intracranial areas has been reported.Furthermore, the chapter delves into the practical application of the technique through a case example, offering insights into its clinical utility, indications, and limitations.
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Affiliation(s)
- Alberto Di Somma
- Department of Neurological Surgery, Institut Clínic de Neurociències (ICN), Hospital Clínic de Barcelona, Universidad de Barcelona, Barcelona, Spain
- Laboratory of Surgical Neuroanatomy, Universitat de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Marta Codes
- Department of Neurological Surgery, Institut Clínic de Neurociències (ICN), Hospital Clínic de Barcelona, Universidad de Barcelona, Barcelona, Spain
| | - Giulia Guizzardi
- Department of Neurological Surgery, Institut Clínic de Neurociències (ICN), Hospital Clínic de Barcelona, Universidad de Barcelona, Barcelona, Spain
- Laboratory of Surgical Neuroanatomy, Universitat de Barcelona, Barcelona, Spain
| | - Alejandra Mosteiro
- Department of Neurological Surgery, Institut Clínic de Neurociències (ICN), Hospital Clínic de Barcelona, Universidad de Barcelona, Barcelona, Spain
| | - Roberto Tafuto
- Division of Neurosurgery, Department of Neuroscience and Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli "Federico II", Naples, Italy
| | - Abel Ferres
- Department of Neurological Surgery, Institut Clínic de Neurociències (ICN), Hospital Clínic de Barcelona, Universidad de Barcelona, Barcelona, Spain
| | - Jessica Matas
- Department of Ophthalmology, Hospital Clínic de Barcelona, Universidad de Barcelona, Barcelona, Spain
| | - Alberto Prats-Galino
- Laboratory of Surgical Neuroanatomy, Universitat de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Joaquim Enseñat
- Department of Neurological Surgery, Institut Clínic de Neurociències (ICN), Hospital Clínic de Barcelona, Universidad de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Luigi Maria Cavallo
- Division of Neurosurgery, Department of Neuroscience and Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli "Federico II", Naples, Italy
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De Rosa A, Mosteiro A, Guizzardi G, Roldán P, Torales J, Matas Fassi J, Cavallo LM, Solari D, Prats-Galino A, Di Somma A, Enseñat J. Endoscopic transorbital resection of the temporal lobe: anatomic qualitative and quantitative study. Front Neuroanat 2023; 17:1282226. [PMID: 37818154 PMCID: PMC10560990 DOI: 10.3389/fnana.2023.1282226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 08/30/2023] [Indexed: 10/12/2023] Open
Abstract
Objective Starting from an anatomic study describing the possibility of reaching the temporal region through an endoscopic transorbital approach, many clinical reports have now demonstrated the applicability of this strategy when dealing with intra-axial lesions. The study aimed to provide both a qualitative anatomic description of the temporal region, as seen through a transorbital perspective, and a quantitative analysis of the amount of temporal lobe resection achievable via this route. Material and methods A total of four cadaveric heads (eight sides) were dissected at the Laboratory of Surgical Neuroanatomy (LSNA) of the University of Barcelona, Spain. A stepwise description of the resection of the temporal lobe through a transorbital perspective is provided. Qualitative anatomical descriptions and quantitative analysis of the amount of the resection were evaluated by means of pre- and post-dissection CT and MRI scans, and three-dimensional reconstructions were made by means of BrainLab®Software. Results The transorbital route gives easy access to the temporal region, without the need for extensive bone removal. The resection of the temporal lobe proceeded in a subpial fashion, mimicking what happens in a surgical scenario. According to our quantitative analysis, the mean volume removed was 51.26%, with the most superior and lateral portion of the temporal lobe being the most difficult to reach. Conclusion This anatomic study provides qualitative and quantitative details about the resection of the temporal lobe via an endoscopic transorbital approach. Our results showed that the resection of more than half of the temporal lobe is possible through this surgical corridor. While the anterior, inferior, and mesial portions of the temporal lobe were easily accessible, the most superior and lateral segment was more difficult to reach and resect. Our study serves as an integration to the current anatomic knowledge and clinical practice knowledge highlighting and also as a starting point for further anatomic studies addressing more selected segments of the temporal lobe, i.e., the mesial temporal region.
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Affiliation(s)
- Andrea De Rosa
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli “Federico II”, Naples, Italy
| | | | | | - Pedro Roldán
- Department of Neurosurgery, Hospital Clinic, Barcelona, Spain
| | - Jorge Torales
- Department of Neurosurgery, Hospital Clinic, Barcelona, Spain
| | - Jessica Matas Fassi
- Department of Ophthalmology, Hospital Clínic de Barcelona, Universidad de Barcelona, Barcelona, Spain
| | - Luigi Maria Cavallo
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli “Federico II”, Naples, Italy
| | - Domenico Solari
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli “Federico II”, Naples, Italy
| | - Alberto Prats-Galino
- Laboratory of Surgical Neuroanatomy, Faculty of Medicine, Universitat de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | | | - Joaquim Enseñat
- Department of Neurosurgery, Hospital Clinic, Barcelona, Spain
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Serioli S, Nizzola M, Plou P, De Bonis A, Meyer J, Leonel LCPC, Tooley AA, Wagner LH, Bradley EA, Van Gompel JJ, Benini ME, Dallan I, Peris-Celda M. Surgical Anatomy of the Microscopic and Endoscopic Transorbital Approach to the Middle Fossa and Cavernous Sinus: Anatomo-Radiological Study with Clinical Applications. Cancers (Basel) 2023; 15:4435. [PMID: 37760405 PMCID: PMC10527149 DOI: 10.3390/cancers15184435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 08/30/2023] [Accepted: 09/01/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND The transorbital approaches (TOAs) have acquired growing notoriety, thanks to their ability to offer alternative corridors to the skull base. However, the limited access and the unfamiliarity with this surgical perspective make recognition of key landmarks difficult, especially for less experienced surgeons. The study wants to offer a detailed description of the anatomy to comprehend the potential and limitations of TOAs. METHODS Measurements of the orbit region and the surrounding areas were performed on two hundred high-resolution CT scans and thirty-nine dry skulls. Five specimens were dissected to illustrate the TOA, and one was used to perform the extradural clinoidectomy. Three clinical cases highlighted the surgical applications. RESULTS A step-by-step description of the key steps of the TOA was proposed and a comparison with the transcranial anterior clinoidectomy was discussed. The mean work distance was 6.1 ± 0.4 cm, and the lateral working angle increased 20 ± 5.4° after removing the lateral orbital rim. CONCLUSIONS TOAs are indicated in selected cases when tumor involves the lateral portion of the cavernous sinus or the middle skull base, obtaining a direct decompression of the optic nerve and avoiding excessive manipulation of the neurovascular structures. Comprehension of surgical anatomy of the orbit and its surrounding structures is essential to safely perform these approaches.
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Affiliation(s)
- Simona Serioli
- Division of Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, 25123 Brescia, Italy;
- Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, MN 55905, USA; (M.N.); (P.P.); (A.D.B.); (J.M.); (L.C.P.C.L.)
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, USA;
| | - Mariagrazia Nizzola
- Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, MN 55905, USA; (M.N.); (P.P.); (A.D.B.); (J.M.); (L.C.P.C.L.)
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, USA;
- Department of Neurosurgery and Gamma Knife Radiosurgery, I.R.C.C.S. San Raffaele Scientific Institute, Vita-Salute University, 20132 Milan, Italy
| | - Pedro Plou
- Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, MN 55905, USA; (M.N.); (P.P.); (A.D.B.); (J.M.); (L.C.P.C.L.)
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, USA;
- Neurosurgery Department, Hospital Italiano de Buenos Aires, Buenos Aires C1199, Argentina
| | - Alessandro De Bonis
- Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, MN 55905, USA; (M.N.); (P.P.); (A.D.B.); (J.M.); (L.C.P.C.L.)
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, USA;
- Department of Neurosurgery and Gamma Knife Radiosurgery, I.R.C.C.S. San Raffaele Scientific Institute, Vita-Salute University, 20132 Milan, Italy
| | - Jenna Meyer
- Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, MN 55905, USA; (M.N.); (P.P.); (A.D.B.); (J.M.); (L.C.P.C.L.)
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, USA;
- Department of Neurologic Surgery, Mayo Clinic, Phoenix, AZ 85054, USA
| | - Luciano C. P. C. Leonel
- Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, MN 55905, USA; (M.N.); (P.P.); (A.D.B.); (J.M.); (L.C.P.C.L.)
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, USA;
| | - Andrea A. Tooley
- Department of Ophthalmology, Mayo Clinic, Rochester, MN 55905, USA; (A.A.T.); (L.H.W.); (E.A.B.)
| | - Lilly H. Wagner
- Department of Ophthalmology, Mayo Clinic, Rochester, MN 55905, USA; (A.A.T.); (L.H.W.); (E.A.B.)
| | - Elizabeth A. Bradley
- Department of Ophthalmology, Mayo Clinic, Rochester, MN 55905, USA; (A.A.T.); (L.H.W.); (E.A.B.)
| | - Jamie J. Van Gompel
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, USA;
- Department of Otolaryngology/Head and Neck Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | - Maria Elena Benini
- Department of Neurosurgery—Head and Neck Surgery, Azienda Ospedaliero-Universitaria Pisana, 56126 Pisa, Italy;
| | - Iacopo Dallan
- Department of Otolaryngology—Head and Neck Surgery, Azienda Ospedaliero-Universitaria Pisana, 56126 Pisa, Italy;
| | - Maria Peris-Celda
- Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, MN 55905, USA; (M.N.); (P.P.); (A.D.B.); (J.M.); (L.C.P.C.L.)
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, USA;
- Department of Otolaryngology/Head and Neck Surgery, Mayo Clinic, Rochester, MN 55905, USA
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Lin BJ, Ju DT, Hueng DY, Chen YH, Ma HI, Liu MY. Transorbital transposition of the temporoparietal fascia flap to reconstruct the skull base defects: A preclinical study with comparison to the transpterygoid transposition. Head Neck 2023; 45:2438-2448. [PMID: 37431182 DOI: 10.1002/hed.27455] [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: 04/24/2023] [Revised: 06/27/2023] [Accepted: 06/29/2023] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND Transpterygoid transposition of the temporoparietal fascia flap (TPFF) is a feasible selection for ventral skull base defect (VSBD) reconstruction, but not anterior skull base defect (ASBD) reconstruction, after expanded endoscopic endonasal approach (EEEA). The goal of this study is to introduce the transorbital transposition of the TPFF for skull base defects reconstruction after EEEA, and make quantitative comparison between the transpterygoid transposition and transorbital transposition. METHODS Cadaveric dissections were performed in five adult cadaveric heads with creating three transporting corridors bilaterally, encompassing superior transorbital corridor, inferior transorbital corridor, and transpterygoid corridor. For each transporting corridor, the minimum necessary length of the TPFF for skull base defects reconstruction was measured. RESULTS The areas of ASBD and VSBD were 1019.63 ± 176.32 mm2 and 572.99 ± 126.21 mm2 . The length of the harvested TPFF was 149.38 ± 6.21 mm. In contrast to the transpterygoid transposition with incomplete coverage, transorbital transposition of the TPFF allowed full coverage of ASBD with a minimum necessary length of 109.75 ± 8.31 mm. For VSBD reconstruction, transorbital transposition of the TPFF needs shorter minimum necessary length (123.88 ± 4.49 mm) than transpterygoid transposition (138.00 ± 6.28 mm). CONCLUSIONS Transorbital corridor is a novel pathway for transporting the TPFF into the sinonasal cavity for skull base defects reconstruction after EEEA. In comparison with transpterygoid transposition, transorbital transposition provides wider coverage of skull base defects with a fixed length of the TPFF.
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Affiliation(s)
- Bon-Jour Lin
- Department of Neurological Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Da-Tong Ju
- Department of Neurological Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Dueng-Yuan Hueng
- Department of Neurological Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Yuan-Hao Chen
- Department of Neurological Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Hsin-I Ma
- Department of Neurological Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Ming-Ying Liu
- Department of Neurological Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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Di Somma A, De Rosa A, Ferrés A, Mosteiro A, Guizzardi G, Fassi JM, Topczewski TE, Reyes L, Roldán P, Torné R, Alobid I, Enseñat J. Endoscopic Transorbital Approach for the Management of Spheno-Orbital Meningiomas: Literature Review and Preliminary Experience. World Neurosurg 2023; 176:43-59. [PMID: 37024084 DOI: 10.1016/j.wneu.2023.03.126] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 03/28/2023] [Accepted: 03/29/2023] [Indexed: 04/08/2023]
Abstract
OBJECTIVE The endoscopic transorbital approach (ETOA) is a minimally invasive approach that could be particularly appropriate for management of spheno-orbital meningiomas. The aim of this study was to perform a systematic review of the literature on the management of spheno-orbital meningiomas via the minimally invasive ETOA, searching for clinical scenarios in which this approach could be best indicated. A secondary aim was to describe 4 illustrative cases. METHODS A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Data including patient demographics, tumor features, and surgical and postoperative outcomes were collected. Cases from our initial experience with ETOA were included in the data. RESULTS Data of 58 patients from 9 selected records and from our surgical series were collected. Subtotal, near-total, and gross total resection rates were 44.8%, 10.3%, and 32.7%, respectively. Symptom improvement after surgery was 100% for proptosis, 93% for visual impairment, and 87% for ophthalmoplegia. The most common postoperative complications were transient ophthalmoplegia and maxillary nerve hypoesthesia. Cerebrospinal fluid leak was reported in 2 patients. CONCLUSIONS Our findings support the use of the ETOA for management of spheno-orbital meningiomas, particularly in at least 3 clinical scenarios: 1) when predominant hyperostotic bone is present; 2) when a globular tumor not showing excessive medial or inferior infiltration is being treated; 3) as part of a multistage treatment for diffuse lesions.
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Affiliation(s)
- Alberto Di Somma
- Institut Clínic de Neurociències, Department of Neurological Surgery, Hospital Clínic de Barcelona, Universidad de Barcelona, Barcelona, Spain
| | - Andrea De Rosa
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli "Federico II", Naples, Italy.
| | - Abel Ferrés
- Institut Clínic de Neurociències, Department of Neurological Surgery, Hospital Clínic de Barcelona, Universidad de Barcelona, Barcelona, Spain
| | - Alejandra Mosteiro
- Institut Clínic de Neurociències, Department of Neurological Surgery, Hospital Clínic de Barcelona, Universidad de Barcelona, Barcelona, Spain
| | - Giulia Guizzardi
- Institut Clínic de Neurociències, Department of Neurological Surgery, Hospital Clínic de Barcelona, Universidad de Barcelona, Barcelona, Spain
| | - Jessica Matas Fassi
- Department of Ophthalmology, Hospital Clínic de Barcelona, Universidad de Barcelona, Barcelona, Spain
| | - Thomaz E Topczewski
- Institut Clínic de Neurociències, Department of Neurological Surgery, Hospital Clínic de Barcelona, Universidad de Barcelona, Barcelona, Spain
| | - Luis Reyes
- Institut Clínic de Neurociències, Department of Neurological Surgery, Hospital Clínic de Barcelona, Universidad de Barcelona, Barcelona, Spain
| | - Pedro Roldán
- Institut Clínic de Neurociències, Department of Neurological Surgery, Hospital Clínic de Barcelona, Universidad de Barcelona, Barcelona, Spain
| | - Ramon Torné
- Institut Clínic de Neurociències, Department of Neurological Surgery, Hospital Clínic de Barcelona, Universidad de Barcelona, Barcelona, Spain
| | - Isam Alobid
- Skull Base Unit, ENT Department, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Centro de Investigación Biomédica en Red Enfermedades Respiratorias, Universidad de Barcelona, Barcelona, Spain
| | - Joaquim Enseñat
- Institut Clínic de Neurociències, Department of Neurological Surgery, Hospital Clínic de Barcelona, Universidad de Barcelona, Barcelona, Spain
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10
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Câmara B, Fava A, Matano F, Okano A, Ronconi D, Silva Costa B, Gadelha Figueiredo E, Chassoux F, Devaux B, Froelich S. Transuncal Selective Amygdalohippocampectomy by an Inferolateral Preseptal Endoscopic Approach Through Inferior Eyelid Conjunctival Incision: An Anatomic Study. Oper Neurosurg (Hagerstown) 2023; 25:199-208. [PMID: 37133253 DOI: 10.1227/ons.0000000000000728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 02/23/2023] [Indexed: 05/04/2023] Open
Abstract
BACKGROUND Transorbital endoscopic approaches have been described for pathologies of anterior and middle fossae. Standard lateral orbitotomy gives access to mesial temporal lobe, but the axis of work is partially obscured by the temporal pole and working corridor is limited. OBJECTIVE To evaluate the usefulness of an inferolateral orbitotomy to provide a more direct corridor to perform a transuncal selective amygdalohippocampectomy. METHODS Three adult cadaveric specimens were used for a total of 6 dissections. A step-by-step description and illustration of the transuncal corridor for a selective amygdalohippocampectomy were performed using the inferolateral orbitotomy through an inferior eyelid conjunctival incision. The anatomic landmarks were demonstrated in detail. Orbitotomies and angles of work were measured from computed tomography scans, and the area of resection was illustrated by postdissection MRI. RESULTS Inferior eyelid conjunctival incision was made for exposure of the inferior orbital rim. Inferolateral transorbital approach was performed to access the transuncal corridor. Endoscopic selective amygdalohippocampectomy was performed through the entorhinal cortex without damage to the temporal neocortex or Meyer's loop. The mean horizontal diameter of the osteotomy was 14.4 mm, and the vertical one was 13.6 mm. The mean angles of work were 65° and 35.5° in the axial and sagittal planes, respectively. Complete amygdalohippocampectomy was achieved in all 6 dissections. CONCLUSION Transuncal selective amygdalohippocampectomy was feasible in cadaveric specimens using the inferolateral transorbital endoscopic approach avoiding damage to the temporal neocortex and Meyer's loop. The inferior eyelid conjunctival incision may result in an excellent cosmetic outcome.
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Affiliation(s)
- Breno Câmara
- Service de Neurochirurgie-Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
- Laboratoire de neurochirurgie expérimentale, Service de Neurochirurgie-Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Arianna Fava
- Service de Neurochirurgie-Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
- Laboratoire de neurochirurgie expérimentale, Service de Neurochirurgie-Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Fumihiro Matano
- Service de Neurochirurgie-Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
- Laboratoire de neurochirurgie expérimentale, Service de Neurochirurgie-Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Atsushi Okano
- Service de Neurochirurgie-Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
- Laboratoire de neurochirurgie expérimentale, Service de Neurochirurgie-Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Daniel Ronconi
- Service de Neurochirurgie-Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
- Laboratoire de neurochirurgie expérimentale, Service de Neurochirurgie-Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Bruno Silva Costa
- Hospital Santa Casa de Misericórdia de Belo Horizonte, Belo Horizonte, Minas Gerais, Brazil
| | | | - Francine Chassoux
- Service de Neurochirurgie-Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Bertrand Devaux
- Service de Neurochirurgie-Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Sébastien Froelich
- Service de Neurochirurgie-Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
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11
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Kwon SM, Na MK, Choi KS, Byoun HS, Nam YS. Cadaveric analysis of transcranial versus endoscopic transorbital petrosectomy: comparison of surgical maneuverability and brainstem exposure. Front Oncol 2023; 13:1186012. [PMID: 37483499 PMCID: PMC10359478 DOI: 10.3389/fonc.2023.1186012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 06/23/2023] [Indexed: 07/25/2023] Open
Abstract
Introduction While accessing the posterior fossa, the anterior transpetrosal approach (ATPA) and endoscopic transorbital approach (ETOA) use the same bony landmarks during petrous apex drilling. However, owing to their contrasting surgical axes, they are expected to show differences in surgical view, maneuverability, and clinical implications. This study aimed to investigate the feasibility of ETOA in accessing the brainstem and to compare the surgical view and maneuverability of each approach. Methods ATPA and ETOA were performed in four human cadaveric heads (eight sides and four sides in each procedure). The angle of attack (AOA) and surgical depth were measured at the target of interest (root exit zone [REZ] of cranial nerve [CN] V, VI, and VII). When measuring the area of exposure, the brainstem was divided into two areas (anterior and lateral brainstem) based on the longitudinal line crossing the entry zone of the trigeminal root, and the area of each was measured. Results ATPA showed significantly greater value at the trigeminal REZ in both vertical (31.8 ± 6.7° vs. 14.3 ± 5.3°, p=0.006) and horizontal AOA (48.5 ± 2.9° vs. 15.0 ± 5.2°, p<0.001) than ETOA. The AOA at facial REZ was also greater in ATPA than ETOA (vertical, 27.5 ± 3.9° vs. 8.3 ± 3.3°, p<0.001; horizontal, 33.8 ± 2.2° vs. 11.8 ± 2.9°, p<0.001). ATPA presented significantly shorter surgical depth (CN V, 5.8 ± 0.5 cm vs. 9.0 ± 0.8, p<0.001; CN VII, 6.3 ± 0.5 cm vs. 9.5 ± 1.0, p=0.001) than ETOA. The mean area of brainstem exposure did not differ between the two approaches. However, ATPA showed significantly better exposure of anterior brainstem than ETOA (240.7 ± 9.6 mm2 vs. 171.7 ± 15.0 mm2, p<0.001), while ETOA demonstrated better lateral brainstem exposure (174.2 ± 29.1 mm2 vs. 231.1 ± 13.6 mm2, p=0.022). Conclusions ETOA could be a valid surgical option, in selected cases, that provides a direct ventral route to the brainstem. Compared with ATPA, ETOA showed less surgical maneuverability, AOA and longer surgical depth; however, it presented comparable brainstem exposure and better exposure of the lateral brainstem.
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Affiliation(s)
- Sae Min Kwon
- Department of Neurosurgery, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Republic of Korea
| | - Min Kyun Na
- Department of Neurosurgery, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Kyu-Sun Choi
- Department of Neurosurgery, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Hyoung Soo Byoun
- Department of Neurosurgery, Chungnam National University Sejong Hospital, Sejong, Republic of Korea
| | - Yong Seok Nam
- Department of Anatomy, College of Korean Medicine, Dongshin University, Naju, Republic of Korea
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12
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Frontera NL, Rosado-Philippi J, Díaz FDV, Díaz AS, Medina AV, Figueroa A, González N, Pradilla G, Garzón T, Rodríguez J, Tarrats L, Valle MMD. TransOrbital NeuroEndoscopic Surgery for Biopsy of the Left Cavernous Sinus: A Literature Review, Case Report, and Cadaveric Proof of Concept. J Neurol Surg Rep 2023; 84:e116-e123. [PMID: 37771654 PMCID: PMC10533359 DOI: 10.1055/a-2155-2419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 08/03/2023] [Indexed: 09/30/2023] Open
Abstract
The aim of this report is to describe TransOrbital NeuroEndoscopic Surgery (TONES) as a safe alternative for obtaining a cavernous sinus (CS) biopsy. We describe this technique in a patient with a diffuse large B cell lymphoma mimicking Tolosa-Hunt's syndrome. Articles were gathered querying PubMed, Embase, and Scopus databases with terms related to a "transorbital neuroendoscopic approach." The literature search was performed by two independent authors (N.L.F. and J.R.), with inconsistencies resolved by the senior author (M.M.D.V.). After screening abstracts for relevance, full-length articles were reviewed for pertinent variables. A comparison was conducted with the illustrative case of a 69-year-old woman who presented to the emergency department with vertigo, ophthalmoplegia, and diplopia for 2 months. A brain magnetic resonance imaging revealed an infiltrative lesion at the left CS. A presumptive diagnosis of Tolosa-Hunt syndrome was made, but a confirmatory biopsy was performed using TONES. Based on our cadaveric study, literature review, and case report, the TONES approach was safe, effective for tissue diagnosis, and associated with minor morbidity and reduced hospital stay. Additional prospective studies are required to study its viability and safety in a larger group of patients.
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Affiliation(s)
- Natasha L. Frontera
- School of Medicine, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | - Julio Rosado-Philippi
- School of Medicine, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | | | - Alejandra Santiago Díaz
- School of Medicine, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | - Adriana Vázquez Medina
- School of Medicine, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | - Arnaldo Figueroa
- School of Medicine, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | - Natalia González
- School of Medicine, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | - Gustavo Pradilla
- Department of Neurosurgery, Emory University, Atlanta, Georgia, United States
| | - Tomas Garzón
- Department of Neurosurgery, Emory University, Atlanta, Georgia, United States
| | - Julio Rodríguez
- Department of Neurosurgery, Emory University, Atlanta, Georgia, United States
| | - Luisam Tarrats
- School of Medicine, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | - Miguel Mayol del Valle
- School of Medicine, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
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13
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Tayebi Meybodi A, Mignucci-Jiménez G, Lawton MT, Liu JK, Preul MC, Sun H. Comprehensive microsurgical anatomy of the middle cranial fossa: Part II-neurovascular anatomy. Front Surg 2023; 10:1132784. [PMID: 37035563 PMCID: PMC10080008 DOI: 10.3389/fsurg.2023.1132784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 02/13/2023] [Indexed: 04/11/2023] Open
Abstract
In order to master the surgical approaches to the middle cranial fossa, the surgeon needs to understand the relevant bony anatomy. However, she/he also needs to have a clear and sound understanding of the neural and vascular anatomy because, oftentimes, the osseous anatomy (except for the optic apparatus) should be removed to expose and protect the neurovascular anatomy. This is the second of a two-part article discussing the neurovascular anatomy of the middle cranial fossa. A brief discussion of the surgical approaches follows.
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Affiliation(s)
- Ali Tayebi Meybodi
- Department of Neurosurgery, Rutgers New Jersey Medical School, Newark, NJ, United States
- Correspondence: Ali Tayebi Meybodi
| | - Giancarlo Mignucci-Jiménez
- The Loyal and Edith Davis Neurosurgical Research Laboratory, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, AZ, United States
| | - Michael T. Lawton
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, AZ, United States
| | - James K. Liu
- Department of Neurosurgery, Rutgers New Jersey Medical School, Newark, NJ, United States
- Departments of Neurosurgery and Otolaryngology, Robert Wood Johnson Barnabas Health, Newark, NJ, United States
| | - Mark C. Preul
- The Loyal and Edith Davis Neurosurgical Research Laboratory, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, AZ, United States
| | - Hai Sun
- Department of Neurosurgery, Rutgers New Jersey Medical School, Newark, NJ, United States
- Department of Neurosurgery, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, United States
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14
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Corvino S, Sacco M, Somma T, Berardinelli J, Ugga L, Colamaria A, Corrivetti F, Iaconetta G, Kong DS, de Notaris M. Functional and clinical outcomes after superior eyelid transorbital endoscopic approach for spheno-orbital meningiomas: illustrative case and literature review. Neurosurg Rev 2022; 46:17. [PMID: 36513789 DOI: 10.1007/s10143-022-01926-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 09/02/2022] [Accepted: 12/04/2022] [Indexed: 12/15/2022]
Abstract
The pattern of growth of spheno-orbital meningiomas accounts for the main presenting symptoms, such as proptosis, eye motility deficit, visual impairment, diplopia. As these are benign tumors, the postoperative patient's quality of life is an important factor to consider during the preoperative planning. A detailed literature review of superior eyelid transorbital endoscopic approach for spheno-orbital meningiomas, including our own case, was made. A Medline search up to March 2022 in PubMed online electronic database was made using the following key phrases: "superior eyelid endoscopic transorbital approach spheno-orbital meningiomas," "superior eyelid endoscopic transorbital approach," "spheno-orbital meningiomas endoscopic approach." The inclusion criteria were surgical series, reviews, and case reports in English language, as well as papers written in other languages, but including the abstract in English. Cadaveric studies, multiportal combined approaches for SOM, were excluded. The literature review has disclosed five studies for a total of 65 patients, whose demographic, clinical, pathological, surgical, complications, and outcome data were analyzed. Functional and esthetic outcome data after superior eyelid transorbital approach are the following: improvement of proptosis (100%), of visual deficits (66.66%) and of ocular paresis (75%), with only 11 complications (4 trigeminal dysesthesia, 2 CSF leak, 2 wound complications, 1 upper eyelid necrosis, 1 hemorrhage of surgical field, 1 keratitis) reported, but at the expense of extent of resection (gross total resection 33.39%). Based on the outcome data, the superior eyelid transorbital endoscopic approach results in a suitable operative technique for selected spheno-orbital meningiomas.
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Affiliation(s)
- Sergio Corvino
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Neurosurgical Clinic, School of Medicine, University of Naples "Federico II", 80131, Naples, Italy.
| | - Matteo Sacco
- Department of Neurosurgery, "Riuniti", 71122, Foggia, Italy
| | - Teresa Somma
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Neurosurgical Clinic, School of Medicine, University of Naples "Federico II", 80131, Naples, Italy
| | - Jacopo Berardinelli
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Neurosurgical Clinic, School of Medicine, University of Naples "Federico II", 80131, Naples, Italy
| | - Lorenzo Ugga
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", 80131, Naples, Italy
| | | | - Francesco Corrivetti
- Department of Neurosurgery, San Luca Hospital, Vallo Della Lucania, Salerno, Italy
| | - Giorgio Iaconetta
- Neurosurgical Clinic A.O.U. "San Giovanni Di Dio E Ruggi d'Aragona", Salerno, Italy
| | - Doo-Sik Kong
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Matteo de Notaris
- Department of Neuroscience, G. Rummo Hospital, Neurosurgery Operative Unit, 82100, Benevento, Italy
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15
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García-Pérez D, Abarca J, González-López P, Nieto J, Lagares A, Paredes I. A Frontal Route to Middle and Posterior Cranial Fossa: Quantitative Study for the Lateral Transorbital Endoscopic Approach and Comparison with the Subtemporal Approach. World Neurosurg 2022; 167:e236-e250. [PMID: 35944860 DOI: 10.1016/j.wneu.2022.07.129] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 07/26/2022] [Accepted: 07/27/2022] [Indexed: 10/31/2022]
Abstract
BACKGROUND Skull base lesions within the middle cranial fossa (MCF) remain challenging. Recent reports suggest that transorbital endoscopic approaches (TOEAs) might be particularly suitable to access the MCF and expose the lateral wall of the cavernous sinus and the Meckel's cave. METHODS The present study was developed to compare the nuances of the subtemporal approach (STA) with those of the lateral TOEA (LTOEA) to the MCF and posterior cranial fossa (PCF) in cadaveric specimens. After orbital craniectomy, interdural opening of the cavernous sinus lateral wall (CSlw), exposure of the Gasserian ganglion, and extradural elevation of the temporal lobe was performed. Next, anterior endoscopic petrosectomy was performed and the PCF was accessed. We quantitatively analyzed and compared the angles of attack and distances between LTOEA and STA to different structures at the CSlw, petrous apex (PA), and PCF. RESULTS Cadaveric dissection through the LTOEA completely exposed the CSlw and PA. LTOA exhibited larger distances than the STA to all targets. Importantly, these differences were greater at the PA and its surrounding key anatomic landmarks. The horizontal and vertical angles of attack allowed by the LTOA were smaller both for the CSlw and PA. However, these differences were not significant for the vertical angle of attack at the CSlw. CONCLUSIONS LTOEA provides a direct ventral route to the medial aspect of MCF, PA, and PCF. Although TOEAs are versatile approaches, the unfamiliar surgical anatomy and limited instrument maneuverability demand extensive cadaveric dissection before moving to the clinical setting.
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Affiliation(s)
- Daniel García-Pérez
- Department of Neurosurgery, University Hospital 12 de Octubre, Madrid, Spain.
| | - Javier Abarca
- Department of Neurosurgery, University General Hospital of Alicante, Alicante, Spain
| | - Pablo González-López
- Department of Neurosurgery, University General Hospital of Alicante, Alicante, Spain
| | - Juan Nieto
- Department of Neurosurgery, University General Hospital of Alicante, Alicante, Spain
| | - Alfonso Lagares
- Department of Neurosurgery, University Hospital 12 de Octubre, Madrid, Spain
| | - Igor Paredes
- Department of Neurosurgery, University Hospital 12 de Octubre, Madrid, Spain
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16
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The Current State of Visualization Techniques in Endoscopic Skull Base Surgery. Brain Sci 2022; 12:brainsci12101337. [PMID: 36291271 PMCID: PMC9599272 DOI: 10.3390/brainsci12101337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 09/26/2022] [Accepted: 09/27/2022] [Indexed: 11/17/2022] Open
Abstract
Skull base surgery has undergone significant progress following key technological developments. From early candle-lit devices to the modern endoscope, refinements in visualization techniques have made endoscopic skull base surgery (ESBS) a standard practice for treating a variety of conditions. The endoscope has also been integrated with other technologies to enhance visualization, including fluorescence agents, intraoperative neuronavigation with augmented reality, and the exoscope. Endoscopic approaches have allowed neurosurgeons to reevaluate skull base neuroanatomy from new perspectives. These advances now serve as the foundation for future developments in ESBS. In this narrative review, we discuss the history and development of ESBS, current visualization techniques, and future innovations.
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17
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Di Somma A, Kong DS, de Notaris M, Moe KS, Sánchez España JC, Schwartz TH, Enseñat J. Endoscopic transorbital surgery levels of difficulty. J Neurosurg 2022; 137:1187-1190. [PMID: 35426817 DOI: 10.3171/2022.3.jns212699] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Alberto Di Somma
- 1Institut Clínic de Neurociències (ICN), Department of Neurological Surgery, Hospital Clínic de Barcelona, Universidad de Barcelona, Barcelona, Spain
| | - Doo-Sik Kong
- 2Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | | | - Kris S Moe
- 4Department of Otolaryngology-Head and Neck Surgery, Department of Neurosurgery, University of Washington, Seattle, Washington
| | - Juan Carlos Sánchez España
- 5Department of Ophthalmology, Hospital Clínic de Barcelona, Universidad de Barcelona, Barcelona, Spain; and
| | - Theodore H Schwartz
- 6Department of Neurosurgery, Weill Cornell Medicine, NewYork-Presbyterian Hospital, New York, New York
| | - Joaquim Enseñat
- 1Institut Clínic de Neurociències (ICN), Department of Neurological Surgery, Hospital Clínic de Barcelona, Universidad de Barcelona, Barcelona, Spain
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18
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Guizzardi G, Mosteiro A, Hoyos J, Ferres A, Topczewski T, Reyes L, Alobid I, Matas J, Cavallo LM, Cappabianca P, Enseñat J, Prats-Galino A, Di Somma A. Endoscopic Transorbital Approach to the Middle Fossa: Qualitative and Quantitative Anatomic Study. Oper Neurosurg (Hagerstown) 2022; 23:e267-e275. [PMID: 36106937 DOI: 10.1227/ons.0000000000000308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 04/03/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND The endoscopic superior eyelid transorbital route to the skull base is gaining progressive popularity in the neurosurgical community. OBJECTIVE To evaluate the anatomy of the middle cranial fossa from this novel ventral perspective to reach the skull base through the transorbital route and to show limits for possible safe middle fossa drilling from the transorbital route. METHODS Anatomic study was performed; 5 cadaveric specimens (ie, 10 sides) and 2 dry skulls (ie, 4 sides) were dissected. RESULTS To obtain a functional result, there are boundaries that correspond to neurovascular structures that traverse, enter, or leave the middle fossa that must be respected: inferiorly, the lateral pterygoid muscle; medially, the Gasserian ganglion and the lateral border of the foramen rotundum; laterally, the foramen spinosum with the middle meningeal artery; superiorly, the lesser sphenoid wing; posteriorly, the anterior border of the foramen ovale. Average bone resected was 6.49 ± 0.80 cm3 which is the 63% of total middle fossa floor. The mean axial surgical length calculated was 3.85 cm (3.18-5.19 cm) while the mean sagittal surgical length was 5.23 cm (4.87-6.55 cm). The mean horizontal angle of approach was 38.14° (32.87°-45.63°), while the mean vertical angle of approach was 18.56° (10.81°-26.76°). CONCLUSION Detailed anatomy of the middle cranial fossa is presented, and herewith we demonstrated that from the endoscopic superior eyelid transorbital approach removal of middle cranial fossa floor is possible when anatomic landmarks are respected.
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Affiliation(s)
- Giulia Guizzardi
- Division of Neurosurgery, Department of Neuroscience, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli "Federico II", Naples, Italy
| | - Alejandra Mosteiro
- Department of Neurological Surgery, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Jhon Hoyos
- Department of Neurological Surgery, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Abel Ferres
- Department of Neurological Surgery, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Thomaz Topczewski
- Department of Neurological Surgery, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Luis Reyes
- Department of Neurological Surgery, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Isam Alobid
- Rhinology Unit and Smell Clinic, ENT Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Jessica Matas
- Clinic Institute of Ophthalmology (ICOF), Hospital Clínic de Barcelona, Barcelona, Spain
| | - Luigi Maria Cavallo
- Division of Neurosurgery, Department of Neuroscience, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli "Federico II", Naples, Italy
| | - Paolo Cappabianca
- Division of Neurosurgery, Department of Neuroscience, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli "Federico II", Naples, Italy
| | - Joaquim Enseñat
- Department of Neurological Surgery, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Alberto Prats-Galino
- Laboratory of Surgical Neuroanatomy, Universitat de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Alberto Di Somma
- Department of Neurological Surgery, Hospital Clínic de Barcelona, Barcelona, Spain.,Rhinology Unit and Smell Clinic, ENT Department, Hospital Clínic de Barcelona, Barcelona, Spain.,Clinic Institute of Ophthalmology (ICOF), Hospital Clínic de Barcelona, Barcelona, Spain.,Laboratory of Surgical Neuroanatomy, Universitat de Barcelona, Barcelona, Spain
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Guizzardi G, Di Somma A, de Notaris M, Corrivetti F, Sánchez JC, Alobid I, Ferres A, Roldan P, Reyes L, Enseñat J, Prats-Galino A. Endoscopic transorbital avenue to the skull base: Four-step conceptual analysis of the anatomic journey. Front Oncol 2022; 12:988131. [PMID: 36119506 PMCID: PMC9481282 DOI: 10.3389/fonc.2022.988131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 08/04/2022] [Indexed: 11/13/2022] Open
Abstract
Background In the last decades, skull base surgery had passed through an impressive evolution. The role of neuroanatomic research has been uppermost, and it has played a central role in the development of novel techniques directed to the skull base. Indeed, the deep and comprehensive study of skull base anatomy has been one of the keys of success of the endoscopic endonasal approach to the skull base. In the same way, dedicated efforts expended in the anatomic lab has been a powerful force for the growth of the endoscopic transorbital approach to the lateral skull base. Therefore, in this conceptual paper, the main steps for the anatomic description of the endoscopic transorbital approach to the skull base have been detailed. Methods The anatomic journey for the development of the endoscopic transorbital approach to the skull base has been analyzed, and four “conceptual” steps have been highlighted. Results As neurosurgeons, the eyeball has always represented a respectful area: to become familiar with this complex and delicate anatomy, we started by examining the orbital anatomy on a dry skull (step 1). Hence, step 1 is represented by a detailed bone study; step 2 is centered on cadaveric dissection; step 3 consists in 3D quantitative assessment of the novel endoscopic transorbital corridor; and finally, step 4 is the translation of the preclinical data in the real surgical scenario by means of dedicated surgical planning. Conclusions The conceptual analysis of the anatomic journey for the description of the endoscopic transorbital approach to the skull base resulted in four main methodological steps that should not be thought strictly consequential but rather interconnected. Indeed, such steps should evolve following the drives that can arise in each specific situation. In conclusion, the four-step anatomic rehearsal can be relevant for the description, diffusion, and development of a novel technique in order to facilitate the application of the endoscopic transorbital approach to the skull base in a real surgical scenario.
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Affiliation(s)
- Giulia Guizzardi
- Laboratory of Surgical Neuroanatomy, Universitat de Barcelona, Barcelona, Spain
| | - Alberto Di Somma
- Laboratory of Surgical Neuroanatomy, Universitat de Barcelona, Barcelona, Spain
- Department of Neurological Surgery, Hospital Clínic de Barcelona, Barcelona, Spain
- *Correspondence: Alberto Di Somma,
| | - Matteo de Notaris
- Department of Neuroscience, Neurosurgery Operative Unit, “San Pio” Hospital, Benevento, Italy
- Laboratory of Neuroscience, European Biomedical Research Institute of Salerno (EBRIS) Foundation, European Biomedical Research Institute of Salerno, Salerno, Italy
| | - Francesco Corrivetti
- Department of Neuroscience, Neurosurgery Operative Unit, “San Pio” Hospital, Benevento, Italy
- Laboratory of Neuroscience, European Biomedical Research Institute of Salerno (EBRIS) Foundation, European Biomedical Research Institute of Salerno, Salerno, Italy
| | - Juan Carlos Sánchez
- Clinic Institute of Ophthalmology (ICOF), Hospital Clínic de Barcelona, Barcelona, Spain
| | - Isam Alobid
- Rhinology Unit and Smell Clinic, ENT Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Abel Ferres
- Department of Neurological Surgery, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Pedro Roldan
- Department of Neurological Surgery, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Luis Reyes
- Department of Neurological Surgery, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Joaquim Enseñat
- Department of Neurological Surgery, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Alberto Prats-Galino
- Laboratory of Surgical Neuroanatomy, Universitat de Barcelona, Barcelona, Spain
- Servei de investigación en anatomía funcional del sistema nervioso, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
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Lim J, Sung KS, Kim W, Yoo J, Jung IH, Choi S, Lim SH, Roh TH, Hong CK, Moon JH. Extended endoscopic transorbital approach with superior-lateral orbital rim osteotomy: cadaveric feasibility study and clinical implications (SevEN-007). J Neurosurg 2022; 137:18-31. [PMID: 34767525 DOI: 10.3171/2021.7.jns21996] [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: 04/19/2021] [Accepted: 07/07/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The endoscopic transorbital approach (ETOA) has been developed, permitting a new surgical corridor. Due to the vertical limitation of the ETOA, some lesions of the anterior cranial fossa are difficult to access. The ETOA with superior-lateral orbital rim (SLOR) osteotomy can achieve surgical freedom of vertical as well as horizontal movement. The purpose of this study was to confirm the feasibility of the ETOA with SLOR osteotomy. METHODS Anatomical dissections were performed in 5 cadaveric heads with a neuroendoscope and neuronavigation system. ETOA with SLOR osteotomy was performed on one side of the head, and ETOA with lateral orbital rim (LOR) osteotomy was performed on the other side. After analysis of the results of the cadaveric study, the ETOA with SLOR osteotomy was applied in 6 clinical cases. RESULTS The horizontal and vertical movement range through ETOA with SLOR osteotomy (43.8° ± 7.49° and 36.1° ± 3.32°, respectively) was improved over ETOA with LOR osteotomy (31.8° ± 5.49° and 23.3° ± 1.34°, respectively) (p < 0.01). Surgical freedom through ETOA with SLOR osteotomy (6025.1 ± 220.1 mm3) was increased relative to ETOA with LOR osteotomy (4191.3 ± 57.2 mm3) (p < 0.01); these values are expressed as the mean ± SD. Access levels of ETOA with SLOR osteotomy were comfortable, including anterior skull base lesion and superior orbital area. The view range of the endoscope for anterior skull base lesions was increased through ETOA with SLOR osteotomy. After SLOR osteotomy, the space for moving surgical instruments and the endoscope was widened. Anterior clinoidectomy could be achieved successfully using ETOA with SLOR osteotomy. The authors performed ETOA with SLOR osteotomy in 6 cases of brain tumor. In all 6 cases, complete removal of the tumor was successfully accomplished. In the 3 cases of anterior clinoidal meningioma, anterior clinoidectomy was performed easily and safely, and manipulation of the extended dural margin and origin dura mater was possible. There was no complication related to this approach. CONCLUSIONS The authors evaluated the clinical feasibility of ETOA with SLOR osteotomy based on a cadaveric study. ETOA with SLOR osteotomy could be applied to more diverse disease groups that do not permit conventional ETOA or to cases in which surgical application is challenging. ETOA with SLOR osteotomy might serve as an opportunity to broaden the indication for the ETOA.
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Affiliation(s)
- Jaejoon Lim
- 1Department of Neurosurgery, Bundang CHA Medical Center, CHA University College of Medicine, Seongnam
| | - Kyoung Su Sung
- 2Department of Neurosurgery, Dong-A University Hospital, Dong-A University College of Medicine, Busan
| | - Woohyun Kim
- 3Department of Neurosurgery, Brain Tumor Center, Severance Hospital, Yonsei University College of Medicine, Seoul
| | - Jihwan Yoo
- 4Department of Neurosurgery, Brain Tumor Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul
| | - In-Ho Jung
- 3Department of Neurosurgery, Brain Tumor Center, Severance Hospital, Yonsei University College of Medicine, Seoul
| | - Seonah Choi
- 3Department of Neurosurgery, Brain Tumor Center, Severance Hospital, Yonsei University College of Medicine, Seoul
| | - Seung Hoon Lim
- 3Department of Neurosurgery, Brain Tumor Center, Severance Hospital, Yonsei University College of Medicine, Seoul
| | - Tae Hoon Roh
- 5Department of Neurosurgery, Ajou University Hospital, Ajou University College of Medicine, Suwon; and
| | - Chang-Ki Hong
- 4Department of Neurosurgery, Brain Tumor Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul
- 6Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Ju Hyung Moon
- 3Department of Neurosurgery, Brain Tumor Center, Severance Hospital, Yonsei University College of Medicine, Seoul
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