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Endoscopic transorbital decompression for traumatic superior orbital fissure syndrome: from cadaveric study to clinical application

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Abstract

Purpose

The endoscopic endonasal approach (EEA) is a minimally invasive and promising modality for treating traumatic superior orbital fissure (SOF) syndrome (tSOFS). Recently, the endoscopic transorbital approach (ETOA) has been considered an alternative method for reaching the anterolateral skull base. This study accessed the practicality of using the ETOA to treat SOF decompression using both cadaveric dissection and clinical application.

Methods

Bilateral anatomic dissections were performed on four adult cadaveric heads using the ETOA and EEA to address SOF decompression. The ETOA procedure for SOF decompression is described, and the extent of SOF decompression was compared between the ETOA and EEA. The clinical feasibility of the ETOA for treating SOF decompression was performed in two patients diagnosed with tSOFS.

Results

ETOA allowed for decompression over the lateral aspect of the SOF, from the meningo-orbital band superolaterally to the maxillary strut inferomedially. By contrast, the EEA allowed for decompression over the medial aspect of the SOF, from the lateral opticocarotid recess superiorly to the maxillary strut inferiorly. In both patients treated using the ETOA and SOF decompression, the severity of ophthalmoplegia got obvious improvement.

Conclusions

Based on the cadaveric findings, ETOA provided a feasible access pathway for SOF decompression with reliable outcomes, and our patients confirmed the clinical efficacy of the ETOA for managing tSOFS.

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Funding

This work was supported by the Tri-Service General Hospital of Taiwan’s Medical Research Project (TSGH-D-110074 and TSGH-D-111088).

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Authors and Affiliations

  1. Department of Neurological Surgery, Tri-Service General Hospital, National Defense Medical Center, No 325, Section 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan

    Bon-Jour Lin, Da-Tong Ju, Dueng-Yuan Hueng, Yuan-Hao Chen, Hsin-I Ma & Ming-Ying Liu

  2. Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan

    Bon-Jour Lin

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  1. Bon-Jour Lin
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Correspondence to Bon-Jour Lin.

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Lin, BJ., Ju, DT., Hueng, DY. et al. Endoscopic transorbital decompression for traumatic superior orbital fissure syndrome: from cadaveric study to clinical application. Eur Arch Otorhinolaryngol 281, 1933–1940 (2024). https://doi.org/10.1007/s00405-023-08440-9

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  • DOI: https://doi.org/10.1007/s00405-023-08440-9

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