We devised a biportal endoscopic transorbital approach (BiETOA) to gain surgical freedom by making a port for the endoscope and investigated the benefits and limitations of BiETOA.
A cylindrical port was designed and 3-D printed using biocompatible material. The port was inserted through a keyhole between the superolateral side of the orbital rim and the temporal muscle. An endoscope was inserted through the port, and other instruments were inserted through the conventional transorbital route. BiETOA was used to dissect eight cadaveric heads, and the angle of attack and surgical freedom were assessed.
The mean maximal angle of attack was significantly different in BiETOA and endoscopic transorbital approach (ETOA) (P < 0.01) but not in BiETOA and ETOA lateral orbital rim (LOR) osteotomy (P = 0.207, P = 0.21). The mean surgical freedom was significantly different in BiETOA and ETOA (P < 0.01) and in BiETOA and ETOA LOR osteotomy (P < 0.01). In the clinical cases, tumors were removed successfully without any complications.
BiETOA provided increased surgical freedom and better visibility of deep target lesion and resulted in good surgical and cosmetic outcomes.
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Endoscopic transorbital approach
Lateral orbital rim resection
Lateral orbital wall approach
Severance Endoscopic Neurosurgery study group
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We are deeply appreciative to Dae Won Kim and Jun Ho Kim for technical support. They are staff in the Surgical Anatomy Education Center, Yonsei University College of Medicine. We also thank professor Min Suk Chung and Beom Sun Chung, Department of Anatomy, Ajou University School of Medicine for providing 3-D anatomical data derived from Visible Korean.
This study was supported by a faculty research grant of Yonsei University College of Medicine (6–2014-0060) and grants of Basic Science Research Program through the National Research Foundation of Korea (NRF), funded by the Korea Government (MSIT) (Grant No. 2018R1C1B5086460) and by the Bio & Medical Technology Development Program of the National Research Foundation (NRF) funded by the Korean government (MSIT) (NRF-2020M3A9E8024890).
The authors declare that they have no competing interests.
Approval was obtained from the ethics committee of Severance Hospital, Yonsei University College of Medicine. The procedures used in this study adhere to the tenets of the Declaration of Helsinki.
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Lim, J., Roh, T.H., Kim, W. et al. Biportal endoscopic transorbital approach: a quantitative anatomical study and clinical application. Acta Neurochir 162, 2119–2128 (2020). https://doi.org/10.1007/s00701-020-04339-0
- Anatomic study
- Cavernous sinus
- Endoscopic transorbital
- Skull base surgery