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Biportal endoscopic transorbital approach: a quantitative anatomical study and clinical application

  • Original Article - Brain Tumors
  • Published:
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Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

BiETOA provided increased surgical freedom and better visibility of deep target lesion and resulted in good surgical and cosmetic outcomes.

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Availability of data and materials

Data sharing is not applicable to this article as no datasets were generated.

Abbreviations

ETOA:

Endoscopic transorbital approach

BiETOA:

Biportal ETOA

CT:

Computed tomographic

LOR:

Lateral orbital rim resection

LOWA:

Lateral orbital wall approach

SevEN:

Severance Endoscopic Neurosurgery study group

CAD:

Computer-aided design

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Acknowledgments

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.

Funding

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).

Author information

Author notes

  1. Jaejoon Lim and Tae Hoon Roh contributed equally to this work.

Authors and Affiliations

  1. Department of Neurosurgery, Bundang CHA Medical Center, CHA University College of Medicine, Seongnam, Republic of Korea

    Jaejoon Lim

  2. Department of Neurosurgery, Ajou Univeristy Hospital, Ajou University College of Medicine, Suwon, Republic of Korea

    Tae Hoon Roh

  3. Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea

    Woohyun Kim, Ju Hyung Moon & Eui Hyun Kim

  4. Department of Neurosurgery, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine, Seoul, Republic of Korea

    Ju-Seong Kim

  5. Department of Neurosurgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea

    Je Beom Hong

  6. Department of Neurosurgery, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Republic of Korea

    Kyoung Su Sung

  7. Department of Neurosurgery, Brain Tumor Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea

    Chang-Ki Hong

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Contributions

Conception and design: Jaejoon Lim, Tae Hoon Roh, and Chang-Ki Hong. Acquisition of data and dissection of cadaver: Jaejoon Lim, Tae Hoon Roh, Woohyun Kim, Ju-Seong Kim, Je Beom Hong, Kyoung Su Sung, Ju Hyung Moon, Eui Hyun Kim, and Chang-Ki Hong. Analysis and interpretation of data: Jaejoon Lim, Tae Hoon Roh, and Chang-Ki Hong. Drafting and revising the article: Jaejoon Lim, Tae Hoon Roh, and Chang-Ki Hong. Reviewed submitted version of manuscript: Jaejoon Lim, Tae Hoon Roh, Woohyun Kim, Ju-Seong Kim, Je Beom Hong, Kyoung Su Sung, Ju Hyung Moon, Eui Hyun Kim, and Chang-Ki Hong.

Corresponding author

Correspondence to Chang-Ki Hong.

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Competing interests

The authors declare that they have no competing interests.

Ethics approval

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

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