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Clinical applications of the endoscopic transorbital approach for various lesions

Abstract

Background

The endoscopic transorbital approach (ETOA) was recently added to the neurosurgical armamentarium. Although this approach could result in less injury to normal brain tissue, shorter operation times, and smaller scars, its clinical applications have not been fully investigated. We, therefore, sought to share our unique experiences of exploring the application of this approach in various diseases.

Methods

From June 2017 to March 2019, we conducted ETOAs via the superior eyelid crease in 22 patients for the treatment of lesions confined to the middle fossa with and without slight extension to the posterior fossa. These lesions included 5 gliomas, 11 meningiomas, 3 schwannomas, 1 lymphoma, 1 cavernous hemangioma in the orbital wall, and 1 hemangiopericytoma mimicking schwannoma. Perioperative radiologic findings and clinical outcomes were recorded.

Results

Gross total resection was accomplished in three (60%) patients with gliomas, nine (81.8%) with meningiomas, two (66.7%) with schwannomas, and one (33.3%) with another lesion. The mean bleeding count was 1051.4 ± 961.1 cc, and major complications were observed in only two (9.1%) cases (one major cerebral artery infarction and one reoperation due to a large amount of bleeding). A cerebrospinal fluid leak was reported in two (9.1%) patients, and transient eye movement palsy was noted in four (18.2%) patients without permanent disability.

Conclusions

The endoscopic transorbital approach could be considered to be feasible for various lesions with different characteristics. After carefully considering the lesion anatomy, consistency, and vascular relationships, using this approach, we could achieve a satisfactory extent of resection without severe complications.

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Correspondence to Chang-Ki Hong.

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Conflict of interest

The authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Written informed consent was obtained from all adult patients.

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Comments

The authors describe their experience with the endoscopic transorbital approach as applied to 22 patients including gliomas, meningiomas and schwannomas. They describe good surgical results, with a high rate of complete resection and a relatively low rate of complications. In experienced surgeons this is clearly a useful approach for extra-axial lesions and further evaluation will be welcome.

Kristian Aquilina

London, UK

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This article is part of the Topical Collection on Brain Tumors

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Yoo, J., Park, H.H., Yun, IS. et al. Clinical applications of the endoscopic transorbital approach for various lesions. Acta Neurochir 163, 2269–2277 (2021). https://doi.org/10.1007/s00701-020-04694-y

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Keywords

  • Endoscopic surgery
  • Transorbital surgery
  • Clinical application