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Combined endoscopic endonasal and transorbital multiportal approach for complex skull base lesions involving multiple compartments

  • Original Article - Brain Tumors
  • Published:
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Abstract

Purpose

This study defines the specific areas that connect the surgical corridors of the endoscopic endonasal (EEA) and transorbital approach (TOA) to identify adequate clinical applications and perspectives of this combined multiportal approach.

Methods

Consecutive patients who underwent combined EEA and TOA procedures for various pathologies involving multiple compartments of the skull base were enrolled.

Results

A total of eight patients (2 chondrosarcomas, 2 meningiomas, 2 schwannomas, 1 glioma, and 1 traumatic optic neuropathy) were included between August 2016 and April 2021. The cavernous sinus (CS) was targeted as the connection area of the combined approach in four patients with tumors infiltrating the middle cranial fossa (MCF) and central skull base through the CS. For two patients with MCF tumors extending into the infratemporal fossa (ITF), the horizontal portion of the greater sphenoid wing and the foramen ovale were utilized as the connection area. In the remaining 2 patients, connection was achieved through the optic canal (OC). Gross total and near total resection was achieved in 5 patients with tumors, and circumferential removal of bone composing the OC was performed in one patient with traumatic compressive optic neuropathy. Postoperative complications included one cardiac arrest due to underlying cardiovascular disease and one case of oculomotor nerve palsy.

Conclusions

The combined EEA and TOA procedure is a useful strategy for complex lesions involving multiple compartments of the skull base. Herein, we identified the specific areas connecting the two surgical approaches, allowing a common path for EEA and TOA procedures.

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References

  1. Alqahtani A, Padoan G, Segnini G, Lepera D, Fortunato S, Dallan I, Pistochini A, Abdulrahman S, Abbate V, Hirt B, Castelnuovo P (2015) Transorbital transnasal endoscopic combined approach to the anterior and middle skull base: a laboratory investigation. Acta Otorhinolaryngol Ital 35:173–179

    CAS  PubMed  PubMed Central  Google Scholar 

  2. Arosio AD, Coden E, Valentini M, Czaczkes C, Battaglia P, Bignami M, Castelnuovo P, Karligkiotis A (2021) Combined endonasal-transorbital approach to manage the far lateral frontal sinus: surgical technique. World Neurosurg 151:5

    Article  PubMed  Google Scholar 

  3. Battaglia P, Turri-Zanoni M, Dallan I, Gallo S, Sica E, Padoan G, Castelnuovo P (2014) Endoscopic endonasal transpterygoid transmaxillary approach to the infratemporal and upper parapharyngeal tumors. Otolaryngol Head Neck Surg 150:696–702

    Article  PubMed  Google Scholar 

  4. Borghei-Razavi H, Truong HQ, Fernandes Cabral DT, Sun X, Celtikci E, Wang E, Snyderman C, Gardner PA, Fernandez-Miranda JC (2019) Endoscopic Endonasal petrosectomy: anatomical investigation, limitations, and surgical relevance. Oper Neurosurg (Hagerstown) 16:557–570

    Article  Google Scholar 

  5. Borghei-Razavi H, Truong HQ, Fernandes-Cabral DT, Celtikci E, Chabot JD, Stefko ST, Wang EW, Snyderman CH, Cohen-Gadol A, Gardner PA, Fernández-Miranda JC (2018) Minimally Invasive approaches for anterior skull base meningiomas: supraorbital eyebrow, endoscopic endonasal, or a combination of both? anatomic study, limitations, and surgical application. World Neurosurg 112:e666–e674

    Article  PubMed  Google Scholar 

  6. Caballero-García J, Aparicio-García C, Linares-Benavides YJ, López-Sánchez M, Abreu-Perdomo FA, Huanca-Amaru J (2021) Minimally invasive 360-degree approach to intraconal orbital tumors. Am J Ophthalmol 224:301–309

    Article  PubMed  Google Scholar 

  7. Dallan I, Castelnuovo P, Locatelli D, Turri-Zanoni M, AlQahtani A, Battaglia P, Hirt B, Sellari-Franceschini S (2015) Multiportal combined transorbital transnasal endoscopic approach for the management of selected skull base lesions: preliminary experience. World Neurosurg 84:97–107

    Article  PubMed  Google Scholar 

  8. Dallan I, Di Somma A, Prats-Galino A, Solari D, Alobid I, Turri-Zanoni M, Fiacchini G, Castelnuovo P, Catapano G, de Notaris M (2017) Endoscopic transorbital route to the cavernous sinus through the meningo-orbital band: a descriptive anatomical study. J Neurosurg 127:622–629

    Article  PubMed  Google Scholar 

  9. Di Somma A, Andaluz N, Cavallo LM, de Notaris M, Dallan I, Solari D, Zimmer LA, Keller JT, Zuccarello M, Prats-Galino A, Cappabianca P (2018) Endoscopic transorbital superior eyelid approach: anatomical study from a neurosurgical perspective. J Neurosurg 129:1203–1216

    Article  PubMed  Google Scholar 

  10. Di Somma A, Cavallo LM, de Notaris M, Solari D, Topczewski TE, Bernal-Sprekelsen M, Ensenat J, Prats-Galino A, Cappabianca P (2017) Endoscopic endonasal medial-to-lateral and transorbital lateral-to-medial optic nerve decompression: an anatomical study with surgical implications. J Neurosurg 127:199–208

    Article  PubMed  Google Scholar 

  11. Di Somma A, Langdon C, de Notaris M, Reyes L, Ortiz-Perez S, Alobid I, Enseñat J (2020) Combined and simultaneous endoscopic endonasal and transorbital surgery for a Meckel’s cave schwannoma: technical nuances of a mini-invasive, multiportal approach. J Neurosurg 134:1836–1845

    Article  PubMed  Google Scholar 

  12. Fernandez-Miranda JC, Gardner PA, Rastelli MM Jr, Peris-Celda M, Koutourousiou M, Peace D, Snyderman CH, Rhoton AL Jr (2014) Endoscopic endonasal transcavernous posterior clinoidectomy with interdural pituitary transposition. J Neurosurg 121:91–99

    Article  PubMed  Google Scholar 

  13. Fernandez-Miranda JC, Zwagerman NT, Abhinav K, Lieber S, Wang EW, Snyderman CH, Gardner PA (2018) Cavernous sinus compartments from the endoscopic endonasal approach: anatomical considerations and surgical relevance to adenoma surgery. J Neurosurg 129:430–441

    Article  PubMed  Google Scholar 

  14. Ferrari M, Schreiber A, Mattavelli D, Belotti F, Rampinelli V, Lancini D, Doglietto F, Fontanella MM, Tschabitscher M, Rodella LF, Nicolai P (2016) The inferolateral transorbital endoscopic approach: a preclinical anatomic study. World Neurosurg 90:403–413

    Article  PubMed  Google Scholar 

  15. Ferrari M, Vural A, Schreiber A, Mattavelli D, Gualtieri T, Taboni S, Bertazzoni G, Rampinelli V, Tomasoni M, Buffoli B, Doglietto F, Rodella LF, Deganello A, Nicolai P (2019) Side-door temporoparietal fascia flap: a novel strategy for anterior skull base reconstruction. World Neurosurg 126:e360–e370

    Article  PubMed  Google Scholar 

  16. Gerges MM, Godil SS, Younus I, Rezk M, Schwartz TH (2019) Endoscopic transorbital approach to the infratemporal fossa and parapharyngeal space: a cadaveric study. J Neurosurg 133:1948–1959

    Article  Google Scholar 

  17. Hong SD, Nam DH, Kong DS, Kim HY, Chung SK, Dhong HJ (2016) Endoscopic modified transseptal transsphenoidal approach for maximal preservation of sinonasal quality of life and olfaction. World Neurosurg 87:162–169

    Article  PubMed  Google Scholar 

  18. Janakiram TN, Parekh P, Haneefa H, Prasad SK (2017) Endoscopic Three-surgeon Six-handed transorbital transnasal technique for excision of juvenile nasopharygeal angiofibroma: new frontier explored. Asian J Neurosurg 12:790–793

    Article  PubMed  PubMed Central  Google Scholar 

  19. Jeon C, Hong CK, Woo KI, Hong SD, Nam DH, Lee JI, Choi JW, Seol HJ, Kong DS (2018) Endoscopic transorbital surgery for Meckel’s cave and middle cranial fossa tumors: surgical technique and early results. J Neurosurg 131:1126–1135

    Article  Google Scholar 

  20. Jeon C, Hong SD, Woo KI, Seol HJ, Nam DH, Lee JI, Kong DS, (2020) Use of endoscopic transorbital and endonasal approaches for 360 degrees circumferential access to orbital tumors. J Neurosurg 135:103–112

    Article  Google Scholar 

  21. Karkas A, Zimmer LA, Theodosopoulos PV, Keller JT, Prades JM (2021) Endonasal endoscopic approach to the pterygopalatine and infratemporal fossae. Eur Ann Otorhinolaryngol Head Neck Dis 138:391–395

    CAS  PubMed  Google Scholar 

  22. Kasemsiri P, Solares CA, Carrau RL, Prosser JD, Prevedello DM, Otto BA, Old M, Kassam AB (2013) Endoscopic endonasal transpterygoid approaches: anatomical landmarks for planning the surgical corridor. Laryngoscope 123:811–815

    Article  PubMed  Google Scholar 

  23. Kempton SJ, Cho DC, Thimmappa B, Martin MC (2016) Benefits of the retrocaruncular approach to the medial orbit: a clinical and anatomic study. Ann Plast Surg 76:295–300

    Article  CAS  PubMed  Google Scholar 

  24. Kong DS, Kim YH, Hong CK (2020) Optimal indications and limitations of endoscopic transorbital superior eyelid surgery for spheno-orbital meningiomas. J Neurosurg 134:1472–1479

    Article  PubMed  Google Scholar 

  25. Kong DS, Shin HJ, Kim HY, Chung SK, Nam DH, Lee JI, Park K, Kim JH (2011) Endoscopic optic canal decompression for compressive optic neuropathy. J Clin Neurosci 18:1541–1545

    Article  PubMed  Google Scholar 

  26. Koutourousiou M, Fernandez-Miranda JC, Wang EW, Snyderman CH, Gardner PA (2014) Endoscopic endonasal surgery for olfactory groove meningiomas: outcomes and limitations in 50 patients. Neurosurg Focus 37:E8

    Article  PubMed  Google Scholar 

  27. Koutourousiou M, VazGuimaraes Filho F, Fernandez-Miranda JC, Wang EW, Stefko ST, Snyderman CH, Gardner PA (2017) Endoscopic endonasal surgery for tumors of the cavernous sinus: a series of 234 Patients. World Neurosurg 103:713–732

    Article  PubMed  Google Scholar 

  28. Lee JJ, Ryu G, Kim HY, Dhong HJ, Chung SK, Hong SD (2019) Endoscopic Two-port Technique for Infratemporal Fossa Tumors: Using Prelacrimal Medial Maxillectomy and Caldwell-Luc Approach. World Neurosurg 124:56–61

  29. Lee MH, Hong SD, Woo KI, Kim YD, Choi JW, Seol HJ, Lee JI, Shin HJ, Nam DH, Kong DS (2019) Endoscopic endonasal versus transorbital surgery for middle cranial fossa tumors: comparison of clinical outcomes based on surgical corridors. World Neurosurg 122:e1491–e1504

    Article  PubMed  Google Scholar 

  30. Lin BJ, Ju DT, Hsu TH, Chung TT, Liu WH, Hueng DY, Chen YH, Hsia CC, Ma HI, Liu MY, Hung HC, Tang CT (2019) Endoscopic transorbital approach to anterolateral skull base through inferior orbital fissure: a cadaveric study. Acta Neurochir (Wien) 161:1919–1929

    Article  Google Scholar 

  31. Locatelli D, Pozzi F, Turri-Zanoni M, Battaglia P, Santi L, Dallan I, Castelnuovo P (2016) Transorbital endoscopic approaches to the skull base: current concepts and future perspectives. J Neurosurg Sci 60:514–525

    PubMed  Google Scholar 

  32. Miller C, Bly R, Moe KS (2020) Endoscopic orbital and periorbital approaches in minimally disruptive skull base surgery. J Neurol Surg B Skull Base 81:459–471

    Article  PubMed  PubMed Central  Google Scholar 

  33. Oyama K, Watanabe K, Hanakita S, Champagne PO, Passeri T, Voormolen EH, Bernat AL, Penet N, Fukushima T, Froelich S (2020) The orbitopterygoid corridor as a deep keyhole for endoscopic access to the paranasal sinuses and clivus. J Neurosurg 134:1480–1489

    Article  PubMed  Google Scholar 

  34. Park HH, Hong SD, Kim YH, Hong CK, Woo KI, Yun IS, Kong DS (2020) Endoscopic transorbital and endonasal approach for trigeminal schwannomas: a retrospective multicenter analysis (KOSEN-005). J Neurosurg 133:467–476

    Article  PubMed  Google Scholar 

  35. Patel CR, Wang EW, Fernandez-Miranda JC, Gardner PA, Snyderman CH (2018) Contralateral transmaxillary corridor: an augmented endoscopic approach to the petrous apex. J Neurosurg 129:211–219

    Article  PubMed  Google Scholar 

  36. Patrona A, Patel KS, Bander ED, Mehta A, Tsiouris AJ, Anand VK, Schwartz TH (2017) Endoscopic endonasal surgery for nonadenomatous, nonmeningeal pathology involving the cavernous sinus. J Neurosurg 126:880–888

    Article  PubMed  Google Scholar 

  37. Priddy BH, Nunes CF, Beer-Furlan A, Carrau R, Dallan I, Prevedello DM (2017) A side door to Meckel’s cave: anatomic feasibility study for the lateral transorbital approach. Oper Neurosurg (Hagerstown) 13:614–621

    Article  Google Scholar 

  38. Roxbury CR, Ishii M, Blitz AM, Reh DD, Gallia GL (2017) Expanded Endonasal endoscopic approaches to the skull base for the radiologist. Radiol Clin North Am 55:1–16

    Article  PubMed  Google Scholar 

  39. Schwartz TH, Morgenstern PF, Anand VK (2019) Lessons learned in the evolution of endoscopic skull base surgery. J Neurosurg 130:337–346

    Article  PubMed  Google Scholar 

  40. Scopel TF, Fernandez-Miranda JC, Pinheiro-Neto CD, Peris-Celda M, Paluzzi A, Gardner PA, Hirsch BE, Snyderman CH (2012) Petrous apex cholesterol granulomas: endonasal versus infracochlear approach. Laryngoscope 122:751–761

    Article  PubMed  Google Scholar 

  41. Topczewski TE, Di Somma A, Pineda J, Ferres A, Torales J, Reyes L, Morillas R, Solari D, Cavallo LM, Cappabianca P, Ensenat J, Prats-Galino A (2020) Endoscopic endonasal and transorbital routes to the petrous apex: anatomic comparative study of two pathways. Acta Neurochir (Wien) 162:2097–2109

    Article  Google Scholar 

  42. Vedhapoodi AG, Periyasamy A, Senthilkumar D (2021) A Novel combined transorbital transnasal endoscopic approach for reconstruction of posttraumatic complex anterior cranial fossa defect. Asian J Neurosurg 16:136–140

    Article  PubMed  PubMed Central  Google Scholar 

  43. Vural A, Carobbio ALC, Ferrari M, Rampinelli V, Schreiber A, Mattavelli D, Doglietto F, Buffoli B, Rodella LF, Taboni S, Tomasoni M, Gualtieri T, Deganello A, Hirtler L, Nicolai P (2021) Transorbital endoscopic approaches to the skull base: a systematic literature review and anatomical description. Neurosurg Rev 44:2857–2878

    Article  PubMed  PubMed Central  Google Scholar 

  44. Zhang Q, Wang Z, Guo H, Yan B, Wang Z, Zhao H, Sahyouni R, Kuan EC (2019) Direct transcavernous sinus approach for endoscopic endonasal resection of intracavernous sinus tumors. World Neurosurg 128:e478–e487

    Article  PubMed  Google Scholar 

  45. Zoli M, Ratti S, Guaraldi F, Milanese L, Pasquini E, Frank G, Billi AM, Manzoli L, Cocco L, Mazzatenta D (2018) Endoscopic endonasal approach to primitive Meckel’s cave tumors: a clinical series. Acta Neurochir (Wien) 160:2349–2361

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea

    Won-Jae Lee, Ho Jun Seol, Jung Won Choi, Jung-Il Lee, Do-Hyun Nam & Doo-Sik Kong

  2. Department of Otorhinolaryngoloy-Head & Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea

    Sang Duk Hong

  3. Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea

    Kyung In Woo

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  1. Won-Jae Lee
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  2. Sang Duk Hong
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  3. Kyung In Woo
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Correspondence to Doo-Sik Kong.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (Samsung Medical Center Institutional Review Board) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

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This article is part of the Topical Collection on Brain Tumors

Supplementary Information

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Video 1 Case illustration of a patient who underwent combined EEA (transmaxillary) and SETOA multiportal procedure for trigeminal schwannoma

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Video 2 Case illustration of the patient who underwent combined EEA (transsphenoidal) and rTOA multiportal procedure for optic pathway glioma

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Supplementary file10 (ZIP 31098 KB)

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Lee, WJ., Hong, S., Woo, K. et al. Combined endoscopic endonasal and transorbital multiportal approach for complex skull base lesions involving multiple compartments. Acta Neurochir 164, 1911–1922 (2022). https://doi.org/10.1007/s00701-022-05203-z

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  • DOI: https://doi.org/10.1007/s00701-022-05203-z

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