Skip to main content

Advertisement

SpringerLink
Log in

Endoscopic transorbital approach for skull base lesions: a report of 16 clinical cases

  • Research
  • Published:
Neurosurgical Review Aims and scope Submit manuscript

Abstract

Due to the deep location, complex anatomy, and adjacent vital neurovascular structures, skull base surgery is challenging and requires specific approaches. The emerging endoscopic transorbital approach (eTOA) technique provides a new approach to the orbital content, spheno-orbital region, lateral cavernous sinus, and Meckel’s cave. In this study, the clinical utility and effectiveness of the eTOA are reported. Sixteen cases who underwent the eTOA were included in the current study. The patients were divided into 3 groups according to tumor location: Group A (intraorbital, 6 cases), group B (spheno-orbital, 7 cases), and group C (cavernous sinus, and Meckel’s cave, 3 cases). The clinical data and surgical results were analyzed. Eight meningiomas, 2 hemangiomas, 1 low-grade glioma, 1 instance of inflammatory hyperplasia tissue, 1 Langerhans cell histiocytosis, 1 epidermoid cyst, 1 trigeminal schwannoma, and 1 bone fibrosis hyperplasia were observed. The mean tumor diameter was 2.4 cm. A single case in Group A and Group C underwent biopsy (12.5%), and 1 case of fibrous dysplasia in Group B underwent sufficient orbit decompression (6.25%). The remaining 13 cases underwent gross total tumor resection (81.25%). No cerebral-spinal fluid leak or infection occurred. And no cosmetic problems or significant complications were observed during the follow-up. As a minimally invasive technique, the eTOA has unique advantages for carefully selected skull base lesions because of its direct route, short working distance, and distinct attack angle.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1–7
Fig. 8–15
Fig. 16
Fig. 17–27
Fig. 28–31

Similar content being viewed by others

Data Availability

The data and material required are contained in this article.

References

  1. Almeida JP, Omay SB, Shetty SR, Chen YN, Ruiz-Treviño AS, Liang B, Anand VK, Levine B, Schwartz TH (2018) Transorbital endoscopic eyelid approach for resection of sphenoorbital meningiomas with predominant hyperostosis: report of 2 cases. J Neurosurg 128:1885–1895. https://doi.org/10.3171/2017.3.Jns163110

    Article  PubMed  Google Scholar 

  2. Altay T, Patel BC, Couldwell WT (2012) Lateral orbital wall approach to the cavernous sinus. J Neurosurg 116:755–763. https://doi.org/10.3171/2011.12.Jns111251

    Article  PubMed  Google Scholar 

  3. Balakrishnan K, Moe KS (2011) Applications and outcomes of orbital and transorbital endoscopic surgery. Otolaryngol Head Neck Surg 144:815–820. https://doi.org/10.1177/0194599810397285

    Article  PubMed  Google Scholar 

  4. Bly RA, Ramakrishna R, Ferreira M, Moe KS (2014) Lateral transorbital neuroendoscopic approach to the lateral cavernous sinus. J Neurol Surg B Skull Base 75:11–17. https://doi.org/10.1055/s-0033-1353363

    Article  PubMed  Google Scholar 

  5. Chabot JD, Gardner PA, Stefko ST, Zwagerman NT, Fernandez-Miranda JC (2017) Lateral orbitotomy approach for lesions involving the middle fossa: a retrospective review of thirteen patients. Neurosurgery 80:309–322. https://doi.org/10.1093/neuros/nyw045

    Article  PubMed  Google Scholar 

  6. 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. https://doi.org/10.1016/j.wneu.2015.02.034

    Article  PubMed  Google Scholar 

  7. Dallan I, Cristofani-Mencacci L, Fiacchini G, Caniglia M, Sellari-Franceschini S, Berrettini S (2021) When multidisciplinary surgical trans-orbital approaches should be considered to reach the skull base. Acta Otorhinolaryngol Ital 41:S59–S66. https://doi.org/10.14639/0392-100X-suppl.1-41-2021-06

    Article  PubMed  PubMed Central  Google Scholar 

  8. de Lara D, DitzelFilho LF, Prevedello DM, Carrau RL, Kasemsiri P, Otto BA, Kassam AB (2014) Endonasal endoscopic approaches to the paramedian skull base. World Neurosurg 82:S121-129. https://doi.org/10.1016/j.wneu.2014.07.036

    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. https://doi.org/10.3171/2017.4.Jns162749

    Article  PubMed  Google Scholar 

  10. 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. https://doi.org/10.1016/j.wneu.2016.03.017

    Article  PubMed  Google Scholar 

  11. Fisch U, Fagan P, Valavanis A (1984) The infratemporal fossa approach for the lateral skull base. Otolaryngol Clin North Am 17:513–552

    Article  CAS  PubMed  Google Scholar 

  12. Hardesty DA, Prevedello DM (2018) What are the limits of endoscopic endonasal approaches to the skull base? J Neurosurg Sci 62:285–286. https://doi.org/10.23736/s0390-5616.18.04401-6

    Article  PubMed  Google Scholar 

  13. Hofstetter CP, Singh A, Anand VK, Kacker A, Schwartz TH (2010) The endoscopic, endonasal, transmaxillary transpterygoid approach to the pterygopalatine fossa, infratemporal fossa, petrous apex, and the Meckel cave. J Neurosurg 113:967–974. https://doi.org/10.3171/2009.10.Jns09157

    Article  PubMed  Google Scholar 

  14. In Woo K, Kong DS, Park JW, Kim M, Kim YD (2021) Orbital decompressive effect of endoscopic transorbital surgery for sphenoorbital meningioma. Graefes Arch Clin Exp Ophthalmol 259:1015–1024. https://doi.org/10.1007/s00417-020-05008-9

    Article  PubMed  Google Scholar 

  15. Inoue T, Rhoton AL Jr, Theele D, Barry ME (1990) Surgical approaches to the cavernous sinus: a microsurgical study. Neurosurgery 26:903–932. https://doi.org/10.1097/00006123-199006000-00001

    Article  CAS  PubMed  Google Scholar 

  16. 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 1–10 https://doi.org/10.3171/2018.6.Jns181099

  17. Jeon C, Hong SD, Woo KI, Seol HJ, Nam DH, Lee JI, Kong DS (2020) Use of endoscopic transorbital and endonasal approaches for 360° circumferential access to orbital tumors. J Neurosurg: 1–10 https://doi.org/10.3171/2020.6.Jns20890

  18. Jouanneau E, Simon E, Jacquesson T, Sindou M, Tringali S, Messerer M, Berhouma M (2014) The endoscopic endonasal approach to the Meckel’s cave tumors: surgical technique and indications. World Neurosurg 82:S155-161. https://doi.org/10.1016/j.wneu.2014.08.003

    Article  PubMed  Google Scholar 

  19. Kalmann R, Mourits MP (1998) Prevalence and management of elevated intraocular pressure in patients with Graves’ orbitopathy. Br J Ophthalmol 82:754–757. https://doi.org/10.1136/bjo.82.7.754

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Kassam AB, Gardner P, Snyderman C, Mintz A, Carrau R (2005) Expanded endonasal approach: fully endoscopic, completely transnasal approach to the middle third of the clivus, petrous bone, middle cranial fossa, and infratemporal fossa. Neurosurg Focus 19:E6

    Article  PubMed  Google Scholar 

  21. Kassam AB, Prevedello DM, Carrau RL, Snyderman CH, Gardner P, Osawa S, Seker A, Rhoton AL Jr (2009) The front door to meckel’s cave: an anteromedial corridor via expanded endoscopic endonasal approach- technical considerations and clinical series. Neurosurgery 64:ons71-82. https://doi.org/10.1227/01.Neu.0000335162.36862.54. (discussion ons82-73)

    Article  PubMed  Google Scholar 

  22. Kawase T, Shiobara R, Toya S (1991) Anterior transpetrosal-transtentorial approach for sphenopetroclival meningiomas: surgical method and results in 10 patients. Neurosurgery 28:869–875 (discussion 875-866)

    Article  CAS  PubMed  Google Scholar 

  23. Kim W, Moon JH, Kim EH, Hong CK, Han J, Hong JB (2021) Optimization of orbital retraction during endoscopic transorbital approach via quantitative measurement of the intraocular pressure - [SevEN 006]. BMC Ophthalmol 21:76. https://doi.org/10.1186/s12886-021-01834-5

    Article  PubMed  PubMed Central  Google Scholar 

  24. Komatsu F, Komatsu M, Di Ieva A, Tschabitscher M (2012) Endoscopic approaches to the trigeminal nerve and clinical consideration for trigeminal schwannomas: a cadaveric study. J Neurosurg 117:690–696. https://doi.org/10.3171/2012.7.Jns11730

    Article  PubMed  Google Scholar 

  25. Koutourousiou M, Gardner PA, Stefko ST, Paluzzi A, Fernandez-Miranda JC, Snyderman CH, Maroon JC (2012) Combined endoscopic endonasal transorbital approach with transconjunctival-medial orbitotomy for excisional biopsy of the optic nerve: technical note. J Neurol Surg Rep 73:52–56. https://doi.org/10.1055/s-0032-1323156

    Article  PubMed  PubMed Central  Google Scholar 

  26. Lim J, Sung KS, Kim W, Yoo J, Jung IH, Choi S, Lim SH, Roh TH, Hong CK, Moon JH (2021) Extended endoscopic transorbital approach with superior-lateral orbital rim osteotomy: cadaveric feasibility study and clinical implications (SevEN-007). J Neurosurg 1–14 https://doi.org/10.3171/2021.7.Jns21996

  27. Lim J, Sung KS, Yoo J, Oh J, Moon JH (2022) Endoscopic transorbital extradural anterior clinoidectomy: a stepwise surgical technique and case series study [SevEN-013]. Front Oncol 12:991065. https://doi.org/10.3389/fonc.2022.991065

    Article  PubMed  PubMed Central  Google Scholar 

  28. López CB, Di Somma A, Cepeda S, Arrese I, Sarabia R, Agustín JH, Topczewski TE, Enseñat J, Prats-Galino A (2021) Extradural anterior clinoidectomy through endoscopic transorbital approach: laboratory investigation for surgical perspective. Acta Neurochir (Wien) 163:2177–2188. https://doi.org/10.1007/s00701-021-04896-y

    Article  PubMed  Google Scholar 

  29. Moe KS, Bergeron CM, Ellenbogen RG (2010) Transorbital neuroendoscopic surgery. Neurosurgery 67:ons16-28. https://doi.org/10.1227/01.Neu.0000373431.08464.43

    Article  PubMed  Google Scholar 

  30. Moe KS, Jothi S, Stern R, Gassner HG (2007) Lateral retrocanthal orbitotomy: a minimally invasive, canthus-sparing approach. Arch Facial Plast Surg 9:419–426. https://doi.org/10.1001/archfaci.9.6.419

    Article  PubMed  Google Scholar 

  31. Moe KS, Kim LJ, Bergeron CM (2011) Transorbital endoscopic repair of cerebrospinal fluid leaks. Laryngoscope 121:13–30. https://doi.org/10.1002/lary.21280

    Article  PubMed  Google Scholar 

  32. Muto J, Kawase T, Yoshida K (2010) Meckel’s cave tumors: relation to the meninges and minimally invasive approaches for surgery: anatomic and clinical studies. Neurosurgery 67:ons291-298. https://doi.org/10.1227/01.Neu.0000382967.84940.52. (discussion ons298-299)

    Article  PubMed  Google Scholar 

  33. Noiphithak R, Yanez-Siller JC, RevueltaBarbero JM, Cho RI, Otto BA, Carrau RL, Prevedello DM (2019) Comparative analysis of the exposure and surgical freedom of the endoscopic extended minipterional craniotomy and the transorbital endoscopic approach to the anterior and middle cranial fossae. Oper Neurosurg (Hagerstown) 17:174–181. https://doi.org/10.1093/ons/opy309

    Article  PubMed  Google Scholar 

  34. Ohtsuka K, Nakamura Y (2000) Open-angle glaucoma associated with Graves disease. Am J Ophthalmol 129:613–617. https://doi.org/10.1016/s0002-9394(99)00473-0

    Article  CAS  PubMed  Google Scholar 

  35. 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. https://doi.org/10.1093/ons/opx042

    Article  PubMed  Google Scholar 

  36. Ramakrishna R, Kim LJ, Bly RA, Moe K, Ferreira M Jr (2016) Transorbital neuroendoscopic surgery for the treatment of skull base lesions. J Clin Neurosci 24:99–104. https://doi.org/10.1016/j.jocn.2015.07.021

    Article  PubMed  Google Scholar 

  37. Raza SM, Amine MA, Anand V, Schwartz TH (2015) Endoscopic endonasal resection of trigeminal schwannomas. Neurosurg Clin N Am 26:473–479. https://doi.org/10.1016/j.nec.2015.03.010

    Article  PubMed  Google Scholar 

  38. Raza SM, Donaldson AM, Mehta A, Tsiouris AJ, Anand VK, Schwartz TH (2014) Surgical management of trigeminal schwannomas: defining the role for endoscopic endonasal approaches. Neurosurg Focus 37:E17. https://doi.org/10.3171/2014.7.Focus14341

    Article  PubMed  Google Scholar 

  39. Samii M, Tatagiba M, Carvalho GA (2000) Retrosigmoid intradural suprameatal approach to Meckel’s cave and the middle fossa: surgical technique and outcome. J Neurosurg 92:235–241. https://doi.org/10.3171/jns.2000.92.2.0235

    Article  CAS  PubMed  Google Scholar 

  40. Sanna M, Bacciu A, Pasanisi E, Taibah A, Piazza P (2007) Posterior petrous face meningiomas: an algorithm for surgical management. Otol Neurotol 28:942–950. https://doi.org/10.1097/MAO.0b013e31814b23f0

    Article  PubMed  Google Scholar 

  41. Schwartz TH, Fraser JF, Brown S, Tabaee A, Kacker A, Anand VK (2008) Endoscopic cranial base surgery: classification of operative approaches. Neurosurgery 62:991–1002. https://doi.org/10.1227/01.neu.0000325861.06832.06. (discussion 1002-1005)

    Article  PubMed  Google Scholar 

  42. Shin M, Kondo K, Saito N (2012) Neuroendoscopic transnasal surgery for skull base tumors: basic approaches, avoidance of pitfalls, and recent innovations. Neurol Med Chir (Tokyo) 52:697–703. https://doi.org/10.2176/nmc.52.697

    Article  PubMed  Google Scholar 

  43. Shin SS, Gardner PA, Stefko ST, Madhok R, Fernandez-Miranda JC, Snyderman CH (2011) Endoscopic endonasal approach for nonvestibular schwannomas. Neurosurgery 69:1046–1057. https://doi.org/10.1227/NEU.0b013e3182287bb9. (discussion 1057)

    Article  PubMed  Google Scholar 

  44. Sun DQ, Menezes AH, Howard MA 3rd, Gantz BJ, Hasan DM, Hansen MR (2018) Surgical management of tumors involving Meckel’s cave and cavernous sinus: role of an extended middle fossa and lateral sphenoidectomy approach. Otol Neurotol 39:82–91. https://doi.org/10.1097/mao.0000000000001602

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  45. Truong HQ, Sun X, Celtikci E, Borghei-Razavi H, Wang EW, Snyderman CH, Gardner PA, Fernandez-Miranda JC (2018) Endoscopic anterior transmaxillary “transalisphenoid” approach to Meckel’s cave and the middle cranial fossa: an anatomical study and clinical application. J Neurosurg 130:227–237. https://doi.org/10.3171/2017.8.JNS171308

    Article  PubMed  Google Scholar 

  46. 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. https://doi.org/10.1007/s10143-020-01470-5

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

We would like to thank the Department of Neurological Surgery, University of Pittsburgh School of Medicine, for providing training in skull base and endoscopic endonasal anatomy to Dr. Sheng Han.

Funding

This study is funded by ShenYang Science and Technology Innovation Project (no. RC200610).

Author information

Author notes

  1. Xiaodi Han and Hongyu Yang contributed equally to this work.

Authors and Affiliations

  1. Department of Neurosurgery, The First Hospital of China Medical University, Shenyang, 110001, China

    Xiaodi Han, Hongyu Yang, Zixun Wang, Longjie Li, Chenyu Li & Sheng Han

  2. Department of Neurosurgery, Central Hospital of Chaoyang City, Chaoyang, 122000, China

    Hongyu Yang

  3. Department of Neurosurgery, Shengjing Hospital of China Medical University, Shenyang, 110001, China

    Anhua Wu

Authors
  1. Xiaodi Han
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hongyu Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Zixun Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Longjie Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Chenyu Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Sheng Han
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Anhua Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Longjie Li, Chenyu Li, Anhua Wu, and Zixun Wang. The first draft of the manuscript was written by Sheng Han, Xiaodi Han, and Hongyu Yang, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Sheng Han or Anhua Wu.

Ethics declarations

Ethics approval

This is an observational study. The XYZ Research Ethics Committee has confirmed that no ethical approval is required.

Consent for publication

The authors affirm that human research participants provided informed consent for publication of the images in Figs. 16 and 31.

Competing interests

The authors declare no competing interests.

Additional information

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Han, X., Yang, H., Wang, Z. et al. Endoscopic transorbital approach for skull base lesions: a report of 16 clinical cases. Neurosurg Rev 46, 74 (2023). https://doi.org/10.1007/s10143-023-01980-y

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s10143-023-01980-y

Keywords

Search

Navigation