Use of endoscopic transorbital and endonasal approaches for 360° circumferential access to orbital tumors

2020 ◽  
pp. 1-10
Author(s):  
Chiman Jeon ◽  
Sang Duk Hong ◽  
Kyung In Woo ◽  
Ho Jun Seol ◽  
Do-Hyun Nam ◽  
...  
Keyword(s):  
Optic Nerve ◽  
Minimally Invasive ◽  
Surgical Techniques ◽  
Cystic Teratoma ◽  
Subtotal Resection ◽  
Zone Model ◽  
Team Approach ◽  
Orbital Tumors ◽  
Total Resection ◽  
Endoscopic Transorbital

OBJECTIVEOrbital tumors are often surgically challenging because they require an extensive fronto-temporo-orbital zygomatic approach (FTOZ) and a multidisciplinary team approach to provide the best outcomes. Recently, minimally invasive endoscopic techniques via a transorbital superior eyelid approach (ETOA) or endoscopic endonasal approach (EEA) have been proposed as viable alternatives to transcranial approaches for orbital tumors. In this study, the authors investigated the feasibility of 360° circumferential access to orbital tumors via both ETOA and EEA.METHODSBetween April 2014 and June 2019, 16 patients with orbital tumors underwent either ETOA or EEA at the authors’ institution. Based on the neuro-topographic “four-zone model” of the orbit with its tumor epicenter around the optic nerve in the coronal plane, ETOA (n = 10, 62.5%) was performed for tumors located predominantly superolateral to the nerve and EEA (n = 6, 37.5%) for those located predominantly inferomedial to the nerve. Eight patients (50%) presented with intraconal tumors and 8 (50%) with extraconal ones. The orbital tumors included orbital schwannoma (n = 6), cavernous hemangioma (n = 2), olfactory groove meningioma (n = 1), sphenoorbital meningioma (n = 1), chondrosarcoma (n = 1), trigeminal schwannoma (n = 1), metastatic osteosarcoma (n = 1), mature cystic teratoma (n = 1), sebaceous carcinoma (n = 1), and ethmoid sinus osteoma (n = 1). The clinical outcomes and details of surgical techniques were reviewed.RESULTSGross-total resection was achieved in 12 patients (75%), near-total resection in 3 (18.8%), and subtotal resection in 1 (6.2%). Eight (88.9%) of the 9 patients with preoperative proptosis showed improvement after surgery, and 4 (66.7%) of the 6 patients with visual symptoms demonstrated improvement. Four (40%) of the 10 patients treated with ETOA experienced partial third nerve palsy immediately after surgery (3 transient and 1 persistent). There have been no postoperative CSF leaks or infections in this series.CONCLUSIONSWithout transcranial approaches requiring temporalis muscle dissection and orbitozygomatic osteotomy, the selection of ETOA or EEA based on a concept of a four-zone model with its epicenter around the optic nerve successfully provides a minimally invasive 360° circumferential access to the entire orbit with acceptable morbidity.

scholarly journals Surgical Techniques and the Choice of Operative Approach for Cranioorbital Lesions

2019 ◽  
Vol 81 (06) ◽  
pp. 686-693
Author(s):  
Haiyong He ◽  
Meiqin Cai ◽  
Manting Li ◽  
Lei Wei ◽  
Lun Luo ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Optic Nerve ◽  
Minimally Invasive ◽  
Surgical Techniques ◽  
Surgical Approaches ◽  
Modified Rankin Scale ◽  
Pterional Approach ◽  
Total Resection ◽  
Significant Difference

Abstract Objectives Cranioorbital lesions present a great challenge for neurosurgeons and ophthalmologists. There is no consensus on the choice of surgical approach. The aims of this study were to investigate 49 cases of cranioorbital lesions and evaluate surgical approaches and outcomes. Patients and Methods A retrospective study was done on 49 patients (51 operations) from 2009 to 2018. Information about the lesion was used to decide whether the supraorbital eyebrow approach (SEA) or pterional approach (PA) was performed. Results Twenty-eight patients had surgical resection using SEA, 21 patients received PA, each group included one case of recurrence, who underwent reoperation via the same approach. SEA provided better cosmetic satisfaction, and a shorter incision than PA (p < 0.05). There was no significant difference in total resection rates, visual outcomes, recovery of ptosis, and other new surgical-related complications between SEA group and PA group (p > 0.05). Forty-nine cases of proptosis (94.1%, 49/51) were improved. Thirty-three patients (33/37, 89.2%) who underwent follow-up for longer than 12 weeks had a modified Rankin Scale (mRS) score ≤ 3. Conclusion Surgery is the preferred treatment for cranioorbital lesions, but total resection is difficult. SEA may be a more minimally invasive option for some more limited lesions superior to optic nerve. PA may be more reasonable for the lesion with obvious hyperostosis and more extensive lesions.

scholarly journals Clinical and ophthalmological outcome of endoscopic transorbital surgery for cranioorbital tumors

2019 ◽  
Vol 131 (3) ◽  
pp. 667-675 ◽  
Author(s):  
Doo-Sik Kong ◽  
Stephanie Ming Young ◽  
Chang-Ki Hong ◽  
Yoon-Duck Kim ◽  
Sang Duk Hong ◽  
...  
Keyword(s):  
Cystic Teratoma ◽  
Complete Recovery ◽  
Csf Leak ◽  
Subtotal Resection ◽  
Total Resection ◽  
Sebaceous Gland Carcinoma ◽  
Recurrent Tumors ◽  
Endoscopic Transorbital ◽  
Gland Carcinoma ◽  
Endoscopic Transorbital Surgery

OBJECTIVECranioorbital tumors are complex lesions that involve the deep orbit, floor of the frontal bone, and lesser and greater wing of the sphenoid bone. The purpose of this study was to describe the clinical and ophthalmological outcomes with an endoscopic transorbital approach (TOA) in the management of cranioorbital tumors involving the deep orbit and intracranial compartment.METHODSThe authors performed endoscopic TOAs via the superior eyelid crease incision in 18 patients (16 TOA alone and 2 TOA combined with a simultaneous endonasal endoscopic resection) with cranioorbital tumors from September 2016 to November 2017. There were 12 patients with sphenoorbital meningiomas. Other lesions included osteosarcoma, plasmacytoma, sebaceous gland carcinoma, intraconal schwannoma, cystic teratoma, and fibrous dysplasia. Ten patients had primary lesions and 8 patients had recurrent tumors. Thirteen patients had intradural lesions, while 5 had only extradural lesions.RESULTSOf 18 patients, 7 patients underwent gross-total resection of the tumor and 7 patients underwent planned near-total resection of the tumor, leaving the cavernous sinus lesion. Subtotal resection was performed in 4 patients with recurrent tumors. There was no postoperative CSF leak requiring reconstruction surgery. Fourteen of 18 patients (77.8%) had preoperative proptosis on the ipsilateral side, and all 14 patients had improvement in exophthalmos; the mean proptosis reduced from 5.7 ± 2.7 mm to 1.5 ± 1.4 mm. However, some residual proptosis was evident in 9 of the 14 (64%). Ten of 18 patients (55.6%) had preoperative optic neuropathy, and 6 of them (60.0%) had improvement; the median best-corrected visual acuity improved from 20/100 to 20/40. Thirteen of 18 patients showed mild ptosis at an immediate postoperative examination, all of whom had a spontaneous and complete recovery of their ptosis during the follow-up period. Three of 7 patients showed improvement in extraocular motility after surgery.CONCLUSIONSEndoscopic TOA can be considered as an option in the management of cranioorbital tumors involving complex anatomical areas, with acceptable sequelae and morbidity.

scholarly journals Optimal indications and limitations of endoscopic transorbital superior eyelid surgery for spheno-orbital meningiomas

2020 ◽  
pp. 1-8 ◽  
Author(s):  
Doo-Sik Kong ◽  
Yong Hwy Kim ◽  
Chang-Ki Hong
Keyword(s):  
Minimally Invasive Surgery ◽  
Minimally Invasive ◽  
Cavernous Sinus ◽  
Invasive Surgery ◽  
Infratemporal Fossa ◽  
Wound Complications ◽  
Total Resection ◽  
Plaque Type ◽  
Endoscopic Transorbital ◽  
Orbital Rim

OBJECTIVESpheno-orbital meningiomas (SOMs) are complicated tumors that involve multiple structures at initial presentation, such as the orbit, temporalis muscle, sphenoidal bone, cavernous sinus, and temporal or infratemporal fossa. The infiltrative growth and complexity of this type of meningioma make total resection impossible. In this study, the authors evaluated the surgical outcome of the endoscopic transorbital approach (eTOA) for SOM. In addition, they identified optimal indications for the use of eTOA and analyzed the feasibility of this approach as a minimally invasive surgery for SOMs of varying types and locations at presentation.METHODSBetween September 2016 and December 2019, the authors performed eTOA in 41 patients with SOM with or without orbital involvement at 3 independent tertiary institutions. The authors evaluated the surgical outcomes of eTOA for SOM and investigated several factors that affect the outcome, such as tumor volume, tumor location, and the presence of lateral orbitotomy. Gross-total resection (GTR) was defined as complete resection of the tumor or intended subtotal resection except the cavernous sinus. This study was undertaken as a multicenter project (006) of the Korean Society of Endoscopic Neurosurgery (KOSEN-006).RESULTSThere were 41 patients (5 men and 36 women) with a median age of 52.0 years (range 24–73 years). Twenty-one patients had tumors that involved the orbital structure, while 14 patients had tumors that presented at the sphenoidal bone along with other structures, such as the cavernous sinus, temporal fossa, and infratemporal fossa. Fifteen patients had the globulous type of tumor and 26 patients had the en plaque type. Overall, GTR was achieved in 21 of 41 patients (51.2%), and complications included CSF leaks in 2 patients and wound complications in 2 patients. Multiple logistic regression analysis showed that the en plaque type of tumor, absence of lateral orbital rim osteotomy, involvement of the temporal floor or infratemporal fossa, and involvement of the orbit and medial one-third of the greater sphenoidal wing were closely associated with lower GTR rates (p < 0.05). Multivariate analysis revealed that the en plaque type of tumor and the absence of lateral orbital rim osteotomy were significant predictors for lower GTR rate.CONCLUSIONSThe en plaque type of SOM remains a challenge despite advances in technique such as minimally invasive surgery. Overall, clinical outcome of eTOA for SOM was comparable to the transcranial surgery. To achieve GTR, eTOA is recommended, with additional lateral orbital rim osteotomy for globulous-type tumors, without involving the floor of the temporal and infratemporal fossa.

scholarly journals Posterior fossa tumors in children, Histopathology &extent of excision as prognostic factors

2020 ◽  
Vol 3 (2) ◽  
pp. 108-119
Author(s):  
Manna Ramadan ◽  
Shaswar Ali
Keyword(s):  
Posterior Fossa ◽  
Tumor Resection ◽  
Choroid Plexus Papilloma ◽  
Surgical Techniques ◽  
Gross Total Resection ◽  
Diagnostic Tools ◽  
Subtotal Resection ◽  
Posterior Fossa Tumors ◽  
Total Resection

The Posterior fossa is the commonest site of primary intracranial tumors in children, for the last two decades the over-all survival and 5-years progression-free survival of children with posterior fossa tumors (PFT) like Medulloblastoma& Ependymomas has been doubled due to the improvement in the diagnostic tools and the advances in the surgical techniques approaching total or near total resection. The aim of the study is to find the relation of histopathology and the extent of excision with mortality and survival. A total of twenty eight cases with Histologically (26 cases) and two cases radiologically (CT-scan and MRI) confirmed pediatric posterior fossa tumors treated in Erbil Teaching Hospital between,Jan.2013 and Dec.2015 were included in the study As a result the twenty-eight pediatric patients were included in the study, mean age was (8 years),16 boys and 12 girls, mean follow-up period was 14 months,11 cases had Medulloblastoma (39%), 5 cases had Ependymoma (18%), 9 cases had Astrocytoma(32%) , 2 cases had Brainstem mass (7%) and one case had Choroid plexus papilloma (4%).Tumor resection was performed in 26 patients, Twenty cases had total resection (77%), and six Pts .had subtotal resection (23%), two cases without surgery During the follow-up period out of the 20 cases that had total resection nineteen are still alive(95%) and only one died (5%),six cases that had Subtotal resection; four of them are dead (67%) and only two cases are still alive(33%). Two cases that had no surgery both of them are dead (100%).Eleven cases of Medulloblastoma 8 of them had gross total resection and three of them had subtotal resection, 9 of them still alive (82%) and two are dead (18%). Nine Pts of Astrocytoma, 8 of them had total resection and one subtotal; eight of them are still .)alive (89%) and only one died (11%Five pts with Ependymoma, three had total resection and two had subtotal resection,three are still alive (60%) and two dead (40%). Two cases of Brainstem mass not operated and both are dead, One case of Choroid papilloma totally resected & still alive. In conclusion treatment of posterior fossa tumors in children with surgery yields long survival rates, children with gross total resection or a near total resection had better outcome. Histopathology subtypes of the tumors were associated with a favorable outcome for Astrocytoma which has less mortality and better survival rate than others

scholarly journals Revisional Techniques for Secondary Cleft Lip Deformities

2021 ◽  
Vol 35 (02) ◽  
pp. 065-071
Author(s):  
Shayan M. Sarrami ◽  
Anna J. Skochdopole ◽  
Andrew M. Ferry ◽  
Edward P. Buchanan ◽  
Larry H. Hollier ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Early Life ◽  
Cleft Lip ◽  
Primary Repair ◽  
Surgical Techniques ◽  
Minimally Invasive Techniques ◽  
Adjacent Tissue ◽  
Tissue Transfer ◽  
Invasive Techniques

AbstractSecondary deformities of repaired cleft lips are an unfortunate complication despite the meticulous approach of modern primary procedures. Most of these surgeries take place in the patient's early life and must be strategically planned to provide optimal cosmesis with minimal interventions. Depending on the level of severity, treatment of the secondary deformities ranges from noninvasive or minimally invasive techniques to complete revision cheiloplasty. Many novel topical, injectable, and laser therapies have allotted physicians more technical flexibility in treating superficial distortions. Nonetheless, surgical techniques such as diamond excision and adjacent tissue transfer remain popular and useful reconstructive modalities. Deformities involving the orbicularis oris must be completely taken down to allow full access to the muscle. Complete revision cheiloplasty requires recreation of the cleft defect and reconstruction similar to the primary repair. Due to the myriad of presentations of these secondary deformities, familiarity with the various treatments available is imperative for any cleft surgeon.

Minimally Invasive Surgical Techniques to Treat Spine Infection S

1996 ◽  
Vol 27 (1) ◽  
pp. 183-199 ◽  
Author(s):  
Larry M. Parker ◽  
Paul C. McAfee ◽  
Ira L. Fedder ◽  
James C. Weis ◽  
W. Peter Geis
Keyword(s):  
Minimally Invasive ◽  
Surgical Techniques ◽  
Spine Infection ◽  
Minimally Invasive Surgical

Sodium Fluorescein-Guided Gross Total Resection of Pediatric Exophytic Brainstem Glioma: 2-Dimensional Operative Video

2020 ◽  
Author(s):  
Christopher Markosian ◽  
Catherine A Mazzola ◽  
Luke D Tomycz
Keyword(s):  
Normal Tissue ◽  
Clinical Case ◽  
Aminolevulinic Acid ◽  
Significant Risk ◽  
Gross Total Resection ◽  
Subtotal Resection ◽  
Sodium Fluorescein ◽  
Total Resection ◽  
Term Survival ◽  
Patient Consent

Abstract Brainstem gliomas comprise 10% to 20% of pediatric intracranial tumors.1 Gross total resection is associated with the greatest long-term survival.1 However, due to the eloquence of surrounding brain tissue, an aggressive resection is not always achievable and can be associated with significant risk.2 Sodium fluorescein can be used to help differentiate between tumor and normal tissue.3,4 In this operative video, we demonstrate the step-by-step technique to utilize fluorescence in surgically resecting an exophytic glioma arising from the midbrain in a 16-yr-old male. Technical nuances are highlighted in this operative video, including the use of the YELLOW 560 (Zeiss) filter to differentiate fluorescent tumor from normal tissue as well as strategic splitting of the tentorium to expose the supratentorial component of the tumor. A decrease in motor potentials of the right leg during the case did not translate into neurological worsening postoperatively; at 3-mo follow-up, the patient attests to better strength and coordination on his affected side. In summary, sodium fluorescein can be used as a critical adjunctive tool for successful surgery in the case of a brainstem tumor. Alternatives to this procedure included gross total resection with 5-aminolevulinic acid, subtotal resection with chemotherapy, and active monitoring, but were not chosen due to their limitations in this clinical case.5-7  Appropriate patient consent was obtained to perform this procedure and present this clinical case and surgical video for academic purposes.

scholarly journals Endonasal endoscopic reoperation for residual or recurrent craniopharyngiomas

2017 ◽  
Vol 126 (2) ◽  
pp. 418-430 ◽  
Author(s):  
Sivashanmugam Dhandapani ◽  
Harminder Singh ◽  
Hazem M. Negm ◽  
Salomon Cohen ◽  
Mark M. Souweidane ◽  
...  
Keyword(s):  
Tumor Volume ◽  
Visual Outcome ◽  
Extent Of Resection ◽  
Endocrine Function ◽  
Subtotal Resection ◽  
Total Resection ◽  
Medical College ◽  
The Impact ◽  
First Time

OBJECTIVE Craniopharyngiomas can be difficult to remove completely based on their intimate relationship with surrounding visual and endocrine structures. Reoperations are not uncommon but have been associated with higher rates of complications and lower extents of resection. So radiation is often offered as an alternative to reoperation. The endonasal endoscopic transsphenoidal approach has been used in recent years for craniopharyngiomas previously removed with craniotomy. The impact of this approach on reoperations has not been widely investigated. METHODS The authors reviewed a prospectively acquired database of endonasal endoscopic resections of craniopharyngiomas over 11 years at Weill Cornell Medical College, NewYork-Presbyterian Hospital, performed by the senior authors. Reoperations were separated from first operations. Pre- and postoperative visual and endocrine function, tumor size, body mass index (BMI), quality of life (QOL), extent of resection (EOR), impact of prior radiation, and complications were compared between groups. EOR was divided into gross-total resection (GTR, 100%), near-total resection (NTR, > 95%), and subtotal resection (STR, < 95%). Univariate and multivariate analyses were performed. RESULTS Of the total 57 endonasal surgical procedures, 22 (39%) were reoperations. First-time operations and reoperations did not differ in tumor volume, radiological configuration, or patients' BMI. Hypopituitarism and diabetes insipidus (DI) were more common before reoperations (82% and 55%, respectively) compared with first operations (60% and 8.6%, respectively; p < 0.001). For the 46 patients in whom GTR was intended, rates of GTR and GTR+NTR were not significantly different between first operations (90% and 97%, respectively) and reoperations (80% and 100%, respectively). For reoperations, prior radiation and larger tumor volume had lower rates of GTR. Vision improved equally in first operations (80%) compared with reoperations (73%). New anterior pituitary deficits were more common in first operations compared with reoperations (51% vs 23%, respectively; p = 0.08), while new DI was more common in reoperations compared with first-time operations (80% vs 47%, respectively; p = 0.08). Nonendocrine complications occurred in 2 (3.6%) first-time operations and no reoperations. Tumor regrowth occurred in 6 patients (11%) over a median follow-up of 46 months and was not different between first versus reoperations, but was associated with STR (33%) compared with GTR+NTR (4%; p = 0.02) and with not receiving radiation after STR (67% vs 22%; p = 0.08). The overall BMI increased significantly from 28.7 to 34.8 kg/m2 over 10 years. Six months after surgery, there was a significant improvement in QOL, which was similar between first-time operations and reoperations, and negatively correlated with STR. CONCLUSIONS Endonasal endoscopic transsphenoidal reoperation results in similar EOR, visual outcome, and improvement in QOL as first-time operations, with no significant increase in complications. EOR is more impacted by tumor volume and prior radiation. Reoperations should be offered to patients with recurrent craniopharyngiomas and may be preferable to radiation in patients in whom GTR or NTR can be achieved.

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