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

Doo-Sik Kong MD, PhD 1 , Yong Hwy Kim MD, PhD 2 and Chang-Ki Hong MD, PhD 3
View More View Less
  • 1 Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine;
  • 2 Department of Neurosurgery, Seoul National University College of Medicine; and
  • 3 Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00
Print or Print + Online

OBJECTIVE

Spheno-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.

METHODS

Between 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).

RESULTS

There 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.

CONCLUSIONS

The 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.

ABBREVIATIONS eTOA = endoscopic transorbital approach; GTR = gross-total resection; SOM = spheno-orbital meningioma.

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00

Contributor Notes

Correspondence Chang-Ki Hong: Gangnam Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea. yedamin@yuhs.ac.

INCLUDE WHEN CITING Published online June 5, 2020; DOI: 10.3171/2020.3.JNS20297.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

  • 1

    De Rosa A, Pineda J, Cavallo LM, Endoscopic endo- and extra-orbital corridors for spheno-orbital region: anatomic study with illustrative case. Acta Neurochir (Wien). 2019;161(8):16331646.

    • Search Google Scholar
    • Export Citation
  • 2

    Dallan I, Sellari-Franceschini S, Turri-Zanoni M, Endoscopic transorbital superior eyelid approach for the management of selected spheno-orbital meningiomas: preliminary experience. Oper Neurosurg (Hagerstown). 2018;14(3):243251.

    • Search Google Scholar
    • Export Citation
  • 3

    Dallan I, Locatelli D, Turri-Zanoni M, Transorbital endoscopic assisted resection of a superior orbital fissure cavernous haemangioma: a technical case report. Eur Arch Otorhinolaryngol. 2015;272(12):38513856.

    • Search Google Scholar
    • Export Citation
  • 4

    Moe KS, Kim LJ, Bergeron CM. Transorbital endoscopic repair of cerebrospinal fluid leaks. Laryngoscope. 2011;121(1):1330.

  • 5

    Jeon C, Hong CK, Woo KI, Endoscopic transorbital surgery for Meckel’s cave and middle cranial fossa tumors: surgical technique and early results. J Neurosurg. 2019;131(4):11261135.

    • Search Google Scholar
    • Export Citation
  • 6

    Kong DS, Young SM, Hong CK, Clinical and ophthalmological outcome of endoscopic transorbital surgery for cranioorbital tumors. J Neurosurg. 2018;131(3):667675.

    • Search Google Scholar
    • Export Citation
  • 7

    Kiyofuji S, Casabella AM, Graffeo CS, Sphenoorbital meningioma: a unique skull base tumor. Surgical technique and results. J Neurosurg. Published online August 23, 2019. doi:10.3171/2019.6.JNS191158

    • Search Google Scholar
    • Export Citation
  • 8

    Park HH, Yoo J, Yun IS, Hong CK. Comparative analysis of endoscopic transorbital approach and extended mini-pterional approach for sphenoid wing meningiomas with osseous involvement: preliminary surgical results. World Neurosurg. Published online January 27, 2020. doi:10.1016/j.wneu.2020.01.115

    • Search Google Scholar
    • Export Citation
  • 9

    Roser F, Nakamura M, Jacobs C, Sphenoid wing meningiomas with osseous involvement. Surg Neurol. 2005;64(1):3743.

  • 10

    Noiphithak R, Yanez-Siller JC, Revuelta Barbero JM, 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). 2019;17(2):174181.

    • Search Google Scholar
    • Export Citation
  • 11

    Dallan I, Caniglia M, Turri-Zanoni M, Transorbital superior eyelid endoscopic approach to the temporal lobe. J Neurosurg Sci. 2018;62(3):369372.

    • Search Google Scholar
    • Export Citation
  • 12

    Di Somma A, Andaluz N, Cavallo LM, Endoscopic transorbital superior eyelid approach: anatomical study from a neurosurgical perspective. J Neurosurg. 2018;129(5):12031216.

    • Search Google Scholar
    • Export Citation
  • 13

    Freeman JL, Davern MS, Oushy S, Spheno-orbital meningiomas: a 16-year surgical experience. World Neurosurg. 2017;99:369380.

  • 14

    Honig S, Trantakis C, Frerich B, Meningiomas involving the sphenoid wing outcome after microsurgical treatment—a clinical review of 73 cases. Cent Eur Neurosurg. 2010;71(4):189198.

    • Search Google Scholar
    • Export Citation
  • 15

    Almeida JP, Omay SB, Shetty SR, Transorbital endoscopic eyelid approach for resection of sphenoorbital meningiomas with predominant hyperostosis: report of 2 cases. J Neurosurg. 2018;128(6):18851895.

    • Search Google Scholar
    • Export Citation
  • 16

    Alqahtani A, Padoan G, Segnini G, Transorbital transnasal endoscopic combined approach to the anterior and middle skull base: a laboratory investigation. Acta Otorhinolaryngol Ital. 2015;35(3):173179.

    • Search Google Scholar
    • Export Citation
  • 17

    Allen RC. The evolving role of the oculoplastic surgeon in skull base surgery. Curr Opin Ophthalmol. 2016;27(5):420427.

  • 18

    Gerges MM, Godil SS, Younus I, Endoscopic transorbital approach to the infratemporal fossa and parapharyngeal space: a cadaveric study. J Neurosurg. Published online November 1, 2019. doi:10.3171/2019.7.JNS191743

    • Search Google Scholar
    • Export Citation
  • 19

    Balakrishnan K, Moe KS. Applications and outcomes of orbital and transorbital endoscopic surgery. Otolaryngol Head Neck Surg. 2011;144(5):815820.

    • Search Google Scholar
    • Export Citation
  • 20

    Dallan I, Castelnuovo P, Turri-Zanoni M, Transorbital endoscopic assisted management of intraorbital lesions: lessons learned from our first 9 cases. Rhinology. 2016;54(3):247253.

    • Search Google Scholar
    • Export Citation
  • 21

    Golbin DA, Lasunin NV, Cherekaev VA, Biopsy and resection of skull base tumors using transorbital endoscopic approaches: primary results. Article in Russian. Vopr Neirokhir. 2019;83(3):4256.

    • Search Google Scholar
    • Export Citation
  • 22

    Lee MH, Hong SD, Woo KI, Endoscopic endonasal versus transorbital surgery for middle cranial fossa tumors: comparison of clinical outcomes based on surgical corridors. World Neurosurg. 2019;122:e1491e1504.

    • Search Google Scholar
    • Export Citation
  • 23

    Lin BJ, Hong KT, Chung TT, Endoscopic transorbital transtentorial approach to middle incisural space: preclinical cadaveric study. Acta Neurochir (Wien). 2019;161(4):831839.

    • Search Google Scholar
    • Export Citation
  • 24

    Lin BJ, Ju DT, Hsu TH, Endoscopic transorbital approach to anterolateral skull base through inferior orbital fissure: a cadaveric study. Acta Neurochir (Wien). 2019;161(9):19191929.

    • Search Google Scholar
    • Export Citation
  • 25

    Locatelli D, Pozzi F, Turri-Zanoni M, Transorbital endoscopic approaches to the skull base: current concepts and future perspectives. J Neurosurg Sci. 2016;60(4):514525.

    • Search Google Scholar
    • Export Citation
  • 26

    Park HH, Hong SD, Kim YH, Endoscopic transorbital and endonasal approach for trigeminal schwannomas: a retrospective multicenter analysis (KOSEN-005). J Neurosurg. Published online June 21, 2019. doi:10.3171/2019.3.JNS19492

    • Search Google Scholar
    • Export Citation
  • 27

    Priddy BH, Nunes CF, Beer-Furlan A, A side door to Meckel’s cave: anatomic feasibility study for the lateral transorbital approach. Oper Neurosurg (Hagerstown). 2017;13(5):614621.

    • Search Google Scholar
    • Export Citation
  • 28

    Noiphithak R, Yanez-Siller JC, Revuelta Barbero JM, Quantitative analysis of the surgical exposure and surgical freedom between transcranial and transorbital endoscopic anterior petrosectomies to the posterior fossa. J Neurosurg. 2018;131(2):569577.

    • Search Google Scholar
    • Export Citation
  • 29

    Tai AX, Sack KD, Herur-Raman A, Jean WC. The benefits of limited orbitotomy on the supraorbital approach: an anatomic and morphometric study in virtual reality. Oper Neurosurg (Hagerstown). 2020;18(5):542550.

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 220 220 220
Full Text Views 44 44 44
PDF Downloads 34 34 34
EPUB Downloads 0 0 0