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Walter C. Jean, Kenneth D. Sack, and Andrew R. Tsen

Transcript This video demonstrates the technique of using augmented reality templates to guide the transorbital approach for intradural tumors. 1–3 For a “minimally invasive” approach to a deep-lying skull base lesion, the bone opening must be small yet provide adequate exposure to the surgical target. Surgical rehearsal in virtual reality (VR) can reveal the nuances of patient-specific anatomy and simultaneously generate navigation-integrated augmented reality templates to ensure precise surgical openings. 4 , 5 To do this, three

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Murat Ulutas, Kadir Çinar, Ihsan Dogan, Mehmet Secer, Semra Isik, and Kaya Aksoy

T he transorbital approaches defined for aneurysm surgery are modifications of supraorbital mini craniotomy, which comprise a craniotomy with an additional superior orbital wall removal. 1 , 5 , 15–17 Anatomical and clinical studies of the endoscopic transorbital approaches to the intracranial pathologies were reported. 2 , 7–9 , 11 , 14 Although the number of anatomical studies on endoscopic transorbital approaches is increasing, only limited results of clinical experiences have been published. 2 , 7 , 8 , 11 The previously defined and well-known lateral

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Kimberley P. Cockerham, Ghassan K. Bejjani, John S. Kennerdell, and Joseph C. Maroon

Orbital tumors can be excised or biopsy samples obtained via transorbital approaches, especially those located in the anterior two thirds of the orbit. The indications and various surgical steps will be reviewed for the anterior, the anteromedial, and the lateral approaches. Some of these approaches can be combined or extended to accommodate large or deep-seated tumors.

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*Jaejoon Lim, Kyoung Su Sung, Woohyun Kim, Jihwan Yoo, In-Ho Jung, Seonah Choi, Seung Hoon Lim, Tae Hoon Roh, Chang-Ki Hong, and Ju Hyung Moon

S ince the introduction of the endoscopic transorbital approach (ETOA), the areas in which surgical treatment is possible with this method have been expanded in the course of several studies. 1–3 Anterior petrosectomy in the posterior fossa area was possible with ETOA, and a new method to access lesions in the insular region via the ETOA has also been reported. 4–6 Additional research has also been conducted to efficiently use the surgical space by modifying the ETOA with insertion of a small port. 7 , 8 In particular, it was observed that even a little

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Christina E. Sarris, Griffin D. Santarelli, and Andrew S. Little

Transcript We will be demonstrating a transorbital approach for endoscopic repair of an anterior skull base encephalocele. The patient is a 77-year-old man with a 2-year history of left-sided nasal drainage. The drainage had a salty, metallic taste and was confirmed beta-2 transferrin positive. He had no prior craniofacial trauma or sinus surgery. His past medical history was significant for obesity, obstructive sleep apnea, and hemidiaphragm paralysis. He had a normal physical exam, including nasal endoscopy. CT of the head demonstrated thinning and erosion of

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Won Jae Lee, Sang Duk Hong, Kyung In Woo, Ho Jun Seol, Jung Won Choi, Jung-Il Lee, Do-Hyun Nam, and Doo-Sik Kong

been investigated in many studies, 11 , 13 , 14 , 16 , 19–22 and Scopel et al. proposed a clinical-surgical classification of PA. 15 They divided PA into three zones according to its relationship with ICA, which is a key element in determining expansion of EEA. ICA is considered the most critical structure that limits accessibility to PA via EEA. 13 , 19 , 23 More recently, an alternative endoscopic surgical route to PA, the endoscopic transorbital approach (TOA), was proposed to overcome this challenge. 19 , 23 , 24 TOA can provide the same surgical window as

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Eui Hyun Kim, Jihwan Yoo, In-Ho Jung, Ji Woong Oh, Ju-Seong Kim, Jin Sook Yoon, Ju Hyung Moon, Seok-Gu Kang, Jong Hee Chang, and Tae Hoon Roh

resection is the middle cerebral artery (MCA) and its branches. In particular, injury of the long insular perforating arteries is frequently associated with infarction in the corona radiata, which results in serious contralateral motor dysfunction. 8 The endoscopic transorbital approach (ETOA) is an emerging surgical corridor for accessing not only various skull base areas but also brain parenchymal regions. 9 , 10 We noted the possibility that the insular region can be approached more safely by an anteroposterior corridor under ETOA. Using cadaveric specimens, we

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Federica Beretta, Norberto Andaluz, Chiraz Chalaala, Claudio Bernucci, Leo Salud, and Mario Zuccarello

a standard protocol for frameless stereotactic study. The heads were then fixed in the Mayfield headholder (Integra Neurosciences); they were consistently, reproducibly rotated 45° to the contralateral side of the approach and tilted backward with the zygoma at the uppermost point. Navigation to predetermined landmarks was sequentially undertaken (described later in more detail) after performing the pterional, supraorbital, and transorbital approaches. Figure 1 depicts the anatomical landmarks selected for this study. F ig . 1. Illustration showing the

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Mina M. Gerges, Saniya S. Godil, Iyan Younus, Michael Rezk, and Theodore H. Schwartz

(hybrid) short and long burrs. We also present a case with narrated video ( Video 1 ) demonstrating the transorbital approach to the ITF for biopsy of a recurrent glioblastoma. VIDEO 1. Illustrative video of the endoscopic transorbital approach to the ITF for tumor biopsy, demonstrated step-by-step. Copyright Mina M. Gerges. Published with permission. Click here to view. Results Cadaveric Dissection Steps Skin Incision The skin incision is made along one of the creases of the inferior eyelid extending from the medial to lateral canthus. Of note, a superior eyelid

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Alhusain Nagm, Toshihiro Ogiwara, and Kazuhiro Hongo

temporal lobe (as documented in the authors’ study 1 ), respectively, means that we are facing an exceptionally deep and narrow surgical corridor. Additionally, the crowding of surgical instruments forces the surgeon to become accustomed to uncomfortable maneuverability and places the orbit at great risk. Therefore, our lead author now opts for adding endoscopic endonasal medial orbital apex decompression (EEMOAD) before starting the transorbital approaches to regions beyond the orbital cone to avoid several drawbacks ( Fig. 1 ). 2 This nuance allows early release of