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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

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

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

connected to a video monitor; images were captured using a high-definition digital video system (Stryker). Specimens were positioned supine, pinned, and fixed in a Mayfield head holder, rotated 5° laterally to the contralateral side ( Fig. 1 ). A skin incision was placed in the superior eyelid crease, above the tarsal plate. A high-speed drill was used for bone removal. Fig. 1. Stepwise dissection of the superior eyelid endoscopic transorbital approach (left side). The head is slightly rotated to the contralateral side. After positioning, tarsorrhaphy is performed, and a

portion of the orbit and inferomedial components of SOMs that may enter into the infratemporal fossa and lateral sphenoid sinus. 13–15 , 39 , 50 , 52 However, resection of lateral skull base lesions, such as lateral sphenoid meningiomas, remains one of the major limitations of the endoscopic endonasal approach. Recently, a multiportal transorbital and endonasal approach has been proposed as a new minimally invasive option to reach the lateral orbit and middle fossa. 20 , 22 , 41 These approaches are particularly suited for patients with predominant hyperostosis and

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

endonasal approach (EEA) according to its corresponding clock position relative to the optic nerve. 3 On the other hand, since Moe et al. first introduced a pure endoscopic transorbital surgery for anterior skull base lesions based on the four quadrants around the orbit, the endoscopic transorbital superior eyelid approach (ETOA) as well as the EEA has been emerging as a minimally invasive alternative to open transcranial approaches for orbital pathologies. 5 , 6 Although the ETOA offers a direct route to skull base lesions involving the orbital apex, middle