Endoscopic Transorbital Approaches for Surgical Treatment of Middle Fossa Pathology: A Case Series
Notice bibliographique
Résumé
Background: In recent years, there has been a shift towards minimally invasive neurosurgery for certain skull base pathologies, focusing on more discrete incisions, smaller craniotomies, and minimal brain retraction. Endoscopic transorbital approaches have been increasingly used to treat lesions of the middle fossae. Lesions such as sphenoid wing meningiomas, trigeminal schwannomas or cavernous sinus disease, which would traditionally require a fronto-temporal craniotomy, can be treated with this minimally invasive approach. Case Presentation: We report four cases of endoscopic transorbital procedures: 3 for removal of sphenoid wing meningiomas, and 1 for a cavernous sinus biopsy. Our surgical approach consists of a superior eyelid approach to the orbital rim and subsequent endoscopy-assisted exposure of the lateral and superior wall of the orbit. Drilling of the sphenoid wing is then pursued to expose the middle fossa dura and meningo-orbital band, and to unroof the superior orbital fissure. Depending on the pathology, the optic canal, anterior clinoid or lateral wall of the cavernous sinus can be reached. The first case is a 63-year-old woman with a left sphenoidal meningioma . Subtotal resection was achieved using a left-sided approach. The patient required reoperation for CSF leak repair on postoperative day 2. The postoperative MRI showed very subtle tumor residue on the anterior clinoid process. She did well on follow-up without any neurological deficit. The second case is a 59-year-old woman with a left spheno-orbital meningioma and predominant hyperostosis diagnosed following progressive loss of vision in her left eye, exophthalmia and constant ocular pressure. Subtotal resection was achieved using a superior eyelid approach. Her surgery involved extensive drilling of the sphenoid wing hyperostosis, decompression of the optic canal and partial anterior clinoidectomy. This was achieved without resection of the orbital rim. Postoperatively, the patient developed transient 3rd, 4th, 5th, and 6th cranial nerve palsies, which had fully recovered on 5-week follow-up. The patient had significant improvement of her vision and the proptosis improved as well. The third case is a 59-year-old woman with a right incidental sphenoid wing meningioma who, underwent subtotal resection with no complications. The last case is an 86-year-old woman who presented with right-sided trigeminal neuralgia and facial hypesthesia. MRI showed an ipsilateral cavernous sinus lesion of unknown etiology. A biopsy was performed using an eyelid approach with interdural dissection for exposure of the lateral wall of cavernous sinus. Pathology findings revealed a nonaggressive lymphoma which was treated with palliative radiotherapy. Her symptoms partially improved after the treatment. Conclusion: Endoscopic transorbital procedures are effective in the treatment of lesion of the middle fossa. They offer a minimally invasive approach with a barely visible scar and minimal brain retraction. These approaches allow access to previously mentioned structures in a more direct trajectory than a pterional or subtemporal approach. Multilayered reconstruction and gentle orbit retraction is necessary to avoid complications. Although the learning curve can be steep, as with all minimally invasive surgeries, we advocate that endoscopic transorbital approaches through the eyelid are an alternative to traditional fronto-temporal craniotomies in the surgical management of middle fossa pathology. Publication History Article published online: 05 February 2024 © 2024. Thieme. All rights reserved. Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,003 |
| Méta-épidémiologie (sens strict) | 0,004 | 0,001 |
| Méta-épidémiologie (sens large) | 0,001 | 0,002 |
| Bibliométrie | 0,004 | 0,003 |
| Études des sciences et des technologies | 0,004 | 0,003 |
| Communication savante | 0,002 | 0,002 |
| Science ouverte | 0,002 | 0,003 |
| Intégrité de la recherche | 0,006 | 0,004 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,003 | 0,002 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».