The Transcaruncular Corridor of the Medial Transorbital Approach to the Frontal Lobe: Technical Nuances and Applications.
Journal
Operative neurosurgery (Hagerstown, Md.)
ISSN: 2332-4260
Titre abrégé: Oper Neurosurg (Hagerstown)
Pays: United States
ID NLM: 101635417
Informations de publication
Date de publication:
01 06 2023
01 06 2023
Historique:
received:
17
08
2022
accepted:
13
12
2022
medline:
17
5
2023
pubmed:
14
3
2023
entrez:
13
3
2023
Statut:
ppublish
Résumé
Medial orbital access through a transcaruncular corridor has yet to be fully characterized as a potential approach to intradural lesions within the skull base. Transorbital approaches present unique potential in the management of complex neurological pathologies and require subspecialty collaboration across multiple disciplines. A 62-year-old man presented with progressive confusion and mild left-sided weakness. He was found to have a right frontal lobe mass with significant vasogenic edema. A comprehensive systemic workup was otherwise unremarkable. A multidisciplinary skull base tumor board conference recommended a medial transorbital approach through transcaruncular corridor, which was performed by neurosurgery and oculoplastics services. Postoperative imaging demonstrated gross total resection of the right frontal lobe mass. Histopathologic evaluation was consistent with amelanotic melanoma with BRAF (V600E) mutation. At his last follow-up visit, 3 months after surgery, the patient did not experience any visual symptoms and had an excellent cosmetic outcome after surgery. The transcaruncular corridor through a medial transorbital approach provides a safe and reliable access to the anterior cranial fossa.
Sections du résumé
BACKGROUND AND IMPORTANCE
Medial orbital access through a transcaruncular corridor has yet to be fully characterized as a potential approach to intradural lesions within the skull base. Transorbital approaches present unique potential in the management of complex neurological pathologies and require subspecialty collaboration across multiple disciplines.
CLINICAL PRESENTATION
A 62-year-old man presented with progressive confusion and mild left-sided weakness. He was found to have a right frontal lobe mass with significant vasogenic edema. A comprehensive systemic workup was otherwise unremarkable. A multidisciplinary skull base tumor board conference recommended a medial transorbital approach through transcaruncular corridor, which was performed by neurosurgery and oculoplastics services. Postoperative imaging demonstrated gross total resection of the right frontal lobe mass. Histopathologic evaluation was consistent with amelanotic melanoma with BRAF (V600E) mutation. At his last follow-up visit, 3 months after surgery, the patient did not experience any visual symptoms and had an excellent cosmetic outcome after surgery.
CONCLUSION
The transcaruncular corridor through a medial transorbital approach provides a safe and reliable access to the anterior cranial fossa.
Identifiants
pubmed: 36912518
doi: 10.1227/ons.0000000000000658
pii: 01787389-202306000-00036
doi:
Types de publication
Case Reports
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e458-e462Informations de copyright
Copyright © Congress of Neurological Surgeons 2023. All rights reserved.
Références
Moe KS, Bergeron CM, Ellenbogen RG. Transorbital neuroendoscopic surgery. Oper Neurosurg. 2010;67(3):ons16-28.
Miller C, Bly R, Moe KS. Endoscopic orbital and periorbital approaches in minimally disruptive skull base surgery. J Neurol Surg B Skull Base. 2020;81(04):459-471.
Stefko ST. Combined surgical approaches in and around the orbit. J Neurol Surg B Skull Base. 2020;81(04):472-479.
Ciporen JN, Moe KS, Ramanathan D, et al. Multiportal endoscopic approaches to the central skull base: a cadaveric study. World Neurosurg. 2010;73(6):705-712.
Abou-Al-Shaar H, Krisht KM, Cohen MA, et al. Cranio-orbital and orbitocranial approaches to orbital and intracranial disease: eye-opening approaches for neurosurgeons. Front Surg. 2020;7:1.
Linzey JR, Wilson TJ, Sullivan SE, Thompson BG, Pandey AS. Frontal sinus breach during routine frontal craniotomy significantly increases risk of surgical site infection: 10-year retrospective analysis. Neurosurgery. 2017;81(3):504-511.
Dasenbrock HH, Liu KX, Devine CA, et al. Length of hospital stay after craniotomy for tumor: a National Surgical Quality Improvement Program analysis. Neurosurg Focus. 2015;39(6):e12.
Kassam AB, Prevedello DM, Carrau RL, et al. Endoscopic endonasal skull base surgery: analysis of complications in the authors’ initial 800 patients. J Neurosurg. 2011;114(6):1544-1568.
Hardesty DA, Montaser A, Kreatsoulas D, et al. Complications after 1002 endoscopic endonasal approach procedures at a single center: lessons learned, 2010-2018. J Neurosurg. 2022;136(2):393-404.
Ramakrishna R, Kim LJ, Bly RA, Moe K, Ferreira MJ. Transorbital neuroendoscopic surgery for the treatment of skull base lesions. J Clin Neurosci. 2016;24:99-104.
Borghei-Razavi H, Truong HQ, Fernandes-Cabral DT, et al. Minimally invasive approaches for anterior skull base meningiomas: supraorbital eyebrow, endoscopic endonasal, or a combination of both? Anatomic study, limitations, and surgical application. World Neurosurg. 2018;112:e666-674.