Endoscopic Transorbital Approach for Spheno-Orbital Tumors: Case Series and Systematic Review of Literature.

Endoscopy Meningioma Radiotherapy Spheno-orbital tumors Surgery Transorbital approach

Journal

World neurosurgery
ISSN: 1878-8769
Titre abrégé: World Neurosurg
Pays: United States
ID NLM: 101528275

Informations de publication

Date de publication:
16 Jun 2023
Historique:
received: 17 04 2023
accepted: 09 06 2023
pubmed: 19 6 2023
medline: 19 6 2023
entrez: 18 6 2023
Statut: aheadofprint

Résumé

Transorbital neuroendoscopic surgery (TONES) comprises a group of approaches with indications expanding from orbital tumors to more complex skull base lesions. We analyzed the role of the endoscopic transorbital approach (eTOA) for spheno-orbital tumors, reporting the results of our clinical series and of a systematic review of the literature. All patients operated on from 2016 to 2022 at our institution for a spheno-orbital tumor through an eTOA were included in a clinical series, and a systematic review of the literature was performed. Our series consisted of 22 patients (16 females, mean age 57 ± 13 years). Gross tumor removal was achieved in 8 patients (36.4%) after the eTOA and in 11 (50.0%) after a multistaged strategy combining the eTOA with the endoscopic endonasal approach. Complications included 1 chronic subdural hematoma and 1 permanent extrinsic ocular muscle deficit. Patients were discharged after 2.4 ± 1.3 days. The most common histotype was meningioma (86.4%). Proptosis improved in all cases, visual deficit in 66.6%, and diplopia in 76.9%. These results were confirmed by the review of the 127 cases reported in the literature. Despite its recent introduction, a significant number of spheno-orbital lesions treated with an eTOA are being reported. Its main advantages are favorable patient outcome and optimal cosmetic results, with minimal morbidity and quick recovery. This approach can be combined with other surgical routes or adjuvant therapies for complex tumors. However, it is a technically demanding procedure, requiring specific skills in endoscopic surgery, that should be reserved to dedicated centers.

Sections du résumé

BACKGROUND BACKGROUND
Transorbital neuroendoscopic surgery (TONES) comprises a group of approaches with indications expanding from orbital tumors to more complex skull base lesions. We analyzed the role of the endoscopic transorbital approach (eTOA) for spheno-orbital tumors, reporting the results of our clinical series and of a systematic review of the literature.
MATERIALS AND METHODS METHODS
All patients operated on from 2016 to 2022 at our institution for a spheno-orbital tumor through an eTOA were included in a clinical series, and a systematic review of the literature was performed.
RESULTS RESULTS
Our series consisted of 22 patients (16 females, mean age 57 ± 13 years). Gross tumor removal was achieved in 8 patients (36.4%) after the eTOA and in 11 (50.0%) after a multistaged strategy combining the eTOA with the endoscopic endonasal approach. Complications included 1 chronic subdural hematoma and 1 permanent extrinsic ocular muscle deficit. Patients were discharged after 2.4 ± 1.3 days. The most common histotype was meningioma (86.4%). Proptosis improved in all cases, visual deficit in 66.6%, and diplopia in 76.9%. These results were confirmed by the review of the 127 cases reported in the literature.
CONCLUSIONS CONCLUSIONS
Despite its recent introduction, a significant number of spheno-orbital lesions treated with an eTOA are being reported. Its main advantages are favorable patient outcome and optimal cosmetic results, with minimal morbidity and quick recovery. This approach can be combined with other surgical routes or adjuvant therapies for complex tumors. However, it is a technically demanding procedure, requiring specific skills in endoscopic surgery, that should be reserved to dedicated centers.

Identifiants

DOI: 10.1016/j.wneu.2023.06.026 PMID: 37331478
pubmed: 37331478
pii: S1878-8750(23)00797-0
doi: 10.1016/j.wneu.2023.06.026
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Informations de copyright

Copyright © 2023 Elsevier Inc. All rights reserved.

Auteurs

Matteo Zoli (M)

IRCCS Istituto delle Scienze Neurologiche di Bologna, Programma Neurochirurgia Ipofisi- Pituitary Unit, Bologna, Italy; Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy. Electronic address: matteo.zoli4@unibo.it.

Giacomo Sollini (G)

ENT Unit, Azienda USL di Bologna, Bellaria Hospital, Bologna, Italy.

Arianna Rustici (A)

IRCCS Istituto delle Scienze Neurologiche di Bologna, Programma Neuroimmagini Funzionali e Molecolari, Bologna, Italy; Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy.

Federica Guaraldi (F)

IRCCS Istituto delle Scienze Neurologiche di Bologna, Programma Neurochirurgia Ipofisi- Pituitary Unit, Bologna, Italy.

Sofia Asioli (S)

IRCCS Istituto delle Scienze Neurologiche di Bologna, Anatomic Pathology Unit, Bologna, Italy; Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy.

Maria Vittoria Altavilla (MV)

School of Anatomic Pathology, Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.

Agnese Orsatti (A)

School of Anatomic Pathology, Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.

Marco Faustini-Fustini (M)

IRCCS Istituto delle Scienze Neurologiche di Bologna, Programma Neurochirurgia Ipofisi- Pituitary Unit, Bologna, Italy.

Ernesto Pasquini (E)

ENT Unit, Azienda USL di Bologna, Bellaria Hospital, Bologna, Italy.

Diego Mazzatenta (D)

IRCCS Istituto delle Scienze Neurologiche di Bologna, Programma Neurochirurgia Ipofisi- Pituitary Unit, Bologna, Italy; Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy.

Classifications MeSH