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Endoscopic Transorbital Approach to Mesial Temporal Lobe for Intra-Axial Lesions: Cadaveric Study and Case Series (SevEN-008)

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Abstract
BACKGROUND Endoscopic transorbital approach (ETOA) has been proposed as a minimally invasive technique for the treatment of skull base lesions located around mesial temporal lobe (MTL), mostly extra-axial pathology.

OBJECTIVE To explore the feasibility of ETOA in accessing intraparenchymal MTL with cadaveric specimens and describe our initial clinical experience of ETOA for intra-axial lesions in MTL.

METHODS Anatomic dissections were performed in 4 adult cadaveric heads using a 0 degrees endoscope. First, a stepwise anatomical investigation of ETOA to intraparenchymal MTL was explored. Then, ETOA was applied clinically for 7 patients with intra-axial lesions in MTL, predominantly high-grade gliomas (HGGs) and low-grade gliomas (LGGs).

RESULTS The extradural stage of ETOA entailed a superior eyelid incision followed by orbital retraction, drilling of orbital roof, greater and lesser wing of sphenoid bone, and cutting of the meningo-orbital band. For the intradural stage, the brain tissue medial to the occipito-temporal gyrus was aspirated until the temporal horn was opened. The structures of MTL could be aspirated selectively in a subpial manner without injury to the neurovascular structures of the ambient and sylvian cisterns, and the lateral neocortex. After cadaveric validation, ETOA was successfully performed for 4 patients with HGGs and 3 patients with LGGs. Gross total resection was achieved in 6 patients (85.7%) without significant surgical morbidities including visual field deficits.

CONCLUSION ETOA provides a logical line of access for intra-axial lesions in MTL. The safe and natural surgical trajectory of ETOA can spare brain retraction, neurovascular injury, and disruption of the lateral neocortex.
Author(s)
박현호노태훈최선아유지환김우현정인호윤인식홍창기
Issued Date
2021
Type
Article
Keyword
Cadaveric studyCase SeriesEndoscopic transorbital approachIntra-axialtemporal lobe
DOI
10.1093/ons/opab319
URI
https://oak.ulsan.ac.kr/handle/2021.oak/7637
https://ulsan-primo.hosted.exlibrisgroup.com/primo-explore/search?query=any,contains,Endoscopic%20Transorbital%20Approach%20to%20Mesial%20Temporal%20Lobe%20for%20Intra-Axial%20Lesions:%20Cadaveric%20Study%20and%20Case%20Series%20(SevEN-008)&tab=default_tab&search_scope=default_scope&vid=ULSAN&lang=ko_KR&offset=0&pcAvailability=true&fromRedirectFilter=true
Publisher
OPERATIVE NEUROSURGERY
Location
미국
Language
영어
ISSN
2332-4252
Citation Volume
21
Citation Number
6
Citation Start Page
506
Citation End Page
515
Appears in Collections:
Medicine > Medicine
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