Abstract Listings 2024

Purpose

To present a case series of two patients who underwent different neuroendoscopic procedures using a transorbital approach and cadaveric study designed to replace the traditional subtemporal and pretemporal approaches.

Methods

A combined orbital approach, using endoscopy and a navigation system were employed in three different procedures carried out by a multi-disciplinary team comprised of neurosurgery, ENT, and oculoplastic surgery. These procedures were:1.Cavernous sinus lesion biopsy in a 46-year-old female.2.Spheno-orbital en-plaque meningioma in a involving the optic canal in a 73-year-old female.3.Cadaveric study aimed to expand the surgical field-of-view and access the anterior petrous ridge and posterior fossa via a minimally invasive transorbital approach.

Results

Procedures were carried out successfully with no intra-operative or post-operative complications. Visual acuity before surgery was 0.0 logMAR in both patients with no post-operative change. Patients had excellent cosmetic results and were spared a standard coronal approach. Cadaveric anterior petrous ridge and posterior fossa approach offers an unobstructed ventral-to-dorsal view of the anterior petrous ridge and posterior fossa.

Conclusion

Open approach surgery was historically the standard of care for similar cases. Our case series and cadaveric study demonstrates the use of an endoscope that enables sufficient visualization and illumination to allow removal of large tumors through small incisions. It is considered safe and effective in most cases, with reduced morbidity and loss of sight, thus limiting the remaining indications for open surgery. Our experience with transorbital endoscopic approach suggests a safe and efficient surgical technique for various neurosurgical conditions. Collaboration with ENT endoscopic and neuro surgeons in complicated orbital surgeries is crucial to provide optimal care for patients.

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