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Journal of Neurosurgical Sciences 2021 Aug 03

DOI: 10.23736/S0390-5616.21.05401-1


language: English

Combined endoscopic endonasal and transorbital approach to skull base tumors: a systematic literature review

Alberto DI SOMMA 1, Giulia GUIZZARDI 2 , Clàudia VALLS CUSINÉ 1, Jhon HOYOS 1, Abel FERRES 1, Thomaz E. TOPCZEWSKI 1, Alejandra MOSTEIRO 1, Andrea DE ROSA 2, Domenico SOLARI 2, Luigi M. CAVALLO 2, Luis REYES 1, Joaquim ENSEÑAT 1

1 Departments of Neurological Surgery, Hospital Clínic de Barcelona, Barcelona, Spain; 2 Division of Neurosurgery, Department of Neuroscience, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli Federico II, Naples, Italy

INTRODUCTION: In the last decades, there has been a marked evolution in skull base surgery techniques and more recently a combination of different corridors has been proposed and used in order to improve angles of attack, shorten working distances, and ameliorate visualization of skull base lesions. Recently, the endoscopic endonasal and transorbital routes have been combined as multiportal approach to reach and treat complex skull base neoplasms. The aim of this paper is to examine data extracted from the recent literature about the feasibility and effectiveness of combined endonasal and transorbital endoscopic multiportal surgery.
EVIDENCE ACQUISITION: A PubMed comprehensive search of literature published until October 2020 was conducted. Nine studies, regarding 24 patients, were included.
EVIDENCE SYNTHESIS: The majority of tumors were meningiomas (62,5%), mostly located at the spheno-orbital region (93,3%). GTR was accomplished in 10 patients (41,7%), NTR in 2 patients (8,3%). Endonasal transpterygoid approach (n = 8) and superior eyelid access (n = 17) were the most used routes used. No case of CSF fistula was observed, and the most common complication was a transient periorbital edema. The average hospitalization time (days) was 5 days.
CONCLUSIONS: A combined endoscopic endonasal and transorbital multiportal approach grants an adequate corridor to access several skull base tumors, such as those extending towards the paramedian aspects, providing good outcomes in terms of extent of tumor resection with acceptable rates of complications. These preliminary results might encourage the use of multiportal approaches in selected complex skull base neoplasms.

KEY WORDS: Endoscopic endonasal; Endoscopic transorbital; Skull base surgery; Multiportal surgery; Combined approach

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