• World Neurosurg · Aug 2023

    Review

    ENDOSCOPIC TRANSORBITAL APPROACH FOR THE MANAGEMENT OF SPHENO-ORBITAL MENINGIOMAS: LITERATURE REVIEW AND PRELIMINARY EXPERIENCE.

    • Alberto Di Somma, Andrea De Rosa, Abel Ferrés, Alejandra Mosteiro, Giulia Guizzardi, Jessica Matas Fassi, Thomaz E Topczewski, Luis Reyes, Pedro Roldán, Ramon Torné, Isam Alobid, and Joaquim Enseñat.
    • Institut Clínic de Neurociències, Department of Neurological Surgery, Hospital Clínic de Barcelona, Universidad de Barcelona, Barcelona, Spain.
    • World Neurosurg. 2023 Aug 1; 176: 435943-59.

    ObjectiveThe endoscopic transorbital approach (ETOA) is a minimally invasive approach that could be particularly appropriate for management of spheno-orbital meningiomas. The aim of this study was to perform a systematic review of the literature on the management of spheno-orbital meningiomas via the minimally invasive ETOA, searching for clinical scenarios in which this approach could be best indicated. A secondary aim was to describe 4 illustrative cases.MethodsA systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Data including patient demographics, tumor features, and surgical and postoperative outcomes were collected. Cases from our initial experience with ETOA were included in the data.ResultsData of 58 patients from 9 selected records and from our surgical series were collected. Subtotal, near-total, and gross total resection rates were 44.8%, 10.3%, and 32.7%, respectively. Symptom improvement after surgery was 100% for proptosis, 93% for visual impairment, and 87% for ophthalmoplegia. The most common postoperative complications were transient ophthalmoplegia and maxillary nerve hypoesthesia. Cerebrospinal fluid leak was reported in 2 patients.ConclusionsOur findings support the use of the ETOA for management of spheno-orbital meningiomas, particularly in at least 3 clinical scenarios: 1) when predominant hyperostotic bone is present; 2) when a globular tumor not showing excessive medial or inferior infiltration is being treated; 3) as part of a multistage treatment for diffuse lesions.Copyright © 2023 Elsevier Inc. All rights reserved.

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