• World Neurosurg · Jun 2023

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

    • Matteo Zoli, Giacomo Sollini, Arianna Rustici, Federica Guaraldi, Sofia Asioli, Maria Vittoria Altavilla, Agnese Orsatti, Marco Faustini-Fustini, Ernesto Pasquini, and Diego Mazzatenta.
    • 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.
    • World Neurosurg. 2023 Jun 16.

    BackgroundTransorbital 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 MethodsAll 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.ResultsOur 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.ConclusionsDespite 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.Copyright © 2023 Elsevier Inc. All rights reserved.

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