TY - JOUR
T1 - The transconjunctival transorbital approach
T2 - A keyhole approach to the midline anterior skull base
AU - Raza, Shaan M.
AU - Quinones-Hinojosa, Alfredo
AU - Lim, Michael
AU - Owusu Boahene, Kofi D.
PY - 2013/12
Y1 - 2013/12
N2 - Objective: To report an initial experience with a medial transorbital approach to the midline skull base performed via a transconjunctival incision. Methods: The authors retrospectively reviewed their clinical experience with this approach in the management of benign cranial base pathology. Preoperative imaging, intraoperative records, hospitalization charts, and postoperative records were reviewed for relevant data. Results: During the period 2009-2011, six patients underwent a transconjunctival craniotomy performed by a neurosurgeon and otolaryngologist-head and neck surgeon working together. The indications for surgery were esthesioneuroblastoma in one patient, juvenile angiofibroma in one patient, Paget disease in one patient, and recalcitrant cerebrospinal fluid leaks in three patients. Three patients had prior cranial base surgery (either open craniotomy or an endonasal approach) done at another institution. The mean length of stay was 3.8 days; mean follow-up was 6 months. Surgery was considered successful in all cases (negative margins or no leak recurrence); diplopia was noted in one patient postoperatively. Conclusions: The transconjunctival medial orbital craniectomy provides a minimally invasive keyhole approach to lesions located anteriorly along the anterior cranial fossa that are in the midline with lateral extension over the orbital roof. Based on our initial experience with this technique, the working space afforded limits complex surgical dissection; this approach is primarily well suited for less extensive pathology.
AB - Objective: To report an initial experience with a medial transorbital approach to the midline skull base performed via a transconjunctival incision. Methods: The authors retrospectively reviewed their clinical experience with this approach in the management of benign cranial base pathology. Preoperative imaging, intraoperative records, hospitalization charts, and postoperative records were reviewed for relevant data. Results: During the period 2009-2011, six patients underwent a transconjunctival craniotomy performed by a neurosurgeon and otolaryngologist-head and neck surgeon working together. The indications for surgery were esthesioneuroblastoma in one patient, juvenile angiofibroma in one patient, Paget disease in one patient, and recalcitrant cerebrospinal fluid leaks in three patients. Three patients had prior cranial base surgery (either open craniotomy or an endonasal approach) done at another institution. The mean length of stay was 3.8 days; mean follow-up was 6 months. Surgery was considered successful in all cases (negative margins or no leak recurrence); diplopia was noted in one patient postoperatively. Conclusions: The transconjunctival medial orbital craniectomy provides a minimally invasive keyhole approach to lesions located anteriorly along the anterior cranial fossa that are in the midline with lateral extension over the orbital roof. Based on our initial experience with this technique, the working space afforded limits complex surgical dissection; this approach is primarily well suited for less extensive pathology.
KW - Anterior cranial fossa
KW - Keyhole craniotomy
KW - Transconjunctival
KW - Transorbital
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U2 - 10.1016/j.wneu.2012.06.027
DO - 10.1016/j.wneu.2012.06.027
M3 - Review article
C2 - 22722037
AN - SCOPUS:84889680094
SN - 1878-8750
VL - 80
SP - 864
EP - 871
JO - World neurosurgery
JF - World neurosurgery
IS - 6
ER -