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J Neurol Surg B Skull Base
DOI: 10.1055/s-0044-1788645
Original Article

Microsurgical Lateral Orbital Approaches to Resect Tumors within the Cavernous Sinus, Middle Fossa, and Temporal Lobe: A Systematic Review

Molly Monsour
1   University of South Florida Morsani College of Medicine, Tampa, Florida, United States
,
Mehdi Rizk
1   University of South Florida Morsani College of Medicine, Tampa, Florida, United States
,
Mehdi Kazelka
1   University of South Florida Morsani College of Medicine, Tampa, Florida, United States
,
Ivo Peto
2   Department of Neurosurgery and Brain Repair, University of South Florida, Morsani College of Medicine, Tampa, Florida, United States
,
Alexander Tai
2   Department of Neurosurgery and Brain Repair, University of South Florida, Morsani College of Medicine, Tampa, Florida, United States
,
Siviero Agazzi
2   Department of Neurosurgery and Brain Repair, University of South Florida, Morsani College of Medicine, Tampa, Florida, United States
,
Davide M. Croci
2   Department of Neurosurgery and Brain Repair, University of South Florida, Morsani College of Medicine, Tampa, Florida, United States
3   Department of Neurosurgery, Lakeland Regional Health, Lakeland, Florida, United States
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Abstract

Introduction Common approaches to remove skull base tumors invading the orbital apex, cavernous sinus, middle fossa, or temporal lobe include orbitozygomatic or fronto-orbital craniotomies. Recently, different types of orbital approaches have been described as alternative minimally invasive techniques.

Objective With this systematic review, we analyzed the typology of intracranial tumors treated through transorbital approaches, especially through the lateral orbital (LO) wall, and analyzing the complication rates and outcomes.

Design A PubMed/Medline search was performed using the criteria: “orbitotomy,” “transorbital,” “transpalpebral,” and “lateral orbitotomy” in combination with “cavernous sinus,” “middle fossa,” and “temporal lobe.”

Main Outcome Measures From these reports, we collected diagnoses, lesion sizes and locations, approaches, outcomes, aesthetic outcomes, postoperative ptosis, postoperative cranial nerve (CN) palsies, length of CN deficits postoperatively, overall complications, and follow-up length.

Results A total of 13 papers and 3 of our own cases matched our inclusion criteria totaling 160 patients. Most patients were treated for meningiomas (135, 84.4%). The approaches included the LO approach (n = 54; 33.8%), deep transorbital (n = 5; 3.1%), mini-LO (n = 91; 56.9%), and modified LO (n = 10; 6.2%). While not all cases reported excision success, the various LO approaches achieved total (n = 42; 26.25%) resection margins. Postoperative ocular complications (including CN palsies, proptosis, or ocular disturbances) totaled 46 (28.8%) new CN palsies, 23 (14.4%) occurrences of vision loss, 1 (1.7%) with worsened proptosis, 5 (3.9%) with worsened enophthalmos, and 42 (26.3%) other complications.

Conclusion Microsurgical LO approaches, especially in the era of radiosurgery, may become a suitable alternative to other more established craniotomies.

Keywords

lateral orbitotomy - cavernous sinus - middle fossa - temporal lobe


Publication History

Received: 23 April 2024

Accepted: 03 July 2024

Article published online:
31 July 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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