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Endoscopic Transorbital Approach to Mesial Temporal Lobe for Intra-Axial Lesions: Cadaveric Study and Case Series (SevEN-008)

 Hun Ho Park  ;  Tae Hoon Roh  ;  Seonah Choi  ;  Jihwan Yoo  ;  Woo Hyun Kim  ;  In-Ho Jung  ;  In-Sik Yun  ;  Chang-Ki Hong 
 OPERATIVE NEUROSURGERY, Vol.21(6) : E506-E515, 2021-11 
Journal Title
Issue Date
Cadaveric study ; Case series ; Endoscopic transorbital approach ; Intra-axial ; Mesial temporal lobe
Background: Endoscopic transorbital approach (ETOA) has been proposed as a minimally invasive technique for the treatment of skull base lesions located around mesial temporal lobe (MTL), mostly extra-axial pathology.

Objective: To explore the feasibility of ETOA in accessing intraparenchymal MTL with cadaveric specimens and describe our initial clinical experience of ETOA for intra-axial lesions in MTL.

Methods: Anatomic dissections were performed in 4 adult cadaveric heads using a 0° endoscope. First, a stepwise anatomical investigation of ETOA to intraparenchymal MTL was explored. Then, ETOA was applied clinically for 7 patients with intra-axial lesions in MTL, predominantly high-grade gliomas (HGGs) and low-grade gliomas (LGGs).

Results: The extradural stage of ETOA entailed a superior eyelid incision followed by orbital retraction, drilling of orbital roof, greater and lesser wing of sphenoid bone, and cutting of the meningo-orbital band. For the intradural stage, the brain tissue medial to the occipito-temporal gyrus was aspirated until the temporal horn was opened. The structures of MTL could be aspirated selectively in a subpial manner without injury to the neurovascular structures of the ambient and sylvian cisterns, and the lateral neocortex. After cadaveric validation, ETOA was successfully performed for 4 patients with HGGs and 3 patients with LGGs. Gross total resection was achieved in 6 patients (85.7%) without significant surgical morbidities including visual field deficits.

Conclusion: ETOA provides a logical line of access for intra-axial lesions in MTL. The safe and natural surgical trajectory of ETOA can spare brain retraction, neurovascular injury, and disruption of the lateral neocortex.
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Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Neurosurgery (신경외과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Plastic and Reconstructive Surgery (성형외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Woohyun(김우현) ORCID logo https://orcid.org/0000-0002-2936-3740
Park, Hun Ho(박현호) ORCID logo https://orcid.org/0000-0002-2526-9693
Yoo, Jihwan(유지환)
Yun, In Sik(윤인식) ORCID logo https://orcid.org/0000-0003-1103-7047
Jung, In-Ho(정인호)
Choi, Seonah(최선아)
Hong, Chang Ki(홍창기) ORCID logo https://orcid.org/0000-0002-2761-0373
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