Objective: The pterional approach (PA) has been used to remove cranio-orbital lesions that have communicated via the supraorbital fissure (SOF). The supraorbital eyebrow approach (SEA) has become increasingly popular as a minimally invasive approach. However, few reports have examined the SEA for cranio-orbital lesions. We assessed the relative advantages, disadvantages, and selection criteria for these 2 approaches.
Methods: The data from all consecutive patients who had undergone removal of a cranio-orbital lesion that communicated via the SOF using the PA or SEA were analyzed.
Results: Of the 25 patients, 13 had undergone surgical resection using the SEA and 12 had undergone resection using the PA. The SEA provided better cosmetic satisfaction, resulted in a shorter surgical time, and required a shorter incision (P < 0.05). Proptosis had improved significantly in all the patients. No significant differences were found in the total resection rates, visual outcomes, recovery of ptosis, or other new surgically related complications between the 2 groups (P > 0.05). All the patients were followed up for an average of 21.9 months. One patient in each group had developed recurrence or progression that required radiotherapy. The disease of the other patients with subtotal resection was stable or atrophic.
Conclusion: The SEA provided better cosmetic satisfaction, resulted in a shorter surgical time, and required a shorter incision. The SEA might be a more minimally invasive option for lesions communicating via the SOF without obvious hyperostosis. The PA might be more reasonable for lesions with obvious hyperostosis and more extensive lesions in the cavernous sinus.
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http://dx.doi.org/10.1016/j.wneu.2019.05.128 | DOI Listing |
Exp Ther Med
January 2025
Department of Radiation Oncology, University of Tsukuba, Tsukuba, Ibaraki 305-8576, Japan.
Oper Neurosurg (Hagerstown)
September 2024
Department of Neurosurgery, Faculty of Medicine, Cairo University, Cairo, Egypt.
Oper Neurosurg (Hagerstown)
September 2024
Semmes-Murphey Clinic, Memphis, Tennessee, USA.
Background And Objectives: Despite advances in cranial base techniques, surgery of the sellar and parasellar regions remains challenging because of complex neurovascular relationships. Lesions within this region frequently present with progressive visual deterioration caused by distortion and compression of the optic chiasm and nerves. In addition to the direct mass effect from mechanical forces acting on the optic apparatus, these lesions alter blood supply and reduce vascular perfusion, prompting surgical treatment to remove the lesion, alleviate compression, and improve blood flow to the optic nerve.
View Article and Find Full Text PDFOper Neurosurg (Hagerstown)
July 2024
Department of Neurosurgery, Emory University, Atlanta, Georgia, USA.
Background And Objectives: Traditional and well-established transcranial approaches to the spheno-orbital region and middle cranial fossa guarantee optimal intracranial exposure, and additional orbital and zygomatic osteotomies provide further control over extracranial components to be resected; however, these techniques come at the cost of additional morbidity. The introduction of minimally invasive endoscopic approaches and the conceptualization of the so-called "multiportal" paradigm might provide an alternative route. This preliminary study investigates the feasibility of the combined Biportal Endoscopic TransOrbital and transMaxillary Approach (bETOMA) approach to the spheno-orbital and middle cranial fossa regions.
View Article and Find Full Text PDFWorld Neurosurg
September 2024
Semmes-Murphey Clinic and Department of Neurosurgery, University of Tennessee, Memphis, Tennessee, USA. Electronic address:
The hypothalamic region is susceptible to involvement of several processes. Lesions in this region remain challenging for surgical access and treatment. Strategies include both endoscopic and microsurgical approaches.
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