The transconjunctival transorbital approach: A keyhole approach to the midline anterior skull base

Shaan M. Raza, Alfredo Quinones-Hinojosa, Michael Lim, Kofi D. Owusu Boahene

Research output: Contribution to journalReview article

14 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)864-871
Number of pages8
JournalWorld Neurosurgery
Volume80
Issue number6
DOIs
StatePublished - Dec 2013
Externally publishedYes

Fingerprint

Skull Base
Craniotomy
Anterior Cranial Fossa
Olfactory Esthesioneuroblastoma
Angiofibroma
Pathology
Diplopia
Dissection
Length of Stay
Hospitalization
Neck
Head
Recurrence

Keywords

  • Anterior cranial fossa
  • Keyhole craniotomy
  • Transconjunctival
  • Transorbital

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

The transconjunctival transorbital approach : A keyhole approach to the midline anterior skull base. / Raza, Shaan M.; Quinones-Hinojosa, Alfredo; Lim, Michael; Owusu Boahene, Kofi D.

In: World Neurosurgery, Vol. 80, No. 6, 12.2013, p. 864-871.

Research output: Contribution to journalReview article

Raza, Shaan M. ; Quinones-Hinojosa, Alfredo ; Lim, Michael ; Owusu Boahene, Kofi D. / The transconjunctival transorbital approach : A keyhole approach to the midline anterior skull base. In: World Neurosurgery. 2013 ; Vol. 80, No. 6. pp. 864-871.
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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.

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KW - Keyhole craniotomy

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