Transorbital Neuroendoscopic Surgery

被引:195
作者
Moe, Kris S. [1 ]
Bergeron, Chris M. [2 ]
Ellenbogen, Richard G. [3 ]
机构
[1] Univ Washington, Med Ctr,Sch Med, Dept Otolaryngol Head & Neck Surg, Div Facial Plast & Reconstruct Surg, Seattle, WA 98195 USA
[2] Univ Calif San Diego, Sch Med, Dept Surg, Div Head & Neck Surg, San Diego, CA 92103 USA
[3] Univ Washington, Sch Med, Dept Neurol Surg, Seattle, WA 98195 USA
关键词
Anterior skull base; Anterior cranial fossa; Endoscopic; Middle cranial fossa; Minimally disruptive; Minimally invasive; Neuroendoscopic; Neuroendoscopy; Transblepharoplasty; Transorbital; Transpalpebral; Transconjunctival; SKULL BASE; TUMORS;
D O I
10.1227/01.NEU.0000373431.08464.43
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
BACKGROUND: Transorbital neuroendoscopic surgery (TONES) pathways attempt to address some of the technical challenges of accessing laterally placed anterior skull base lesions or paramedian lesions that cross neurovascular structures. TONES approaches allow simultaneous coplanar visualization and working space above and below the skull base. OBJECTIVE:To present an anatomic study, a description of the surgical techniques, and an analysis of the safety and efficacy of 20 consecutive procedures using TONES for a variety of pathological conditions. METHODS: Sixteen patients underwent 20 TONES procedures for anterior skull base pathology, including repair of cerebrospinal leak, optic nerve decompression, repair of cranial base fractures, and removal of 3 skull base tumors. Ten patients were male, and 6 were female. The mean age at presentation was 44 years. Follow-up was 6 to 18 months with a mean of 9 months. RESULTS: There were no significant complications or treatment failures in any of the 20 procedures. A variety of pathological conditions were treated, including cerebrospinal fluid leaks, fractures, mass lesions, and tumors. The TONES approach provided up to 4 separate access ports with ample exposure for manipulation and correction of the pathology. CONCLUSION: This anatomic and prospective outcome study demonstrates that TONES provides safe and effective coplanar endoscopic access to the anterior and middle cranial base. These novel TONES approaches may be added to the wide range of published minimally invasive armamentarium when approaching challenging skull base pathology.
引用
收藏
页码:16 / 28
页数:13
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