The feasibility and clinical outcome of endoscopic transorbital transcavernous approaches with or without petrosectomy for petroclival lesions.

IF 3.5 2区 医学 Q1 CLINICAL NEUROLOGY Journal of neurosurgery Pub Date : 2024-11-08 DOI:10.3171/2024.6.JNS232976
Doo-Sik Kong, Won Jae Lee, Gung Ju Kim, Chang-Ki Hong
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Abstract

Objective: Petroclival tumors such as petroclival meningiomas or trigeminal schwannomas extending to the posterior cranial fossa are challenging to treat due to their deep-seated location and proximity to critical neurovascular structures. This study aimed to evaluate the feasibility, safety, and clinical outcomes of endoscopic transorbital surgery for the resection of central skull base tumors involving the petroclival area.

Methods: The authors conducted a retrospective analysis of 32 patients with petroclival tumors including meningiomas and trigeminal schwannomas who underwent endoscopic transorbital surgery between September 2017 and December 2022. Preoperative clinical and radiological data were collected, and patients were followed up postoperatively for a median period of 34.7 months. Surgical technique, complications, and clinical outcomes were assessed.

Results: Endoscopic transorbital surgery provided a minimally invasive and direct corridor to the petroclival region. All 32 patients successfully underwent tumor resection, with gross-total or near-total tumor resection achieved in 28 patients. The mean tumor diameter was 3.5 cm. Based on tumor pathology, the endoscopic transorbital transcavernous trans-Meckel's cave approach (21 cases) or transorbital anterior transpetrosal approach (11 cases) was selected. The most common complication was facial paresthesia in 4 of 21 patients with trigeminal schwannomas and in 1 of 11 patients with petroclival meningiomas. Diplopia due to fourth cranial nerve injury occurred in 3 of 11 patients with petroclival meningiomas. Postoperative clinical improvement in neuralgic pain was observed in 3 of 4 patients. One patient developed a temporary facial palsy (House-Brackmann grade III) and another patient had transient paraparesis after removal of petroclival meningioma.

Conclusions: Endoscopic transorbital surgery appears to be a safe and effective technique for the resection of petroclival lesions, offering excellent visualization and access to the tumor while minimizing morbidity. However, further studies with larger patient cohorts and longer follow-up are warranted to validate the long-term efficacy and safety of this approach. This study contributes to the growing body of evidence supporting the utility of endoscopic transorbital techniques in skull base surgery.

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内窥镜下经眶经腔途径治疗瓣膜病变(带或不带瓣膜切除术)的可行性和临床效果。
目的:瓣膜肿瘤,如瓣膜脑膜瘤或延伸至后颅窝的三叉神经分裂瘤,由于其位置深且邻近重要的神经血管结构,治疗难度很大。本研究旨在评估经眶内镜手术切除涉及瓣膜区的中央颅底肿瘤的可行性、安全性和临床效果:作者对2017年9月至2022年12月期间接受内镜下经眶手术的32例瓣状肿瘤(包括脑膜瘤和三叉神经分裂瘤)患者进行了回顾性分析。我们收集了患者术前的临床和放射学数据,并对患者进行了中位 34.7 个月的术后随访。对手术技术、并发症和临床效果进行了评估:结果:内窥镜经眶手术提供了一条直达瓣膜区的微创通道。所有32名患者都成功接受了肿瘤切除术,其中28名患者实现了肿瘤全切或接近全切。肿瘤的平均直径为 3.5 厘米。根据肿瘤病理情况,选择了内镜下经眶经腔经梅克尔洞入路(21例)或经眶前经蝶入路(11例)。最常见的并发症是面部麻痹,21 例三叉神经片状瘤患者中有 4 例,11 例瓣状脑膜瘤患者中有 1 例。11例瓣状脑膜瘤患者中有3例因第四颅神经损伤导致复视。4 名患者中有 3 名术后神经痛临床症状有所改善。一名患者出现暂时性面瘫(House-Brackmann III级),另一名患者在切除瓣膜脑膜瘤后出现一过性偏瘫:结论:内窥镜经眶手术似乎是一种安全有效的瓣膜病变切除技术,可提供良好的可视性和肿瘤入路,同时将发病率降至最低。然而,要验证这种方法的长期疗效和安全性,还需要对更大的患者群体和更长时间的随访进行进一步研究。这项研究为越来越多的证据支持内窥镜经眶技术在颅底手术中的应用做出了贡献。
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来源期刊
Journal of neurosurgery
Journal of neurosurgery 医学-临床神经学
CiteScore
7.20
自引率
7.30%
发文量
1003
审稿时长
1 months
期刊介绍: The Journal of Neurosurgery, Journal of Neurosurgery: Spine, Journal of Neurosurgery: Pediatrics, and Neurosurgical Focus are devoted to the publication of original works relating primarily to neurosurgery, including studies in clinical neurophysiology, organic neurology, ophthalmology, radiology, pathology, and molecular biology. The Editors and Editorial Boards encourage submission of clinical and laboratory studies. Other manuscripts accepted for review include technical notes on instruments or equipment that are innovative or useful to clinicians and researchers in the field of neuroscience; papers describing unusual cases; manuscripts on historical persons or events related to neurosurgery; and in Neurosurgical Focus, occasional reviews. Letters to the Editor commenting on articles recently published in the Journal of Neurosurgery, Journal of Neurosurgery: Spine, and Journal of Neurosurgery: Pediatrics are welcome.
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