Neurosurgical focus: Video最新文献

Recurrent craniopharyngiomas represent a complex neurosurgical challenge. These histologically benign lesions show aggressive behavior that frequently recurs. The aim in treatment is to achieve an optimal balance between local control and quality of life. However, no agreement on the management of recurrent cases exists. Different surgical strategies are utilized for the management of these lesions using transcranial or endoscopic approaches. The authors present the case of a 38-year-old man with a large recurrent craniopharyngioma, previously treated with several endonasal interventions, responsible for headaches and unsteady gait. The recurrent cystic portion of the tumor, invading the pons, was treated using an endoscopic transorbital approach. The video can be found here: https://stream.cadmore.media/r10.3171/2025.1.FOCVID24177.

A parapharyngeal space (PPS) tumor is a rare head and neck tumor. The choice of approach depends on the location, pathology, extent of invasion, and relationship with surrounding neurovascular structures. In this video, a PPS tumor was resected using a triportal approach: endoscopic transorbital, robotic transoral, and endoscopic transnasal surgery. Neurosurgeons, otorhinolaryngologists, and ophthalmologists jointly performed the operation. The pathology was a liposarcoma in the right upper parapharyngeal space, abutting the internal carotid artery. Postoperative endoscopy, MRI, and PET-CT showed no recurrence. The triportal approach is a novel technique in improving the exposure and multiangular dissection of PPS tumors with optimal protection to surrounding neurovascular structures. The video can be found here: https://stream.cadmore.media/r10.3171/2025.1.FOCVID24167.

CSF leaks due to anterior skull base defects, particularly those involving the posterior wall of the frontal sinus, are complex and often require surgical intervention. The endoscopic transorbital approach provides a direct, minimally invasive method with enhanced access and improved working angles. The authors present a video of a 41-year-old female with a spontaneous CSF leak and frontal sinus encephalocele who underwent endoscopic transorbital repair. This approach effectively controlled the defect, resulting in the resolution of the CSF leak with no recurrence at 1-year follow-up. The endoscopic transorbital approach is a reliable surgical option for these challenging cases. The video can be found here: https://stream.cadmore.media/r10.3171/2025.1.FOCVID24153.

In recent years, endoscopic transorbital approaches have found wider applications and more indications. Their use has been described for resection of epileptogenic pathology in the adult population and for lesions located at the temporal lobe. In this video, the authors describe the case of a 47-year-old woman with a 9-month history of episodes of confusion, altered spatiotemporal awareness, and dizziness, only partially responding to antiepileptic drugs. MRI showed a temporomesial cavernous hemangioma. Endoscopic transorbital resection through a modified superior eyelid approach is shown. Radical resection was obtained without any postoperative complications, and an optimal cosmetic outcome was achieved. The video can be found here: https://stream.cadmore.media/r10.3171/2025.1.FOCVID24183.

The endoscopic transorbital approach (ETOA) is a minimally invasive technique that provides direct access to the mesial temporal lobe while avoiding brain retraction, preserving the lateral temporal neocortex, and minimizing the risk of damage to the optic radiations. In this video, the authors demonstrate an extended ETOA with lateral orbitotomy for the resection of a mesial temporal lobe glioma, emphasizing its utility along the long axis of the amygdala-hippocampal complex. This video is intended to serve as a practical guide for accessing the mesial temporal lobe through the extended transorbital corridor. The video can be found here: https://stream.cadmore.media/r10.3171/2025.1.FOCVID24189.

The transorbital approach has emerged as a minimally invasive technique in neurosurgery. The authors present the case of a meningioma of the lateral wall of the cavernous sinus treated with a transorbital eyebrow lacrimal keyhole approach (TELKA) in a 64-year-old man with partial seizures. By removing the lip of the superolateral orbital rim, the so-called lacrimal keyhole, via an eyebrow incision, optimal microscopic and endoscopic visualization and maneuverability were achieved, avoiding dangerous ocular globe retraction. Together with the chopstick technique using angled endoscopes and malleable rotative suction, TELKA allowed a safe and effective resection minimizing soft tissue dissection, brain manipulation, and ocular retraction. The video can be found here: https://stream.cadmore.media/r10.3171/2025.1.FOCVID24190.

The lateral transorbital approach (LTOA) is useful for lesions situated in the middle fossa, adjacent to the lateral wall of the cavernous sinus, as it minimizes brain retraction and provides an extradural corridor. In this video, the authors present the case of a 35-year-old male, complaining of headache and diplopia. MRI revealed a dural-based middle fossa lesion adjacent to the lateral wall of the cavernous sinus. An endoscopic LTOA was performed through a superior eyelid incision. Postoperative MRI showed minimal residual enhancement, and histopathological analysis reported a grade III anaplastic meningioma. The patient was discharged after 48 hours without a new neurological deficit. The video can be found here: https://stream.cadmore.media/r10.3171/2025.1.FOCVID24176.

This video presents the transorbital endoscopic resection of a Meckel's cave lesion, initially suspected as a trigeminal schwannoma. A 35-year-old woman with trigeminal hypoesthesia, pain, and gait instability underwent near-total tumor removal, with a transient cranial nerve III deficit that resolved completely. Histopathology identified the tumor as a hybrid benign lesion (trigeminal schwannoma/neurofibroma, WHO grade I). This minimally invasive technique offers effective tumor resection while preserving neurological function, making it a valuable option for select patients. Postoperative follow-up was recommended for ongoing assessment and care. The video can be found here: https://stream.cadmore.media/r10.3171/2025.1.FOCVID24164.

The transorbital craniotomy represents a minimally invasive approach to the mesial structures of the middle fossa. This video depicts the approach to the lateral sphenoid recess in a patient with CSF rhinorrhea secondary to a lateral sphenoid encephalocele. The transorbital approach represents a unique advantage to repairing the lateral sphenoid sinus in comparison to the endoscopic endonasal approach, which requires traversing, and often transecting, the vidian nerve. Following identification of the skull base defect, repair is performed as an underlay with an abdominal fat graft. Following surgery, the patient had no recurrent rhinorrhea. The video can be found here: https://stream.cadmore.media/r10.3171/2025.1.FOCVID24207.

This surgical video demonstrates the case of a 38-year-old male with recurrent inverted papilloma involving the lamina papyracea and frontal sinus outflow tract. The frontal sinus was diminutive on the side of the tumor, and as such a combined endoscopic endonasal with endoscopic transorbital via transcaruncular route was advised for resection of the anterolateral tumor and contralateral margin. After endonasal resection, a transorbital approach was utilized to traverse the lamina papyracea from lateral to medial and resect tumor along the ethmoid roof and posterior table of the frontal sinus. The video can be found here: https://stream.cadmore.media/r10.3171/2025.1.FOCVID24201.