[Biopsy and resection of skull base tumors using transorbital endoscopic approaches: primary results]

Autor: N. N. Grigorieva, Cherekaev Va, S. N. Mindlin, Maxim Kutin, N K Serova, Imaev Aa, Gol'bin Da, Lasunin Nv
Rok vydání: 2019
Předmět:
Zdroj: Zhurnal voprosy neirokhirurgii imeni N. N. Burdenko. 83(3)
ISSN: 0042-8817
Popis: Transorbital neuroendoscopic surgery is a new skull base surgery technique that uses the orbit as an artificial corridor to the anterior and middle skull base. The space is created between the periorbita and orbital walls by their additional resection and gentle traction of the orbital contents. Skull base structures are reached using cosmetic incisions. The major advantages of transorbital endoscopic approaches include their variety, possibility of their combination, and access to the central and lateral skull base lesions. The aim of this study was to analyze the primary results of transorbital endoscopic biopsy and resection of skull base lesions, which were performed at the N.N. Burdenko National Medical Research Center for Neurosurgery (Moscow, Russia).In 2017-2018, the authors operated on 12 patients with skull base lesions using transorbital endoscopic approaches. The series included ten female and two male patients. The patient's age varied between 24 and 78 years. All patients were admitted for the first time. Half of them underwent biopsy, while the other half underwent tumor resection. The upper-lateral transorbital approach with an eyebrow incision was used in most (8/12) patients; the retrocaruncular approach was used in two cases; the lateral retrocanthal approach was applied in one case; the upper-medial approach with an eyebrow incision was used in one patient.The histological diagnosis was established in all six biopsies: 3 pseudotumors, 2 WHO Grade I meningiomas, and 1 clear-cell kidney cancer. Tumor resection was successful in 5 out of 6 patients; repeated surgery was required in one patient. In one case, the transorbital approach was combined with the transnasal one for treatment of supraorbital mucocele. One patient developed a persistent neurological deficit (dysfunction of the fifth and sixth nerves) after upper-lateral transorbital surgery. There were no poor cosmetic results in the series.Transorbital neuroendoscopic surgery needs an interdisciplinary approach and a sufficient amount of surgical experience. Surgical skills setting includes microsurgical and endoscopic tumor resection, harvesting and positioning of free and vascularized grafts for skull base reconstruction and prevention of postoperative enophthalmos, and facial incisions and their cosmetic closure. Implementation of new local vascularized flaps may significantly improve the results of transorbital endoscopic procedures and extend the spectrum of indications.Трансорбитальная эндоскопическая хирургия основания черепа - это новое направление минимально инвазивной нейрохирургии, которое предполагает использование глазницы как искусственного хирургического коридора для подхода к передним и средним отделам основания черепа за счет создания пространства между надкостницей глазницы и ее стенками, тракции содержимого глазницы, резекции костных структур, отделяющих ее от полости черепа, и экономных местных разрезов. Наиболее существенными достоинствами трансорбитальных доступов являются их разнообразие и возможность подхода как к срединным, так и латеральным структурам основания черепа, причем и наружного, и внутреннего. Цель исследования - анализ первых результатов применения трансорбитальных эндоскопических доступов в ФГАУ 'НМИЦ нейрохирургии им. акад. Н.Н. Бурденко' Минздрава России для биопсии и удаления новообразований основания черепа. Материал и методы. В 2017-2018 гг. авторами были прооперированы 12 пациентов (10 женщин и 2 мужчины, возраст варьировал от 24 до 78 лет) с новообразованиями основания черепа с использованием трансорбитальных эндоскопических доступов. Все пациенты были первичными. В
Databáze: OpenAIRE
Externí odkaz: