1Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul.
2Department of Neurosurgery, Asan Medical Center, Ulsan University School of Medicine, Seoul; and.
J Neurosurg. 2023 Aug 4;140(2):412-419. doi: 10.3171/2023.5.JNS2326. Print 2024 Feb 1.
The endoscopic transorbital approach (ETOA) and transorbital anterior clinoidectomy have been suggested as novel procedures through which to reach the superolateral compartments of the orbit, allowing optic canal decompression. However, there is limited literature describing the technical details and surgical outcomes of these procedures. In this study, the authors aimed to analyze the feasibility and efficacy of endoscopic transorbital decompression of the optic canal through anterior clinoidectomy for compressive optic neuropathic lesions.
Between 2016 and 2022, the authors performed ETOA for compressive optic neuropathic lesions in 14 patients. All these patients underwent transorbital anterior clinoidectomy through the surgically defined "intraorbital clinoidal triangle," which is composed of the roof of the superior orbital fissure, the medial margin of the optic canal, the medial border of the superior orbital fissure, and the optic strut. Demographic data, tumor characteristics, pre- and postoperative imaging, pre- and postoperative visual examinations, and surgical outcomes were retrospectively reviewed.
The mean age at the time of ETOA was 53.3 years (range 41-64 years), and the mean follow-up was 16.8 months (range 6.7-51.4 months). The inclusion criterion in this study was having a meningioma (14 patients). In the preoperative visual function examination, 7 patients with a meningioma showed progressive visual impairment. After endoscopic transorbital optic canal decompression, visual function improved in 5 patients, remained unchanged in 8 patients, and worsened in 1 patient. No new-onset neurological deficit was associated with ETOA and anterior clinoidectomy in any patients.
Endoscopic transorbital decompression of the optic canal with extradural anterior clinoidectomy is a safe and feasible technique that avoids significant injury to the clinoidal internal carotid artery and surrounding neurovascular structures.
经眶内窥镜(transorbital approach, ETOA) 和经眶前床突切除术(transorbital anterior clinoidectomy, TAC) 已被提议作为到达眶外侧部的新方法，可进行视神经管减压。然而，关于这些手术的技术细节和手术结果的文献有限。在这项研究中，作者旨在分析经眶内窥镜视神经管减压联合经眶前路床突切除术治疗压迫性视神经病变的可行性和疗效。
2016 年至 2022 年，作者对 14 例压迫性视神经病变患者进行了 ETOA。所有患者均通过手术定义的“眶内床突三角”行经眶前路床突切除术，该三角由眶上裂顶、视神经管内侧缘、眶上裂内侧缘和视神经柱组成。回顾性分析患者的人口统计学资料、肿瘤特征、术前和术后影像学、术前和术后视力检查以及手术结果。
ETOA 时的平均年龄为 53.3 岁（范围 41-64 岁），平均随访时间为 16.8 个月（范围 6.7-51.4 个月）。本研究的纳入标准为脑膜瘤（14 例）。在术前视力检查中，7 例脑膜瘤患者出现进行性视力损害。经内镜经眶视神经管减压后，5 例患者视力改善，8 例患者视力无变化，1 例患者视力恶化。在任何患者中，内镜经眶视神经管减压联合经眶前路床突切除均未引起新的神经功能缺损。
经眶内窥镜视神经管减压联合硬膜外经眶前路床突切除术是一种安全可行的技术，可避免对床突内颈动脉和周围神经血管结构的严重损伤。
