Jeon Chiman, Hong Chang-Ki, Chong Kyuha, Lee Won Jae, Kim Gung Ju, Lee Jung-Il, Nam Do-Hyun, Seol Ho Jun, Choi Jung Won, Shin Hyung Jin, Kong Doo-Sik
1Department of Neurosurgery, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Gyeonggi-do.
2Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul.
J Neurosurg. 2024 Oct 25;142(3):819-828. doi: 10.3171/2024.6.JNS232810. Print 2025 Mar 1.
The endoscopic transorbital approach (ETOA) has emerged as a promising minimally invasive technique for resection of lesions in the mediobasal temporal region (MTR) due to its potential to preserve the integrity of the optic radiation (OR). This study evaluated the safety and efficacy of ETOA using an OR-sparing surgical strategy for mediobasal temporal lesions.
A retrospective review was conducted of the medical records of 15 patients (7 females and 8 males) who underwent ETOA for lesions in the MTR between November 2017 and November 2022. Preoperative diffusion tensor imaging (DTI) tractography of the OR was utilized in all cases for surgical planning to visualize the spatial relations between the OR and the target mediobasal temporal lesion.
The median age of the treated patients was 43 years (range 22-76 years), with a median follow-up duration of 12 months (range 6-35 months). Eleven lesions (73.3%) involved only the anterior segment of the MTR, while 4 lesions (26.7%) affected both the anterior and middle segments. Gross-total resection was achieved in 13 patients (86.7%) and subtotal resection in 2 (13.3%). The final pathologies included low-grade glioma (n = 5), cavernous malformation (n = 3), glioblastoma multiforme (n = 2), multinodular and vacuolating neuronal tumor (n = 1), pleomorphic xanthoastrocytoma (n = 1), anaplastic oligodendroglioma (n = 1), adenoid cystic carcinoma (n = 1), and metastatic renal cell carcinoma (n = 1). Postoperative neuro-ophthalmological examinations revealed that all patients maintained their previous visual function. Follow-up DTI tractography further confirmed the preservation of the preoperative ORs in the treated patients. No postoperative CSF leaks, infections, or cosmetic problems occurred in this series.
The combined use of ETOA and OR tractography appears to be a feasible approach for resecting lesions involving the MTR, especially in the anterior segment. In the authors' experience, this surgical strategy enables maximal safe resection while minimizing the risk of postoperative visual dysfunction. Further studies with larger sample sizes are warranted to validate these findings and assess long-term outcomes.
内镜经眶入路（ETOA）已成为一种有前景的微创技术，用于切除中颞叶基底部（MTR）病变，因其有可能保留视辐射（OR）的完整性。本研究评估了采用保留OR的手术策略的ETOA治疗中颞叶基底部病变的安全性和有效性。
对2017年11月至2022年11月期间接受ETOA治疗MTR病变的15例患者（7例女性，8例男性）的病历进行回顾性分析。所有病例术前均利用OR的弥散张量成像（DTI）纤维束成像进行手术规划，以可视化OR与目标中颞叶基底部病变之间的空间关系。
治疗患者的中位年龄为43岁（范围22 - 76岁），中位随访时间为12个月（范围6 - 35个月）。11个病变（73.3%）仅累及MTR的前段，4个病变（26.7%）累及前段和中段。13例患者（86.7%）实现了全切除，2例（13.3%）实现了次全切除。最终病理包括低级别胶质瘤（n = 5）、海绵状畸形（n = 3）、多形性胶质母细胞瘤（n = 2）、多结节空泡性神经元肿瘤（n = 1）、多形性黄色星形细胞瘤（n = 1）、间变性少突胶质细胞瘤（n = 1）、腺样囊性癌（n = 1）和肾细胞癌转移瘤（n = 1）。术后神经眼科检查显示所有患者均保持了术前的视力功能。随访DTI纤维束成像进一步证实了治疗患者术前OR的保留。本系列中未发生术后脑脊液漏、感染或美容问题。
ETOA与OR纤维束成像联合应用似乎是切除累及MTR病变的可行方法，尤其是在前段。根据作者的经验，这种手术策略能够在最大程度安全切除的同时，将术后视觉功能障碍的风险降至最低。有必要进行更大样本量的进一步研究以验证这些发现并评估长期结果。
