Corvino Sergio, Berardinelli Jacopo, Corazzelli Giuseppe, Altieri Roberto, Dallan Iacopo, Corrivetti Francesco, de Notaris Matteo
Department of Neurosciences, Reproductive and Odontostomatological Sciences, Neurosurgical Clinic, School of Medicine, University of Naples "Federico II", 80131, Naples, Italy.
Department of Neurosciences, Reproductive and Odontostomatological Sciences, Division of Neurosurgery, University of Naples Federico II, 80131, Naples, Italy.
Neurosurg Rev. 2025 Mar 6;48(1):282. doi: 10.1007/s10143-025-03426-z.
The endoscopic superior eyelid transorbital approach (SETOA) has demonstrated considerable versatility and effectiveness in managing various paramedian anterior and middle skull base pathologies. However, as with any relatively new technique, potential complications remain. We conducted an extensive literature search in MEDLINE and Embase in accordance with PRISMA guidelines including case reports and surgical series reporting cerebrospinal fluid (CSF) leak rate following SETOA for intracranial pathologies. Factors analyzed included lesion location (extra- or intra-axial), reconstruction techniques, and complication management. ROBINS-I tool was employed to assess the risk of bias. Twenty-five studies including 240 cases were eligible. The majority of lesions were intradural extra-axial (68.3%), while trigeminal schwannomas comprised all extradural cases (25.0%). Sixteen patients (6.6%) presented intradural intra-axial tumors. Osteodural reconstruction involved dural substitutes in one third of the cases (32.5%) either alone (14.2%) or combined with fat free graft (18.3%). CSF leak occurred in 6 patients (2.50%), mostly resolving via conservative management (66.6%). The risk of postoperative CSF leak was found to be significantly higher in patients undergoing resection for intra-axial tumors (OR 0.13, 95% CI: 0.04-0.49) compared to those undergoing resection for extra-axial (OR 0.01, 95% CI: 0.00-0.02; I = 0%; p < 0.001). Key limitations include the retrospective nature and small sample sizes among included studies as well as data heterogeneity and lack of standardized protocols for reconstruction across studies. SETOA appears safe for addressing selected extradural and intradural skull base pathologies with a low postoperative CSF leak rate. The natural repositioning of the orbital content to its original position may be instrumental in preventing its postoperative occurrence. The investigation followed a prespecified protocol registered on PROSPERO (PROSPERO 2024 CRD42024614111).
内镜经眶上睑入路（SETOA）在处理各种中线上前部和中部颅底病变方面已显示出相当的灵活性和有效性。然而，与任何相对较新的技术一样，潜在并发症仍然存在。我们按照PRISMA指南在MEDLINE和Embase中进行了广泛的文献检索，包括病例报告和手术系列，报告SETOA治疗颅内病变后的脑脊液（CSF）漏率。分析的因素包括病变位置（轴外或轴内）、重建技术和并发症处理。采用ROBINS-I工具评估偏倚风险。25项研究（包括240例病例）符合条件。大多数病变为硬膜内轴外病变（68.3%），而三叉神经鞘瘤占所有硬膜外病例的25.0%。16例患者（6.6%）为硬膜内轴内肿瘤。骨膜重建在三分之一的病例（32.5%）中使用了硬膜替代物，单独使用（14.2%）或与无脂肪移植物联合使用（18.3%）。6例患者（2.50%）发生脑脊液漏，大多通过保守治疗得以解决（66.6%）。与轴外肿瘤切除术患者相比，轴内肿瘤切除术患者术后脑脊液漏的风险显著更高（OR 0.13，95% CI：0.04 - 0.49），而轴外肿瘤切除术患者术后脑脊液漏的风险为（OR 0.01，95% CI：0.00 - 0.02；I = 0%；p < 0.001）。主要局限性包括纳入研究的回顾性性质和小样本量，以及数据异质性和各研究间缺乏标准化的重建方案。SETOA在处理选定的硬膜外和硬膜内颅底病变时似乎是安全的，术后脑脊液漏率较低。眶内容物自然复位到其原始位置可能有助于预防术后脑脊液漏的发生。本研究遵循在PROSPERO上注册的预先指定方案（PROSPERO 2024 CRD42024614111）。
