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Minimally invasive surgery of the anterior skull base: transorbital approaches.

Gassner HG, Schwan F, Schebesch KM - GMS Curr Top Otorhinolaryngol Head Neck Surg (2016)

Bottom Line: The more recently described transorbital approaches represent minimally invasive alternatives with a differing spectrum of access corridors.The purpose of the present paper is to discuss transorbital approaches to the anterior skull base in the light of the current literature.Their execution requires an interdisciplinary team approach.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Otolaryngology, Head & Neck Surgery, University Medicine of Regensburg, Germany.

ABSTRACT
Minimally invasive approaches are becoming increasingly popular to access the anterior skull base. With interdisciplinary cooperation, in particular endonasal endoscopic approaches have seen an impressive expansion of indications over the past decades. The more recently described transorbital approaches represent minimally invasive alternatives with a differing spectrum of access corridors. The purpose of the present paper is to discuss transorbital approaches to the anterior skull base in the light of the current literature. The transorbital approaches allow excellent exposure of areas that are difficult to reach like the anterior and posterior wall of the frontal sinus; working angles may be more favorable and the paranasal sinus system can be preserved while exposing the skull base. Because of their minimal morbidity and the cosmetically excellent results, the transorbital approaches represent an important addition to established endonasal endoscopic and open approaches to the anterior skull base. Their execution requires an interdisciplinary team approach.

No MeSH data available.


Related in: MedlinePlus

After 2 years follow-up, the patient is recurrence-free. The diplopia resolved almost completely and does not affect her daily life. The cephalgia persisted and is controlled with single agent medical therapy.
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Figure 10: After 2 years follow-up, the patient is recurrence-free. The diplopia resolved almost completely and does not affect her daily life. The cephalgia persisted and is controlled with single agent medical therapy.

Mentions: Figure 6 (Fig. 6), Figure 7 (Fig. 7), Figure 8 (Fig. 8), Figure 9 (Fig. 9) and Figure 10 (Fig. 10) illustrate the potential of the upper eyelid approach with removal of the trochlea. The recurrence shown in Figure 6 (Fig. 6) of a monostotic fibrous dysplasia that was transcranially resected 2 years previously manifested by increasing diplopia and displacement of the bulb. The lesion encompassed the bony base of the trochlea and the trochlear fossa. As depicted in Figure 7 (Fig. 7), the trochlea was released through the superior eyelid approach and the lesion was resected. After duraplasty (Figure 9 (Fig. 9)), persistent CSF rhinorrhea was observed and revision via the same access became necessary on the first postoperative day. Bone anchores were placed in the crista galli and the lateral orbital roof. With these sutures, a duraplasty of abdominal fat and fascia lata was secured (Figure 6 (Fig. 6), Figure 7 (Fig. 7), Figure 8 (Fig. 8), Figure 9 (Fig. 9), Figure 10 (Fig. 10)).


Minimally invasive surgery of the anterior skull base: transorbital approaches.

Gassner HG, Schwan F, Schebesch KM - GMS Curr Top Otorhinolaryngol Head Neck Surg (2016)

After 2 years follow-up, the patient is recurrence-free. The diplopia resolved almost completely and does not affect her daily life. The cephalgia persisted and is controlled with single agent medical therapy.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4940979&req=5

Figure 10: After 2 years follow-up, the patient is recurrence-free. The diplopia resolved almost completely and does not affect her daily life. The cephalgia persisted and is controlled with single agent medical therapy.
Mentions: Figure 6 (Fig. 6), Figure 7 (Fig. 7), Figure 8 (Fig. 8), Figure 9 (Fig. 9) and Figure 10 (Fig. 10) illustrate the potential of the upper eyelid approach with removal of the trochlea. The recurrence shown in Figure 6 (Fig. 6) of a monostotic fibrous dysplasia that was transcranially resected 2 years previously manifested by increasing diplopia and displacement of the bulb. The lesion encompassed the bony base of the trochlea and the trochlear fossa. As depicted in Figure 7 (Fig. 7), the trochlea was released through the superior eyelid approach and the lesion was resected. After duraplasty (Figure 9 (Fig. 9)), persistent CSF rhinorrhea was observed and revision via the same access became necessary on the first postoperative day. Bone anchores were placed in the crista galli and the lateral orbital roof. With these sutures, a duraplasty of abdominal fat and fascia lata was secured (Figure 6 (Fig. 6), Figure 7 (Fig. 7), Figure 8 (Fig. 8), Figure 9 (Fig. 9), Figure 10 (Fig. 10)).

Bottom Line: The more recently described transorbital approaches represent minimally invasive alternatives with a differing spectrum of access corridors.The purpose of the present paper is to discuss transorbital approaches to the anterior skull base in the light of the current literature.Their execution requires an interdisciplinary team approach.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Otolaryngology, Head & Neck Surgery, University Medicine of Regensburg, Germany.

ABSTRACT
Minimally invasive approaches are becoming increasingly popular to access the anterior skull base. With interdisciplinary cooperation, in particular endonasal endoscopic approaches have seen an impressive expansion of indications over the past decades. The more recently described transorbital approaches represent minimally invasive alternatives with a differing spectrum of access corridors. The purpose of the present paper is to discuss transorbital approaches to the anterior skull base in the light of the current literature. The transorbital approaches allow excellent exposure of areas that are difficult to reach like the anterior and posterior wall of the frontal sinus; working angles may be more favorable and the paranasal sinus system can be preserved while exposing the skull base. Because of their minimal morbidity and the cosmetically excellent results, the transorbital approaches represent an important addition to established endonasal endoscopic and open approaches to the anterior skull base. Their execution requires an interdisciplinary team approach.

No MeSH data available.


Related in: MedlinePlus