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| Name | Combined Endoscopic and Open Approach for Resection of Orbital Roof Meningioma |
| Video Uploader | Video From NEUROSURGERY Journal |
| Upload Date | This Video Uploaded At 27-02-2018 17:21:26 |
| Video Discription | The use of the endoscopic endonasal approach (EEA) for resection of anterior skull base meningiomas has become increasingly popular. However, the orbital contents, especially the optic nerves, limit the lateral exposure of EEA. For skull base tumors lateral to the optic nerve, a supraorbital craniotomy provides excellent exposure with minimal brain retraction. However, the angle of the orbital roof can make it difficult to access more medial regions of the anterior cranial base. In addition, the limited size of the pericranial flap that can be harvested makes reconstruction challenging for large anterior skull base defects. For tumors that overlap the boundaries of a single approach, multiple minimally invasive surgical corridors may be combined for optimal resection instead of a larger traditional craniotomy and skin incision. The patient is a 48 year-old male who presents with a 3cm orbital roof meningioma extending to the midline medially, laterally past the optic nerve, with extension into the ethmoid sinus. Using image guidance, a left uninarial EEA allowed early devascularization and complete resection of the tumor invading the ethmoid sinus and anterior skull base, and provided a vascularized nasoseptal flap for skull base reconstruction. The rest of the tumor with all involved dura and bone extending over the orbital roof was removed using a supraorbital craniotomy. The combination of minimally invasive approaches allowed for aggressive Simpson Grade 1 resection without post-operative CSF leak, preservation of olfaction, and excellent cosmesis. |
| Category | Science & Technology |
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