Endoscopic transventral natural corridors resection for lateral skull base lesions

doi:10.3969/j.issn.1672-6731.2025.04.003

Abstract

Abstract:

Objective: To evaluate the clinical application of endoscopic transorbital and transoral approaches for lateral skull base lesion resection. Methods and Results: A retrospective analysis was conducted on 17 patients undergoing endoscopic transorbital or transoral lateral skull base surgery at General Hospital of Eastern Theater Command from June 2021 to September 2024. Eight cases underwent endoscopic transorbital approach surgery, with lesions mainly located in the orbit, lateral orbital apex or spheno-orbital region. Seven cases underwent gross total resection, and one case underwent subtotal resection; postoperative exophthalmos all relieved (4/4), improvement of vision and ocular motility disorders occurred in 4 cases (4/7) and 2 cases (2/4) respectively. There were no postoperative complications such as bleeding, new developed neurological dysfunction, cerebrospinal fluid leakage, intracranial infection, etc., but all patients had significant swelling around the eyelids, which subsided on its own after about 7 d. Nine cases underwent endoscopic transoral approach surgery for lesions in the pterygopalatine fossa, infratemporal fossa, or anterior region of Meckel cave, with gross total resection in 7 cases and subtotal resection in 2 cases; facial numbness improved in 4 cases (4/6) after surgery; no surgery-related complications were observed. One patient with subtotal resection showed tumor progression 3 months after surgery. Conclusions: Endoscopic transorbital and transoral approaches are minimally invasive techniques utilizing ventral natural corridors. They provide effective options for specific skull base regions, expanding the armamentarium of endoscopic skull base surgery.

Key words: Skull base, Brain diseases, Natural orifice endoscopic surgery, Orbit, Mouth, Neurosurgical procedures

摘要：

目的: 探讨内镜下经眶和经口入路在切除侧颅底病变中的临床应用。方法与结果: 纳入2021年6月至2024年9月于东部战区总医院接受内镜下经眶或经口入路手术切除侧颅底病变的17例患者。8例接受内镜下经眶入路手术，病变主要位于眶内、眶尖外侧及蝶眶区域，7例手术全切除、1例次全切除；术后眼球突出症状均缓解（4/4），4例（4/7）视力较术前改善，2例（2/4）眼动障碍较术前缓解；均无术区出血、新发神经功能障碍、脑脊液漏、颅内感染等手术相关并发症，但有明显的眼睑周围肿胀，约7 d肿胀自行消退。9例接受内镜下经口入路手术，病变主要位于翼腭窝、颞下窝或Meckel囊前部，7例手术全切除、2例次全切除；4例（4/6）术后面部麻木较术前改善；均未见手术相关并发症；1例次全切除患者术后3个月影像学提示肿瘤进展。结论: 内镜下经眶和经口入路是经腹侧颅底自然腔道的微侵袭手术方式，适用于特定区域的颅底病变，丰富内镜颅底外科的手术入路选择。

关键词: 颅底, 脑疾病, 自然腔道内镜手术, 眼眶, 口腔, 神经外科手术

Zi-xiang CONG, Xin-rui ZENG, Jun-hao ZHU, Jin YANG, Chi-yuan MA. Endoscopic transventral natural corridors resection for lateral skull base lesions[J]. Chinese Journal of Contemporary Neurology and Neurosurgery, 2025, 25(4): 281-285.

丛子翔, 曾新睿, 朱俊豪, 杨进, 马驰原. 内镜下经腹侧颅底自然腔道切除侧颅底病变[J]. 中国现代神经疾病杂志, 2025, 25(4): 281-285.

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URL: https://journal11.magtechjournal.com/cjcnn/EN/10.3969/j.issn.1672-6731.2025.04.003

https://journal11.magtechjournal.com/cjcnn/EN/Y2025/V25/I4/281

Figures/Tables 2

Figure 1 Pre - and post - operative MRI findings and intraoperative findings of endoscopic transorbital approach Preoperative axial enhanced T1WI showed the lesion was located on the outer side of the optic nerve and extended along the spheno - orbital direction (arrow indicates, Panel 1a). The surgical incision of endoscopic transorbital approach (Panel 1b). After removing the lateral orbital bone, the surgeon exposed and separated the lesion tissue in the orbit under endoscopy (Panel 1c). Axial enhanced T 1WI within 48 h after surgery showed gross total resection of the lesion (Panel 1d)

Figure 2 Pre-and post-operative MRI findings and intraoperative findings of endoscopic transoral approach Preoperative axial enhanced T1WI showed the lesion was located in the pterygopalatine fossa and protruded into the maxillary sinus (arrow indicates, Panel 2a). The surgical incision of endoscopic transoral approach (Panel 2b). After entering the maxillary sinus under endoscopy, the surgeon could observe the posterior wall of the maxillary sinus bulging due to lesion pushing (Panel 2c). Axial enhanced T1WI within 48 h after surgery showed gross total resection of the lesion (Panel 2d)

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