Minimally Invasive Trans-eyelid Endoscopy-Assisted Approach to Anterior and Middle Cranial Fossa

Introduction: Trans-eyelid (TeA) approach is a minimally invasive alternative to lesions of anterior cranial fossa. However, it is not clear if this approach is suitable for tumors extending laterally to middle cranial fossa. The advantage of the endoscopy assistance is also obscure.

Objective: To describe step-by-step technique to perform a trans-eyelid approach with endoscopic assistance to anterior and middle cranial fossa.

Methods: We performed TeA in four cadaveric heads, a total of eight sides. The different sizes of incisions and craniotomies were performed, and exposure was compared using a Medtronic StealthStation Surgical Navigation system. After initial measurement with the microscope, the endoscope was introduced in the surgical field.

Results: The different incisions were done to evaluate the best length to balance esthetic result and an efficient exposure. The skin incision and initial dissection was done to expose orbital septum (OS). The OS is continuous to the periosteum of the orbital rim. The periosteum was incised carefully and a subperiosteal dissection showed the orbital rim and temporal muscle. The frontozygomatic suture (ZFS) was used as reference to measure the sizes and location of the craniotomies. After craniotomy, the lesser sphenoid wing and the orbital roof were drilled exposing the dura of the temporal and frontal lobe. An enlargement of 1 cm on the craniotomy medially and superiorly allowed a better exposure of the planum sphenoidale, tuberculum sellae and also the contralateral ICA and optic nerve. A 0.5-cm lateral extension offered an adequate visualization of the middle cranial fossa. Measurements and detailed angulation was performed with the neuro-navigation probe using microscope and endoscope visualization.

Conclusion: Tailoring the trans-eyelid approach make it appropriate for lesions in the anterior and middle cranial fossa, especially around sphenoidal wings within 2 cm range of spheno-orbital region. Endoscopy adds the extra exposure that is limited by the narrow corridor ([Figs. 1]–[3]).

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Artikel online veröffentlicht:
15. Februar 2022