Introduction: Transpalpebral or trans-eyelid approach is a modified tans-orbital access to the anterior and middle cranial fossa. We describe our study from cadaveric anatomy to clinical operations with some revisions and new experience.
Methods: We used 10 cadavers to compare trans-orbital (n=5) and trans-eyelid approaches (n=5) in a step-by-step fashion. And then assisted by an experienced ophthalmologist for incisions, we treated 3 patients (2 female and 1 male) via this approach: One with sphenoidal wing meningioma invading into orbit, one with sellar tuberculum meningioma, and the third one with pituitary adenoma.
Results: There were some differences of exposure between trans-orbital and trans-eyelid approaches. While studying the anatomy of cadavers, we made several revisions to the previously reported approach by N. Andaluz (2008) and K. Abdel Aziz (2011): 1) move the incision a little lower to the edge of the eyelid, which resembles the double-eyelid incision. 2) dissect more periosteum tissue in case of repairing the opened frontal sinus and reconstruction of the skull base. We also apply neuro-endoscopic assisted technique to study the cadaver and patients, and use VR technique to help designing and practice operations. Then we treated 3 patients by this approach. All tumors were totally resected, and Simpson Grade I were achieved in 2 meningioma cases. Complications included mild stroke and orbital apex syndrome because of tumor invasion. No cerebrospinal fluid leakage. Excellent cosmetic outcome was accomplished in 3 patients.
Conclusions: We found that transpalpebral or trans-eyelid approach is more suitable for lesions situated around sphenoidal wings within 2cm range, especially lesions invading cranio-orbital communicating region, anterior and lateral to the internal carotid artery. Comparing to trans-orbital frontal minicraniotomy, this approach may expose the lesion more lateral to the temporal lobe. This is a safe and minimally invasive approach, with an excellent cosmetic results.
Patient Care: This new approach modifies the traditional trans-orbital approach for tumors of anterior and middle cranial fossa. Preliminary study showed that this was a safe and minimally invasive approach, with an excellent cosmetic results.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the importance of this new modified approach for tumors of anterior and middle cranial fossa, 2) Discuss, in small groups, this new modified approach, 3) Identify an effective treatment for tumors of anterior and middle cranial fossa.