How I do It: Endoscopic transorbital resection of sphenoid osseous meningioma via the lateral orbital 'sliding coach door' approach.

in Acta neurochirurgica by James M W Robins, Jiten Parmar, Asim J Sheikh

TLDR

  • A novel surgical technique, the 'sliding coach door' osteotomy, was used to resect a sphenoid osseous meningioma through a lateral canthal incision, resulting in satisfactory resection and cosmesis, but with a residual dural tail requiring future surveillance.

Abstract

A 63-year-old presented with reduced left visual acuity and V1 sensation. Imaging demonstrated left sphenoid osseous meningioma narrowing superior orbital fissure with intracranial extension to superior temporal gyrus. Endoscopic transorbital approach utilising novel lateral orbit 'sliding coach door' osteotomy performed. Lateral canthal incision with lateral canthal ligament division mobilises and decompresses globe infero-medially. Osteotomy performed, tethered by temporalis. Osteotomy slides postero-laterally creating working space lateral to inferior and superior orbital fissures. This technique requires reduced soft tissue dissection and facilitates reconstruction. Adequate working space enabled satisfactory resection with residual dural tail requiring future surveillance. Cosmesis was satisfactory.

Overview

  • The study describes a surgical procedure for resecting a sphenoid osseous meningioma, a type of tumor that grows in the bones and membranes surrounding the brain.
  • The procedure, called the 'sliding coach door' osteotomy, utilizes a novel lateral orbit approach to access the tumor through a lateral canthal incision.
  • The goal of the study is to demonstrate the safety and effectiveness of this new technique, which aims to reduce soft tissue dissection and facilitate reconstruction after resection.

Comparative Analysis & Findings

  • The study presents a single case report, describing the use of the 'sliding coach door' osteotomy to resect a left sphenoid osseous meningioma.
  • The procedure resulted in satisfactory resection of the tumor, although a residual dural tail remained, requiring future surveillance.
  • The authors report a positive outcome in terms of cosmesis and functioning, with the patient experiencing reduced symptoms after surgery.

Implications and Future Directions

  • The study's findings suggest that the 'sliding coach door' osteotomy may be a valuable addition to the surgical armamentarium for treating sphenoid osseous meningiomas.
  • Future studies could explore the use of this technique in larger patient populations or compare it to other surgical approaches for similar tumors.
  • Further research may also be needed to refine the technique and optimize outcomes, including addressing the issue of residual dural tails and improving overall survival rates.
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