title: The modified hemi-Lothrop procedure: a variation of the endoscopic endonasal approach for resection of a supraorbital psammomatoid ossifying fibroma.
abstract: Tumors in the supraorbital region are most commonly accessed through transcranial approaches, including fronto-orbital, orbitozygomatic, and eyebrow supraorbital keyhole approaches. Purely endoscopic endonasal approaches (EEA) are more challenging to perform because of limitations in access and visualization for lateral extension beyond the midline corridor. The modified hemi-Lothrop procedure, a variation of an extended EEA, allows for binostril access and visualization of the lateral supraorbital region while preserving the contralateral frontal sinus drainage pathway. The operative technique and nuances are illustrated in a rare case of a supraorbital juvenile psammomatoid ossifying fibroma (JPOF) causing symptomatic orbital compression. The key components of the approach consisted of an endoscopic Draf IIB (left frontal sinusotomy) ipsilateral to the tumor, and a superior septectomy for binostril bimanual instrumentation. Excellent visualization, access, and tumor removal of the supraorbital region was achieved with angled endoscopy and curved instrumentation from the contralateral nasal cavity and through the septectomy window ("cross-court" trajectory). The modified hemi-Lothrop procedure with angled endoscopy is a safe and effective alternative route to traditional transcranial approaches to access the supraorbital region. To our knowledge, this is the first case of a supraorbital JPOF that was successfully resected via a purely EEA.
authors.affiliation: Department of Neurological Surgery, Rutgers New Jersey Medical School, 90 Bergen Street, Suite 8100, Newark, NJ 07103, USA; Department of Otolaryngology, Head & Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA; Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, NJ, USA. Electronic address: james.liu.md@rutgers.edu.
authors.forename: James K
authors.initials: JK
authors.lastname: Liu
authors.affiliation: Department of Neurological Surgery, Rutgers New Jersey Medical School, 90 Bergen Street, Suite 8100, Newark, NJ 07103, USA.
authors.forename: Zachary S
authors.initials: ZS
authors.lastname: Mendelson
authors.affiliation: Department of Otolaryngology, Head & Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA.
authors.forename: Pariket M
authors.initials: PM
authors.lastname: Dubal
authors.affiliation: Department of Pathology and Laboratory Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA.
authors.forename: Neena
authors.initials: N
authors.lastname: Mirani
authors.affiliation: Department of Neurological Surgery, Rutgers New Jersey Medical School, 90 Bergen Street, Suite 8100, Newark, NJ 07103, USA; Department of Otolaryngology, Head & Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA; Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, NJ, USA.
authors.forename: Jean Anderson
authors.initials: JA
authors.lastname: Eloy
mesh_terms: D018214:Fibroma, Ossifying / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods*; D044583:Neuroendoscopy / Q000379:methods*; D019291:Skull Base / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D019292:Skull Base Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: Endoscopic endonasal approach; Endoscopic skull base surgery; Juvenile psammomatoid ossifying fibroma; Modified hemi-Lothrop; Skull base tumor; Supraorbital tumor