Multiportal Combined Transorbital Transnasal Endoscopic Approach for the Management of Selected Skull Base Lesions: Preliminary Experience.
BACKGROUND
Skull base lesions are challenging to treat and may be managed using several approaches each with its own advantages and limitations. In selected cases, a modular, combined, multiportal approach could overcome the limits of a single approach and respond well to the needs of the patient.


METHODS
We report a preclinical study on 5 cadaveric specimens and 4 preliminary clinical experiences with the combined multiportal transnasal transorbital endoscopic approach for the management of selected complex skull base pathologies. The technical feasibility and safety of this combined approach were evaluated in the preclinical study. The applicability in vivo of such an approach, together with early and late complications, specific morbidity, and hospitalization time were analyzed in the preliminary clinical experiences.


RESULTS
The transnasal endoscopic extended approach combined with the transorbital endoscopic approach offered greater visualization and tissue handling than a single approach alone could. The multiportal combined transorbital transnasal endoscopic approach was used effectively in vivo to resect 1 case of malignant schwannoma arising from the second branch of the trigeminal nerve and 3 cases of spheno-orbital meningioma without significant complications and with minimal morbidity for the patients.


CONCLUSIONS
The multiportal combined transorbital transnasal endoscopic approach is a safe and effective procedure for management of selected complex skull base lesions that is able to capitalize on the advantages and overcome the limitations of each single approach. This combined approach offers a multiperspective view of the spaces and allows for a more synergized procedure, especially when dealing with multicompartmental lesions.
First Otorhinolaryngologic Unit, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy.
Iacopo
I
Dallan
Unit of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy.
Paolo
P
Castelnuovo
Department of Neurosurgery, Civic Hospital, Legnano, Italy.
Davide
D
Locatelli
Unit of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy. Electronic address: tzmario@inwind.it.
Mario
M
Turri-Zanoni
Department of Otorhinolaryngology, Riyadh Military Hospital, Riyadh, Saudi Arabia.
Abdulaziz
A
AlQahtani
Unit of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy.
Paolo
P
Battaglia
Department of Clinical Anatomy, Eberhard-Karls-University, Tübingen, Germany.
Bernard
B
Hirt
First Otorhinolaryngologic Unit, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy.
Stefano
S
Sellari-Franceschini
D000328:Adult; D000368:Aged; D002102:Cadaver; D003390:Cranial Nerve Neoplasms / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay; D008279:Magnetic Resonance Imaging; D008297:Male; D008577:Meningeal Neoplasms / Q000601:surgery*; D008579:Meningioma / Q000601:surgery*; D008875:Middle Aged; D057605:Natural Orifice Endoscopic Surgery / Q000009:adverse effects / Q000379:methods*; D009442:Neurilemmoma / Q000601:surgery*; D044583:Neuroendoscopy / Q000009:adverse effects / Q000379:methods*; D009666:Nose; D009915:Orbit; D016896:Treatment Outcome; D020433:Trigeminal Nerve Diseases / Q000601:surgery*
Endonasal; Endoscopic; Multiportal approach; Orbit; Skull base; Superior eyelid approach