title: Lateral Transorbital Endoscopic Access to the Hippocampus, Amygdala, and Entorhinal Cortex: Initial Clinical Experience.
abstract: OBJECTIVE
  Transorbital approaches traditionally have focused on skull base and cavernous sinus lesions medial to the globe. Lateral orbital approaches to the temporal lobe have not been widely explored despite several theoretical advantages compared to open craniotomy. Recently, we demonstrated the feasibility of the lateral transorbital technique in cadaveric specimens with endoscopic visualization. We describe our initial clinical experience with the endoscope-assisted lateral transorbital approach to lesions in the temporal lobe.
  
  
  METHODS
  Two patients with mesial temporal lobe pathology presenting with seizures underwent surgery. The use of a transpalpebral or Stallard-Wright eyebrow incision enabled access to the intraorbital compartment, and a lateral orbital wall 'keyhole' opening permitted visualization of the anterior temporal pole.
  
  
  RESULTS
  This approach afforded adequate access to the surgical target and surrounding structures and was well tolerated by the patients. To the best of our knowledge, this report constitutes the first case series describing the endoscope-assisted lateral transorbital approach to the temporal lobe. We discuss the limits of exposure, the nuances of opening and closing, and comparisons to open craniotomy.
  
  
  CONCLUSIONS
  Further prospective investigation of this approach is warranted for comparison to traditional approaches to the mesial temporal lobe.
authors.affiliation: Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa., USA.
authors.forename: H Isaac
authors.initials: HI
authors.lastname: Chen
authors.forename: Leif-Erik
authors.initials: LE
authors.lastname: Bohman
authors.forename: Lyndsey
authors.initials: L
authors.lastname: Emery
authors.forename: Maria
authors.initials: M
authors.lastname: Martinez-Lage
authors.forename: Andrew G
authors.initials: AG
authors.lastname: Richardson
authors.forename: Kathryn A
authors.initials: KA
authors.lastname: Davis
authors.forename: John R
authors.initials: JR
authors.lastname: Pollard
authors.forename: Brian
authors.initials: B
authors.lastname: Litt
authors.forename: Roberta E
authors.initials: RE
authors.lastname: Gausas
authors.forename: Timothy H
authors.initials: TH
authors.lastname: Lucas
mesh_terms: D000328:Adult; D000679:Amygdala / Q000473:pathology / Q000601:surgery*; D001706:Biopsy; D001932:Brain Neoplasms / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D003399:Craniotomy / Q000379:methods; D004724:Endoscopy / Q000379:methods*; D018728:Entorhinal Cortex / Q000473:pathology / Q000601:surgery*; D005260:Female; D006624:Hippocampus / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D009915:Orbit; D012640:Seizures / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*