The lateral retrocanthal transorbital endoscopic approach to the middle fossa: cadaveric stepwise approach and review of quantitative cadaveric data

OBJECTIVE

The lateral retrocanthal transorbital endoscopic approach (LRCTEA) facilitates trajectory to the middle fossa, preserving the lateral canthal tendon and thus avoiding postoperative complications such as eyelid malposition. Here, the authors sought to define the surgical anatomy and technique of LRCTEA using a stepwise approach in cadaveric heads and offer an in-depth examination of existing quantitative data from cadaveric studies.

METHODS

The authors performed LRCTEA to the middle cranial fossa under neuronavigation in 7 cadaveric head specimens that underwent high-resolution (1-mm) CT scans preceding the dissections.

RESULTS

The LRCTEA provided access to middle fossa regions including the cavernous sinus, Meckel's cave, and medial temporal lobe. The trajectories and endpoints of the approach were confirmed using electromagnetic neuronavigation. A stepwise approach was delineated and recorded.

CONCLUSIONS

The authors' cadaveric study delineates the surgical anatomy and technique of the LRCTEA, providing a stepwise approach for its implementation. As these approaches continue to evolve, their development and refinement will play an important role in expanding the surgical options available to neurosurgeons, ultimately improving outcomes for patients with complex skull base pathologies. The LRCTEA presents a promising advancement in skull base surgery, particularly for accessing challenging middle fossa regions. However, surgeons must remain vigilant to potential complications, including transient diplopia, orbital hematoma, or damage to the optic apparatus.

Post-operative rebleeding in patients with spontaneous supratentorial intracerebral hemorrhage: factors and clinical outcomes

OBJECTIVE

To explore factors affecting postoperative rebleeding in patients with spontaneous supratentorial intracerebral hemorrhage (SSICH).

METHODS

We retrospectively analyzed data from 724 patients with SSICH treated at Renmin Hospital of Wuhan University from December 2018 to October 2021. Finally, 294 people were eligible to be included in this study. Hematoma locations were classified as basal ganglia, thalamus, subcortex, or intraventricular. Surgery was categorized as neuroendoscopic surgery, burr hole (stereotactic drilling and drainage), or open craniotomy. Postoperative rebleeding was recorded. The incidence, risk factors, and prognosis of postoperative rebleeding were evaluated.

RESULTS

All procedures were successfully completed. Postoperative rebleeding occurred in 57 patients (19.83%, 57/294). Univariate logistic regression analysis identified these risk factors for rebleeding: admission Glasgow Coma Scale (GCS) score, irregular hematoma morphology by preoperative Computed Tomography (CT), postoperative hypertension, hematoma location, surgical method (P<0.05), and preoperative hematoma volume (P<0.1). Multivariate logistic regression analysis confirmed admission GCS score, irregular hematoma morphology by preoperative CT, postoperative hypertension, hematoma location, and surgical method as significant risk factors (P<0.05). Burr hole surgery and basal ganglia hematomas were associated with increased odds of rebleeding, and the mortality rates in patients with rebleeding versus no rebleeding were 7.02% versus 0.84%.

CONCLUSIONS

Neuroendoscopic surgery, craniotomy, and burr hole are all effective for treating SSICH, but burr hole surgery was an important risk factor for rebleeding and an adverse outcome. Admission GCS score, irregular hematoma morphology, blood pressure control, hematoma location, and surgical method are affected the risk of postoperative rebleeding. 3D Slicer-assisted neuroendoscopic surgery may be the most effective treatment for many patients with SSICH.

craniotomy in the treatment of adult intracranial arachnoid cyst

Purpose

Intracranial arachnoid cysts are common, accounting for about 1%-2% of intracranial space-occupying lesions. There is controversy over the method of surgical intervention, and in order to provide guidance for surgical decision making, this study compares the efficacy of craniotomy vs. neuroendoscopic surgery in treating arachnoid cysts.

Methods

The adult patients with arachnoid cyst admitted to our department from October 2016 to August 2021 were retrospectively analyzed. Thirteen adult patients were recruited, and divided into two groups: neuroendoscopic group (group A) and craniotomy group (group B). We compared the gender, age, clinical symptoms, preoperative and postoperative cyst sizes, symptom improvement, complications, length of hospital stay, and hospital costs between two groups to analyze the therapeutic effects of these two surgical methods.

Results

The cost of hospitalization in group A was significantly lower than that in group B (47,292.8 vs. 65,151.8 yuan, P < 0.05), and there was no difference in the length of hospital stay between the two groups. The preoperative cysts in group A were significantly larger than those in group B (6.38 vs. 2.97 cm, P < 0.05). In groups A and B, the short-term symptom improvement rates were 100% and 75.0%, respectively. The long-term symptom improvement rates were 77.78% and 75.0% (P > 0.05), respectively.

Conclusion

Both neuroendoscopic and craniotomy have good curative effects for the treatment of intracranial arachnoid cysts. There was no significant difference in the outcomes between the two surgical techniques. The cost of hospitalization can be reduced with neuroendoscopic surgery. Neuroendoscopic treatment is recommended for large intracranial arachnoid cysts, and craniotomy is suitable for small intracranial arachnoid cysts.

craniotomy in the treatment of adult intracranial arachnoid cyst

[This corrects the article DOI: 10.3389/fsurg.2022.1054416.].

Endoscopic Orbital and Periorbital Approaches in Minimally Disruptive Skull Base Surgery

Endoscopic surgery of the orbit, periorbital region, and adjacent areas of the anterior and middle cranial fossae and brain has gained significant popularity over the last decade. These procedures are now being used at multiple institutions internationally with a success and safety record that has been demonstrated to be at par with or better than other techniques. The approaches provide minimally disruptive, scarless access to regions that previously required extensive open operations with significant retraction of critical neurovascular structures leading to prolonged morbidity and hospitalization. This paper will describe the basic techniques of these approaches, how they can be used alone or in multiportal (para- and contraportal) technique and guide the reader to resources for further learning.

Analysis of three surgical treatments for spontaneous supratentorial intracerebral hemorrhage

This retrospective study aimed to evaluate the effectiveness and safety of 3 surgical procedures for Spontaneous Supratentorial Intracerebral Hemorrhage (SICH).A total of 63 patients with SICH were randomized into 3 groups. Group A (n = 21) underwent craniotomy surgery, group B (n = 22) underwent burr hole, urokinase infusion and catheter drainage, and group C (n = 20) underwent neuroendoscopic surgery. The hematoma evacuation rate of the operation was analyzed by 3D Slice software and the average surgery time, visualization during operation, decompressive effect, mortality, Glasgow Coma Scale (GCS) improvement, complications include rebleeding, pneumonia, intracranial infection were also compared among 3 groups.All procedures were successfully completed and the hematoma evacuation rate was significant differences among 3 groups which were 79.8%, 43.1%, 89.3% respectively (P < .01), and group C was the highest group. Group B was smallest traumatic one and shared the shortest operation time, but for the lack of hemostasis, it also the highest rebleeding group (P = .03). Although there were different in complications, but there was no significant in pneumonia, intracranial infection, GCS improvement and mortality rate.All these 3 methods had its own advantages and shortcomings, and every approach had its indications for SICH. Although for neuroendoscopic technical's minimal invasive, direct vision, effectively hematoma evacuation rate, and the relatively optimistic result, it might be a more promising approach for SICH.