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Exo- and endoscopic lateral orbital wall approach for the medial temporal lobe glioma: how I do it

  • How I Do it
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Abstract

Background

The endoscopic transorbital approach provides a direct access to the medial temporal lobe (MTL). However, when excising a highly vascular tumour, a wider access route that enables the concurrent use of standard neurosurgical instruments with both hands is preferable.

Method

We described the concept and technique of the lateral orbital wall approach (LOWA), which comprises orbitotomy and mini-craniotomy to treat MTL lesions using an exoscope and endoscope.

Conclusion

The LOWA provides a safe and natural surgical corridor to the MTL and enables 2- or 3-hand surgery. Hence, LOWA can potentially improve safety and efficiency to treat MTL lesions.

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Data availability

The data supporting the findings of this study are available from the corresponding author, KI, upon reasonable request.

Abbreviations

MTL:

Medial temporal lobe

LOWA:

Lateral orbital wall approach

LTL:

Lateral temporal lobe

ESTA:

Endoscopic superior eyelid transorbital approach

MRI:

Magnetic resonance imaging

CSF:

Cerebrospinal fluid

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Acknowledgements

We thank all staff members of the Department of Neurosurgery at Aichi Medical University for their support and for taking care of the patients in this study.

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute City, Aichi Prefecture, 480-1195, Japan

    Kenichiro Iwami, Tadashi Watanabe & Koji Osuka

  2. Skull Base Surgery Center, Aichi Medical University Hospital, 1-1 Yazakokarimata, Nagakute City, Prefecture Aichi, 480-1195, Japan

    Kenichiro Iwami

  3. Department of Neurosurgery, Fukushima Medical University, Fukushima, Japan

    Masazumi Fujii

Authors
  1. Kenichiro Iwami
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  2. Masazumi Fujii
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  3. Tadashi Watanabe
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  4. Koji Osuka
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Contributions

Conception and design: Kenichiro Iwami and Tadashi Watanabe. Data acquisition: Kenichiro Iwami and Koji Osuka. Data analysis and interpretation: Kenichiro Iwami and Koji Osuka. Drafting of the article: Kenichiro Iwami. Critical revision of the article: Kenichiro Iwami and Masazumi Fujii. Review of the submitted version of the manuscript: All authors. Kenichiro Iwami approved the final version of the manuscript on behalf of all authors. Administrative/technical support: Kenichiro Iwami. Study supervision: Kenichiro Iwami and Masazumi Fujii.

Corresponding author

Correspondence to Kenichiro Iwami.

Ethics declarations

Ethics approval and consent to participate

This study was conducted in accordance with the guidelines of the Declaration of Helsinki and approved by the Institutional Review Board of Aichi Medical University Hospital (approval number: 2020–020). Written informed consent was obtained from all the patients.

Conflict of interest

The authors declare no competing interest.

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Key Points

1. Advantages of the lateral orbitotomy approach include direct access to the MTL while reserving the LTL and a wide enough surgical corridor to perform 2- or 3-hand surgery using common neurosurgical instruments.

2. Considering the importance of the dominant hemisphere’s temporal lobe verbal function and the tendency of malignant gliomas to bleed, the LOWA should be used to treat malignant gliomas occurring in the dominant hemisphere’s MTL.

3. The Z-shaped skin incision was made along the lateral orbital rim, allowing for effective dissection of the orbital periosteum and temporal muscle from the lateral orbital wall.

4. Osteoplastic bone flap of approximately 2 × 2 cm from the lateral orbital wall was removed.

5. A small oval craniotomy was performed on the greater sphenoid wing, just lateral to the superior orbital fissure.

6. The dura mater was cut to expose the temporal tip.

7. The tumour’s anterior part was dissected and removed using the stereoscopic view of an exoscope.

8. An endoscope can improve the visualisation during the removal of tumours in the deep part.

9. Meticulous layer-by-layer closure of the wound prevented CSF leak and minimised postoperative cosmetic problems.

10. The LOWA can be used in many neurosurgical institutions because it employs techniques and tools commonly used in microscopic surgery.

Supplementary Information

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Iwami, K., Fujii, M., Watanabe, T. et al. Exo- and endoscopic lateral orbital wall approach for the medial temporal lobe glioma: how I do it. Acta Neurochir 166, 110 (2024). https://doi.org/10.1007/s00701-024-06011-3

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