{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T18:28:13Z","timestamp":1787682493207,"version":"build-2784847793"},"reference-count":33,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,12,1]]},"abstract":"<jats:sec>\n<jats:title>OBJECTIVE<\/jats:title>\n<jats:p>The endoscopic transorbital approach (ETOA) has been demonstrated to be a feasible ventral route to the petrous apex. Yet, it has been pointed to as a deep and narrow corridor for anterior petrosectomy; particularly, medialization of the instruments can become an issue when targeting the petroclival area. To overcome this limitation, an ETOA with orbital rim removal (ETOA-OR) has been suggested, but not de facto compared, with a transorbital approach without removal of the rim. This addition could augment the surgical exposure and freedom of movement when accessing the petrous apex area.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>Five human cadaveric heads (10 sides) were dissected. First, anterior petrosectomy was performed via a conventional ETOA (without orbital rim removal). Second, en bloc removal of the orbital rim was performed, with enlargement of the orbital craniectomy and, subsequently, further drilling of the medial petrous apex. Qualitative and quantitative comparisons are provided. An illustrative surgical case is also shown.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>The transorbital route allowed the authors to perform an anterior petrosectomy in all specimens. The landmarks of bone removal are superposed onto those in the transcranial route. The ETOA-OR increased the volume of craniectomy (from 4.0 mL to 5.5 mL), the lateromedial angulation, and superoinferior angulation of the instruments within the petrous area. Thus, this approach improved the exposure of the medial petroclival area, allowing for an augmented petrosectomy (from 1.4 mL to 2.0 mL, 39.5% increase) and for increased maneuverability, both in the petrous area (from 44.1 cm<jats:sup>2<\/jats:sup> to 76.5 cm<jats:sup>2<\/jats:sup>, 73.3% increase) and in the posterior fossa (from 20.2 cm<jats:sup>2<\/jats:sup> to 52.0 cm<jats:sup>2<\/jats:sup>, 158% increase). The ETOA-OR was also pragmatically applied to treat a recurrent petroclival meningioma. Complete removal was achieved, the abducens nerve palsy improved, and the trigeminal neuralgia decreased in severity, yet still required medication.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>The authors provide the first formal anatomical comparison between the transorbital approach with preservation of the orbital rim and a transorbital approach with removal of the rim to access the petrous apex. In addition, an illustrative case is used as a proof of concept and feasibility. According to the authors\u2019 data, the ETOA-OR significantly improves surgical exposure and the surgeon\u2019s comfort in this deep region. The bony defect can be reconstructed to avoid cosmetic deformities, maintaining the minimally disruptive concept of transorbital surgery.<\/jats:p>\n<\/jats:sec>","DOI":"10.3171\/2024.3.jns232834","type":"journal-article","created":{"date-parts":[[2024,6,15]],"date-time":"2024-06-15T01:22:59Z","timestamp":1718414579000},"page":"1595-1603","source":"Crossref","is-referenced-by-count":11,"title":["Endoscopic transorbital approach to the petrous apex: is orbital rim removal worthwhile for the exposure? An anatomical study with illustrative case"],"prefix":"10.3171","volume":"141","author":[{"given":"Chang-Ki","family":"Hong","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Asan Medical Center, Ulsan University School of Medicine, Seoul, South Korea;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alejandra","family":"Mosteiro","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Doo-Sik","family":"Kong","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberto","family":"Tafuto","sequence":"additional","affiliation":[{"name":"Department of Neurosciences, Division of Neurosurgery, Reproductive and Odontostomatological Sciences, Universit\u00e0 degli Studi di Napoli \"Federico II,\" Naples, Italy;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marta","family":"Codes","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abel","family":"Ferres","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica","family":"Matas","sequence":"additional","affiliation":[{"name":"Ophthalmology, Hospital Clinic, Barcelona, Spain;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberto","family":"Manfrellotti","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Azienda Socio Sanitaria Territoriale\u2013Monza, Ospedale San Gerardo, Monza, Italy;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alberto","family":"Prats-Galino","sequence":"additional","affiliation":[{"name":"Laboratory of Surgical Neuroanatomy, Faculty of Medicine, Universitat de Barcelona, Spain; and"},{"name":"Research Group of Clinical Neurophysiology, Institut d\u2019Investigacions Biom\u00e8diques August Pi i Sunyer (IDIBAPS), Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alberto","family":"Di Somma","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joaquim","family":"Ense\u00f1at","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1","series-title":"World Neurosurg","first-page":"54","article-title":"Endoscopic transorbital surgery: another leap of faith?","volume":"159","author":"Schwartz TH","year":"2022","unstructured":"Schwartz TH, Henderson F Jr, Di Somma A,  Endoscopic transorbital surgery: another leap of faith? World Neurosurg. 2022;159:54\u201355."},{"issue":"5","key":"b2","series-title":"J Neurosurg Sci","first-page":"406","article-title":"Combined endoscopic endonasal and transorbital approach to skull base tumors: a systematic literature review","volume":"66","author":"Di Somma A","year":"2022","unstructured":"Di Somma A, Guizzardi G, Valls Cusin\u00e9 C,  Combined endoscopic endonasal and transorbital approach to skull base tumors: a systematic literature review. J Neurosurg Sci. 2022;66(5):406\u2013412."},{"issue":"4","key":"b3","series-title":"J Neurosurg","first-page":"1187","article-title":"Endoscopic transorbital surgery levels of difficulty","volume":"137","author":"Di Somma A","year":"2022","unstructured":"Di Somma A, Kong DS, de Notaris M,  Endoscopic transorbital surgery levels of difficulty. J Neurosurg. 2022;137(4):1187\u20131190."},{"issue":"4","key":"b4","series-title":"Acta Neurochir (Wien)","first-page":"707","article-title":"Endoscopic transorbital route to the petrous apex: a feasibility anatomic study","volume":"160","author":"Di Somma A","year":"2018","unstructured":"Di Somma A, Andaluz N, Cavallo LM,  Endoscopic transorbital route to the petrous apex: a feasibility anatomic study. Acta Neurochir (Wien). 2018;160(4):707\u2013720."},{"issue":"9","key":"b5","series-title":"Acta Neurochir (Wien)","first-page":"2097","article-title":"Endoscopic endonasal and transorbital routes to the petrous apex: anatomic comparative study of two pathways","volume":"162","author":"Topczewski TE","year":"2020","unstructured":"Topczewski TE, Di Somma A, Pineda J,  Endoscopic endonasal and transorbital routes to the petrous apex: anatomic comparative study of two pathways. Acta Neurochir (Wien). 2020;162(9):2097\u20132109."},{"key":"b6","series-title":"World Neurosurg","first-page":"e405","article-title":"Extended anterior petrosectomy through the transcranial middle fossa approach and extended endoscopic transsphenoidal-transclival approach: qualitative and quantitative anatomic analysis","volume":"138","author":"Hasanbelliu A","year":"2020","unstructured":"Hasanbelliu A, Andaluz N, Di Somma A,  Extended anterior petrosectomy through the transcranial middle fossa approach and extended endoscopic transsphenoidal-transclival approach: qualitative and quantitative anatomic analysis. World Neurosurg. 2020;138:e405\u2013e412."},{"issue":"4","key":"b7","series-title":"J Neurosurg","first-page":"1126","article-title":"Endoscopic transorbital surgery for Meckel\u2019s cave and middle cranial fossa tumors: surgical technique and early results","volume":"131","author":"Jeon C","year":"2018","unstructured":"Jeon C, Hong CK, Woo KI,  Endoscopic transorbital surgery for Meckel\u2019s cave and middle cranial fossa tumors: surgical technique and early results. J Neurosurg. 2018;131(4):1126\u20131135."},{"issue":"2","key":"b8","series-title":"J Neurosurg","first-page":"431","article-title":"Endoscopic endonasal and transorbital approaches to petrous apex lesions","volume":"136","author":"Lee WJ","year":"2021","unstructured":"Lee WJ, Hong SD, Woo KI,  Endoscopic endonasal and transorbital approaches to petrous apex lesions. J Neurosurg. 2021;136(2):431\u2013440."},{"issue":"2","key":"b9","series-title":"J Neurosurg","first-page":"467","article-title":"Endoscopic transorbital and endonasal approach for trigeminal schwannomas: a retrospective multicenter analysis (KOSEN-005)","volume":"133","author":"Park HH","year":"2020","unstructured":"Park HH, Hong SD, Kim YH,  Endoscopic transorbital and endonasal approach for trigeminal schwannomas: a retrospective multicenter analysis (KOSEN-005). J Neurosurg. 2020;133(2):467\u2013476."},{"issue":"1","key":"b10","series-title":"Oper Neurosurg (Hagerstown)","first-page":"86","article-title":"Comparative analysis between lateral orbital rim preservation and osteotomy for transorbital endoscopic approaches to the cavernous sinus: an anatomic study","volume":"16","author":"Noiphithak R","year":"2019","unstructured":"Noiphithak R, Yanez-Siller JC, Revuelta Barbero JM, Otto BA, Carrau RL, Prevedello DM. Comparative analysis between lateral orbital rim preservation and osteotomy for transorbital endoscopic approaches to the cavernous sinus: an anatomic study. Oper Neurosurg (Hagerstown). 2019;16(1):86\u201393."},{"issue":"1","key":"b11","series-title":"J Neurosurg","first-page":"18","article-title":"Extended endoscopic transorbital approach with superior-lateral orbital rim osteotomy: cadaveric feasibility study and clinical implications (SevEN-007)","volume":"137","author":"Lim J","year":"2021","unstructured":"Lim J, Sung KS, Kim W,  Extended endoscopic transorbital approach with superior-lateral orbital rim osteotomy: cadaveric feasibility study and clinical implications (SevEN-007). J Neurosurg. 2021;137(1):18\u201331."},{"issue":"7","key":"b12","series-title":"Acta Neurochir (Wien)","first-page":"1953","article-title":"Endoscopic superior eyelid transorbital approach: how I do it","volume":"164","author":"Di Somma A","year":"2022","unstructured":"Di Somma A, Sanchez Espa\u00f1a JC, Alobid I, Ense\u00f1at J. Endoscopic superior eyelid transorbital approach: how I do it. Acta Neurochir (Wien). 2022;164(7):1953\u20131959."},{"key":"b13","series-title":"Front Surg","first-page":"1007447","article-title":"Superior eyelid endoscopic transorbital approach to the tentorial area: a qualitative and quantitative anatomic study","volume":"9","author":"De Rosa A","year":"2022","unstructured":"De Rosa A, Di Somma A, Mosteiro A,  Superior eyelid endoscopic transorbital approach to the tentorial area: a qualitative and quantitative anatomic study. Front Surg. 2022;9:1007447."},{"key":"b14","series-title":"World Neurosurg","first-page":"e236","article-title":"A frontal route to middle and posterior cranial fossa: quantitative study for the lateral transorbital endoscopic approach and comparison with the subtemporal approach","volume":"167","author":"Garc\u00eda-P\u00e9rez D","year":"2022","unstructured":"Garc\u00eda-P\u00e9rez D, Abarca J, Gonz\u00e1lez-L\u00f3pez P, Nieto J, Lagares A, Paredes I. A frontal route to middle and posterior cranial fossa: quantitative study for the lateral transorbital endoscopic approach and comparison with the subtemporal approach. World Neurosurg. 2022;167:e236\u2013e250."},{"issue":"4","key":"b15","series-title":"Oper Neurosurg (Hagerstown)","first-page":"e267","article-title":"Endoscopic transorbital approach to the middle fossa: qualitative and quantitative anatomic study","volume":"23","author":"Guizzardi G","year":"2022","unstructured":"Guizzardi G, Mosteiro A, Hoyos J,  Endoscopic transorbital approach to the middle fossa: qualitative and quantitative anatomic study. Oper Neurosurg (Hagerstown). 2022;23(4):e267\u2013e275."},{"key":"b16","series-title":"World Neurosurg","first-page":"e86","article-title":"Minimally invasive approaches to the lateral cavernous sinus and Meckel\u2019s cave: comparison of transorbital and subtemporal endoscopic techniques","volume":"141","author":"Lima LR","year":"2020","unstructured":"Lima LR, Beer-Furlan A, Prevedello DM,  Minimally invasive approaches to the lateral cavernous sinus and Meckel\u2019s cave: comparison of transorbital and subtemporal endoscopic techniques. World Neurosurg. 2020;141:e86\u2013e96."},{"issue":"4","key":"b17","series-title":"Acta Neurochir (Wien)","first-page":"831","article-title":"Endoscopic transorbital transtentorial approach to middle incisural space: preclinical cadaveric study","volume":"161","author":"Lin BJ","year":"2019","unstructured":"Lin BJ, Hong KT, Chung TT,  Endoscopic transorbital transtentorial approach to middle incisural space: preclinical cadaveric study. Acta Neurochir (Wien). 2019;161(4):831\u2013839."},{"issue":"3 Suppl Operative","key":"b18","series-title":"Neurosurgery","first-page":"ons16","article-title":"Transorbital neuroendoscopic surgery","volume":"67","author":"Moe KS","year":"2010","unstructured":"Moe KS, Bergeron CM, Ellenbogen RG. Transorbital neuroendoscopic surgery. Neurosurgery. 2010;67(3 Suppl Operative):ons16\u2013ons28."},{"issue":"5","key":"b19","series-title":"Oper Neurosurg (Hagerstown)","first-page":"614","article-title":"A side door to Meckel\u2019s cave: anatomic feasibility study for the lateral transorbital approach","volume":"13","author":"Priddy BH","year":"2017","unstructured":"Priddy BH, Nunes CF, Beer-Furlan A, Carrau R, Dallan I, Prevedello DM. A side door to Meckel\u2019s cave: anatomic feasibility study for the lateral transorbital approach. Oper Neurosurg (Hagerstown). 2017;13(5):614\u2013621."},{"issue":"6 Suppl","key":"b20","series-title":"World Neurosurg","first-page":"S121","article-title":"Endonasal endoscopic approaches to the paramedian skull base","volume":"82","author":"de Lara D","year":"2014","unstructured":"de Lara D, Ditzel Filho LF, Prevedello DM,  Endonasal endoscopic approaches to the paramedian skull base. World Neurosurg. 2014;82(6 Suppl):S121\u2013S129."},{"issue":"5","key":"b21","series-title":"Oper Neurosurg (Hagerstown)","first-page":"557","article-title":"Endoscopic endonasal petrosectomy: anatomical investigation, limitations, and surgical relevance","volume":"16","author":"Borghei-Razavi H","year":"2019","unstructured":"Borghei-Razavi H, Truong HQ, Fernandes Cabral DT,  Endoscopic endonasal petrosectomy: anatomical investigation, limitations, and surgical relevance. Oper Neurosurg (Hagerstown). 2019;16(5):557\u2013570."},{"issue":"6","key":"b22","series-title":"Oper Neurosurg (Hagerstown)","first-page":"E494","article-title":"Quantitative anatomic comparison of microsurgical transcranial, endoscopic endonasal, and transorbital approaches to the spheno-orbital region","volume":"21","author":"Agosti E","year":"2021","unstructured":"Agosti E, Turri-Zanoni M, Saraceno G,  Quantitative anatomic comparison of microsurgical transcranial, endoscopic endonasal, and transorbital approaches to the spheno-orbital region. Oper Neurosurg (Hagerstown). 2021;21(6):E494\u2013E505."},{"issue":"7","key":"b23","series-title":"Acta Neurochir (Wien)","first-page":"1821","article-title":"The feasibility of three port endonasal, transorbital, and sublabial approach to the petroclival region: neurosurgical audit and multiportal anatomic quantitative investigation","volume":"165","author":"Corvino S","year":"2023","unstructured":"Corvino S, Guizzardi G, Sacco M,  The feasibility of three port endonasal, transorbital, and sublabial approach to the petroclival region: neurosurgical audit and multiportal anatomic quantitative investigation. Acta Neurochir (Wien). 2023;165(7):1821\u20131831."},{"issue":"6","key":"b24","series-title":"J Neurosurg","first-page":"1836","article-title":"Combined and simultaneous endoscopic endonasal and transorbital surgery for a Meckel\u2019s cave schwannoma: technical nuances of a mini-invasive, multiportal approach","volume":"134","author":"Di Somma A","year":"2020","unstructured":"Di Somma A, Langdon C, de Notaris M,  Combined and simultaneous endoscopic endonasal and transorbital surgery for a Meckel\u2019s cave schwannoma: technical nuances of a mini-invasive, multiportal approach. J Neurosurg. 2020;134(6):1836\u20131845."},{"issue":"5","key":"b25","series-title":"J Neurosurg","first-page":"967","article-title":"The endoscopic, endonasal, transmaxillary transpterygoid approach to the pterygopalatine fossa, infratemporal fossa, petrous apex, and the Meckel cave","volume":"113","author":"Hofstetter CP","year":"2010","unstructured":"Hofstetter CP, Singh A, Anand VK, Kacker A, Schwartz TH. The endoscopic, endonasal, transmaxillary transpterygoid approach to the pterygopalatine fossa, infratemporal fossa, petrous apex, and the Meckel cave. J Neurosurg. 2010;113(5):967\u2013974."},{"issue":"7","key":"b26","series-title":"Acta Neurochir (Wien)","first-page":"1911","article-title":"Combined endoscopic endonasal and transorbital multiportal approach for complex skull base lesions involving multiple compartments","volume":"164","author":"Lee WJ","year":"2022","unstructured":"Lee WJ, Hong SD, Woo KI,  Combined endoscopic endonasal and transorbital multiportal approach for complex skull base lesions involving multiple compartments. Acta Neurochir (Wien). 2022;164(7):1911\u20131922."},{"issue":"3","key":"b27","series-title":"J Neurosurg Sci","first-page":"322","article-title":"The limits of the endoscopic endonasal transclival approach for posterior fossa tumors","volume":"62","author":"Bossi Todeschini A","year":"2018","unstructured":"Bossi Todeschini A, Montaser AS, Hardesty DA, Carrau RL, Prevedello DM. The limits of the endoscopic endonasal transclival approach for posterior fossa tumors. J Neurosurg Sci. 2018;62(3):322\u2013331."},{"issue":"1","key":"b28","series-title":"Sci Rep","first-page":"3012","article-title":"The transnasal endoscopic approach for resection of clival tumors: a single-center experience","volume":"13","author":"Butenschoen VM","year":"2023","unstructured":"Butenschoen VM, Krauss P, Bernhardt D,  The transnasal endoscopic approach for resection of clival tumors: a single-center experience. Sci Rep. 2023;13(1):3012."},{"key":"b29","series-title":"World Neurosurg","first-page":"e246","article-title":"Endoscopic endonasal transclival approach to tumors of the clivus and anterior region of the posterior cranial fossa (results of surgical treatment of 136 patients)","volume":"121","author":"Shkarubo AN","year":"2019","unstructured":"Shkarubo AN, Koval KV, Chernov IV, Andreev DN, Panteleyev AA. Endoscopic endonasal transclival approach to tumors of the clivus and anterior region of the posterior cranial fossa (results of surgical treatment of 136 patients). World Neurosurg. 2019;121:e246\u2013e261."},{"issue":"1","key":"b30","series-title":"J Neurol Surg B Skull Base","first-page":"18","article-title":"The risk of meningitis following expanded endoscopic endonasal skull base surgery: a systematic review","volume":"75","author":"Lai LT","year":"2014","unstructured":"Lai LT, Trooboff S, Morgan MK, Harvey RJ. The risk of meningitis following expanded endoscopic endonasal skull base surgery: a systematic review. J Neurol Surg B Skull Base. 2014;75(1):18\u201326."},{"issue":"12","key":"b31","series-title":"Brain Sci","first-page":"1685","article-title":"Endoscopic endonasal skull base surgery complication avoidance: a contemporary review","volume":"12","author":"Porras JL","year":"2022","unstructured":"Porras JL, Rowan NR, Mukherjee D. Endoscopic endonasal skull base surgery complication avoidance: a contemporary review. Brain Sci. 2022;12(12):1685."},{"issue":"2","key":"b32","series-title":"Neurosurgery","first-page":"309","article-title":"Lateral orbitotomy approach for lesions involving the middle fossa: a retrospective review of thirteen patients","volume":"80","author":"Chabot JD","year":"2017","unstructured":"Chabot JD, Gardner PA, Stefko ST, Zwagerman NT, Fernandez-Miranda JC. Lateral orbitotomy approach for lesions involving the middle fossa: a retrospective review of thirteen patients. Neurosurgery. 2017;80(2):309\u2013322."},{"issue":"3-4","key":"b33","series-title":"Acta Neurochir (Wien)","first-page":"113","article-title":"Middle fossa transpetrosal\u2013transtentorial approaches for petroclival meningiomas. Selective pyramid resection and radicality","volume":"129","author":"Kawase T","year":"1994","unstructured":"Kawase T, Shiobara R, Toya S. Middle fossa transpetrosal\u2013transtentorial approaches for petroclival meningiomas. Selective pyramid resection and radicality. Acta Neurochir (Wien). 1994;129(3-4):113\u2013120."}],"container-title":["Journal of Neurosurgery"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/141\/6\/article-p1595.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/141\/6\/article-p1595.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/141\/6\/article-p1595.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,12,12]],"date-time":"2024-12-12T15:44:54Z","timestamp":1734018294000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/141\/6\/article-p1595.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,12,1]]},"references-count":33,"journal-issue":{"issue":"6"},"URL":"https:\/\/doi.org\/10.3171\/2024.3.jns232834","relation":{},"ISSN":["0022-3085","1933-0693"],"issn-type":[{"value":"0022-3085","type":"print"},{"value":"1933-0693","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,12,1]]}}}