2025 Proffered Presentations
S370: ENDOSCOPIC TRANSORBITAL APPROACH FOR SELECT RECURRENT AND NEWLY DIAGNOSED ANTEROMEDIAL TEMPORAL LOBE GLIOMAS
Jonathan A Tangsrivimol, MD; Nader Delavari, MD; Kyle Godfrey, MD; Thoedore H Schwartz, MD; Weill Cornell Medicine
Objective: The endoscopic lateral transorbital approach (eLTOA) has emerged as a minimal access technique for accessing the middle fossa and periorbital region. This study explores the applicability of eLTOA in the management of recurrent and newly diagnosed medial temporal lobe gliomas.
Methods: Forty patients at our institution underwent eLTOA between 2016 and 2024. There were 5 surgeries for glioma. Patients were assessed for demographic and clinical data, radiographic characteristics, and histopathological and molecular findings.
Results: There were four recurrent gliomas in need of biopsy for diagnosis and molecular genotyping and one newly diagnosed tumor, where the aim was gross-total resection. Histologic diagnoses remained unchanged in three recurrent cases (two glioblastoma multiforme [GBM] and one xanthoastrocytoma). One case was upgraded from oligoastrocytoma Grade II to glioblastoma Grade IV. GTR was obtained in the newly diagnosed tumor and histology was dysembryoplastic neuroepithelial tumor (DNET). Average length of stay was 3 days. There was one case of transient diplopia.
Discussion: We have presented a small case series in which eLTOA was used to approach the anteromedial temporal lobe to manage recurrent and newly diagnosed gliomas. We chose to use this approach because our center developed a facility with it for removing middle fossa skull base tumors and realized that it also offered advantages for select intraparenchymal tumors. The most common approach for newly diagnosed temporal lobe gliomas is a standard temporal lobe craniotomy, which is performed through a reverse question mark skin incision with splitting and downward mobilization of the temporalis muscle and a craniotomy to expose the temporal lobe neocortex. When these tumors recur, this same approach is used again for diagnostic confirmation, restaging, additional cytoreduction and molecular characterization. However, reopening previously irradiated scarred skin, muscle and dura can be tedious and the risk of infection and post-operative discomfort is not insignificant. Moreover, if the recurrence occurs in the medial temporal lobe, sacrifice of some amount of overlying neocortex may be required, which risks damage to areas of brain that may be important for language processing on the dominant side, as well as the optic radiations.
Conclusions: eLTOA offers a minimally invasive, direct approach to medial temporal lobe gliomas that minimizes the risks of infection and temporalis muscle atrophy associated with reoperation through a previously irradiated incision. We found it most useful for restaging recurrent tumors, although GTR can be obtained in well-selected newly diagnosed tumors.