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P033: ENDOSCOPIC TRANSORBITAL APPROACH FOR SKULL BASE AND ORBITAL PATHOLOGIES: A SYSTEMATIC REVIEW AND META-ANALYSIS
Rudolfh Batista Arend, MS¹; Bruno Zilli Peroni, MS¹; Filipe Virgilio Ribeiro, MS²; Daniel Marchi Kieling, MS¹; Victor Luiz Ferreira Kauer, MS¹; Henrique Padilha Gnoatto, MS¹; Daniel Felipe Savaris, MS¹; Anderson Silva Corin, MS³; Pedro Henrique Ieggli, MS¹; Raphael Bertani, MD⁴; Alex Roman, MsC, MD⁵; Martin Batista Coutinho da Silva, MD⁶; Guilherme Gago⁷; ¹Federal University of Fronteira Sul, Passo Fundo, RS, Brazil; ²Barão de Mauá Faculty of Medicine, Ribeirão Preto, SP, Brazil; ³Federal University of Pelotas, Pelotas, RS, Brazil; ⁴Hospital Israelita Albert Einstein, SP, Brazil; ⁵Institute of Neurosurgery and Spine Surgery (INCC), Passo Fundo, RS, Brazil; ⁶University of Passo Fundo, Passo Fundo, Brazil; ⁷Université Laval, Quebec, Canada

Objective: To evaluate the complication rates associated with the Endoscopic Transorbital Approach (ETOA) in the management of skull base and orbital pathologies.

Method: We systematically searched on PubMed, Embase, Scopus, and Web of Science up to July 2025. We included studies reporting patients with diverse skull base and orbital pathologies treated unically via an ETOA, with mortality, morbidity, early and/or long-term complications data; we excluded studies with mixed approaches, series with <5 patients, and secondary evidence (systematic reviews/meta-analyses, conference abstracts, case reports). A single-group meta-analysis of proportions was performed using random-effects with Freeman–Tukey transformation; heterogeneity was summarized with I². Funnel asymmetry was assessed with Egger’s test. Full protocol was registered in PROSPERO (CRD420251130069).

Result: A total of 14 observational studies, comprising 249 patients, were included. Superior eyelid incision was employed in 60% of the studies. Of 25 different pathologies, meningioma represented the most frequent lesion (74.9% of cases), followed by dermoid cyst (3.4%) and glioma (2.9%).  Mean follow-up was 22.8 ± 15.8 months. CSF leak was observed in 1% (95%CI: 0.00-0.03; I²=0%). Ptosis and diplopia occurred in 2% (95%CI: 0.00-0.06, I²=21.6%; 95%CI: 0.00-0.07, I²=34.3%, respectively). Medial gaze palsy occurred in 4% (95%CI: 0.00-0.08; I²=38.9%). Omitting Yoo et al., medial gaze palsy occurred in 3% (95%CI: 0.00-0.08; I²=0%). Improvement in visual function was seen in 51% (95%CI: 0.25-0.78; I²=91.1%). Omitting Dallan et al., improvement in visual function occurred in 38% (95%CI: 0.19-0.57; I²=69.5%). Visual dysfunction was observed in 1% (95%CI: 0.00-0.03; I²=43.9%). Removing Feller et al., visual dysfunction represented 0% (95%CI: 0.00-0.03; I²=0%). Transient facial numbness occurred in 7% (95%CI: 0.01-0.14; I²=26.3%). Wound infection occurred in 2% (95%CI: 0.00-0.05; I²=0%). Mortality was 0% (95%CI: 0.00-0.03; I²=68%). During follow-up, 2 deaths were observed due to disease-progression.

Conclusion: ETOA is a safe technique for managing diverse skull base and orbital lesions, with low rates of CSF leak, visual dysfunction, and cranial nerve complications. Functional outcomes are generally favorable, and morbimortality is minimal. Heterogeneity in pathologies and techniques limits definitive conclusions. Future prospective and comparative studies are needed to clarify indications, optimize surgical planning, and standardize outcome reporting.

Figure 1: PRISMA Flow Diagram

 

Figure 2: Forest plot of cerebrospinal fluid leak

 

Figure 3: (A) Forest plot, (B) Baujat plot and (C) leave-one-out analysis of recurrence rates

Figure 4: Forest plot of mortality

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