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P323: DYNAMIC TWO-MAN ENDOSCOPIC TRANSORBITAL SURGERY: EARLY EXPERIENCE IN ONE INSTITUTION
Ya-Jui Lin¹; Cheng-Chi Lee¹; Bo-Ru Lai²; Ju-En Nien¹; Kuo-Chen Wei¹; ¹Department of Neurosurgery, Chang Gung Memorial Hospital, Linkou; ²Division of Trauma Plastic Surgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou, and Craniofacial Research Center

Background: The endoscopic transorbital approach (ETOA) provides a minimally invasive route to the anterior and middle cranial fossa. However, the narrow operative corridor can limit maneuverability when performed by a single surgeon. The two-man, four-handed technique—where one surgeon dynamically controls the endoscope while the other performs bimanual dissection—may overcome these limitations and enhance surgical safety.

Methods: We retrospectively reviewed 12 patients who underwent two-man ETOA at Linkou Chang Gung Memorial Hospitalbetween November 2024 and September 2025. Patient demographics, pathology, extent of resection, operative time, complications, and outcomes were analyzed.

Results: Pathologies included 8 meningiomas, 2 metastatic tumors, and 2 gliomas. Extent of resection was gross total in 4 cases, near-total in 4 cases, subtotal in 2 cases, and biopsy in 2 cases. The two-man technique allowed continuous dynamic visualization and facilitated bimanual dissection with reduced need for endoscope repositioning. There was no mortality, no cerebrospinal fluid (CSF) leak, and no diplopia. All patients achieved good cosmetic outcomes.

Conclusion: The two-man endoscopic transorbital approach is a safe and effective option for selected anterior and middle cranial fossa tumors. By combining dynamic endoscopy with true bimanual dissection, this collaborative method enhances surgical ergonomics, facilitates maximal safe resection, and provides diagnostic access when complete removal is not feasible. Our early experience demonstrates excellent safety and cosmetic results; further studies are warranted to validate these findings.

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