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S120: ENDOSCOPIC TRANSORBITAL APPROACH FOR SKULL BASE TUMORS: EARLY CLINICAL EXPERIENCE AT A TERTIARY NEUROSURGICAL CENTER IN MEXICO CITY
Andrea Garcia-Bitar, MD; Paola M Quiñones-Nájera, MD; Luis A Rodríguez-Hernández, MD; Rodolfo Villalobos-Díaz, MD; Edgardo J Mateo-Nouel, MD; Alejandra A Mendoza-Sandoval, MD; Gerardo Y Guinto-Nishimura, MD; Juan L Gómez-Amador, MD; Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suárez"

Objectives: The objective of this study was to evaluate the effectiveness, defined by extent of resection and volumetric analysis, and the safety profile, defined by complications and visual outcomes, of the endoscopic transorbital approach (ETOA) for skull base tumors. An additional objective was to describe the applicability of a combined ETOA and transnasal endoscopic (TNE) strategy for complex lesions.

Background: The ETOA provides a minimally invasive corridor to the anterior and middle cranial fossa, minimizing brain retraction and potentially improving recovery and cosmetic outcomes. While increasing evidence supports its use in Europe, Asia, and North America, reports from Latin America are lacking. This study presents one of the first prospective case series in the region, offering early experience and outcomes.

Methods: A prospective observational case series was conducted including consecutive adult patients undergoing tumor resection via ETOA between January 2023 and March 2025. Demographic, histopathological, surgical, volumetric, and postoperative data were systematically collected. Volumetric analysis included pre- and postoperative tumor volumes and extent of resection (EOR). Visual outcomes were assessed using a standardized scale from amaurosis (0) to <20/60 (5). Descriptive statistics were performed.

Results: Twelve patients were included, with a median age of 41 years, ranging from 27 to 57 years. Pathologies included seven meningiomas, two schwannomas (trigeminal and orbital recurrent), one chordoid chordoma, one plasmacytoma positive for lambda light chains, and one non-functioning pituitary neuroendocrine tumor (PitNET). The PitNET was treated with a combined ETOA and TNE approach. Volumetric data were available for a subset: the median preoperative tumor volume was 44.7 cm3 (range 5.7–92.5), the median postoperative volume was 0.7 cm3 (range 0–32.3), and the median EOR was 89.7% (range 13.2–100%). The median operative time was 5 hours, blood loss was approximately 200 ml, and hospital stay was 8 days. Six patients (50%) developed perioperative complications recorded in the database, though none required reoperation, and no vascular injuries, infections, or deaths occurred. One patient (8%) developed a cerebrospinal fluid fistula that resolved conservatively. Tumor recurrence within six months occurred in two patients (16%), both after subtotal resection. Visual outcomes showed improvement in three patients (25%), deterioration in four patients (33%) including one with new amaurosis, and stability in five patients (42%).

Conclusions: The ETOA is a feasible and safe approach for selected skull base tumors, achieving satisfactory resection rates and an acceptable complication profile. Volumetric analysis confirmed high resection rates in most cases, while visual outcomes highlighted both the potential for functional recovery and the risk of postoperative decline. The successful use of a combined ETOA and TNE underscores the adaptability of minimally invasive skull base strategies. This study represents one of the first prospective Latin American series on ETOA and supports its incorporation into skull base practice, although multicenter studies with larger cohorts and longer follow-up are needed to confirm long-term oncological and functional outcomes.

 

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