Ophthalmic Outcomes of Transorbital Endoscopic Skull Base Surgery

Area of Science:

• Neurosurgery
• Ophthalmology
• Skull Base Surgery

Background:

• Transorbital endoscopic approaches provide minimally invasive access to the skull base.
• These techniques aim to decrease surgical morbidity in select patients.

Purpose of the Study:

• To expand understanding of transorbital neurological surgery.
• To analyze ophthalmologic outcomes and morbidity in a larger cohort with extended follow-up.

Main Methods:

• Retrospective consecutive case review of lateral transorbital endoscope-assisted surgeries (2016-2024).
• Stratification into four groups based on pathology/location: intradural, extradural, cavernous sinus/Meckel cave, and sphenoid wing meningiomas.
• Collection of demographic and detailed ophthalmologic data.

Main Results:

• Thirty-five patients included across four pathological groups.
• Visual acuity and visual field mean deviation trended towards improvement but lacked statistical significance.
• Significant improvements observed in diplopia (p=0.01), extraocular motility (p=0.04), and exophthalmos (p=0.04).
• Persistent V1/V2 hypoesthesia occurred in 66% of subjects postoperatively.

Conclusions:

• Lateral transorbital endoscopic approaches demonstrate favorable ophthalmological morbidity profiles.
• Visual outcomes are generally stable or improved, with significant functional gains.
• Patients must be counseled regarding the risk of persistent facial hypoesthesia.