Ophthalmic Outcomes of Transorbital Endoscopic Skull Base Surgery

Transorbital endoscopic approaches to the skull base provide minimally invasive access with decreased surgical morbidity in appropriately selected cases. This study expands on the current understanding of transorbital neurological surgery by expanding the cohort, duration of follow-up, detailed ophthalmologic outcomes, and analysis.

A retrospective consecutive case review was performed. Included subjects underwent lateral transorbital endoscope-assisted surgical approaches at a single center between 2016 and 2024. Subjects were stratified into 4 groups based on pathology (and/or) location: intradural, extradural, cavernous sinus and Meckel cave, and sphenoid wing meningiomas ± hyperostosis. Demographic information and ophthalmologic data were collected.

Thirty-five subjects were included: intracranial intradural (n = 8), intracranial extradural (n = 8), cavernous sinus and Meckel cave (n = 11), and sphenoid wing meningioma (n = 8). On average, visual acuity (VA) trended toward improvement in all groups except sphenoid wing meningioma; however, this trend did not reach statistical significance ( p = 0.39). Fifteen patients completed preoperative and postoperative Humphrey visual field testing. Overall, mean deviation scores trended toward improvement from -3.59 ± 4.28 to -1.82 ± 2.82 dB; however, this trend did not reach statistical significance ( p = 0.35). A similar trend was seen in all groups except the extradural group. There were statistically significant improvements in diplopia ( p = 0.01), extraocular motility ( p = 0.04), and exophthalmos ( p = 0.04) in all groups. Dyschromatopsia trended toward a decrease from 23% to 10% and, however, did not reach statistical significance ( p = 0.06). Transient diplopia, ptosis, and extraocular motility deficits were common but generally resolved; however, 66% of subjects had persistent postoperative V1 or V2 hypoesthesia.

Visual outcomes were stable or improved in almost all patients. However, patients should be alerted to the possibility of persistent facial hypoesthesia. These results provide evidence that lateral transorbital endoscope-assisted approaches may have favorable ophthalmological morbidity profiles when performed by expert, multidisciplinary teams in carefully selected cases.