Endoscopic Transorbital Approach for Select Recurrent and Newly Diagnosed Anteromedial Temporal Lobe Gliomas

Area of Science:

• Neurosurgery
• Minimally Invasive Techniques
• Oncology

Background:

• The endoscopic lateral transorbital approach (eLTOA) is a minimal access technique for the middle fossa and periorbital region.
• Its application in managing medial temporal lobe gliomas is explored.

Purpose of the Study:

• To evaluate the applicability of eLTOA in the management of recurrent and newly diagnosed medial temporal lobe gliomas.
• To assess the safety and efficacy of eLTOA for glioma surgery.

Main Methods:

• Retrospective review of 40 patients undergoing eLTOA from 2016-2024.
• Analysis of five glioma cases, including demographic, clinical, radiographic, histopathological, and molecular data.

Main Results:

• eLTOA was used for biopsy and molecular genotyping in four recurrent gliomas and gross total resection (GTR) in one newly diagnosed tumor.
• Histological diagnoses included glioblastoma multiforme, xanthoastrocytoma, and dysembryoplastic neuroepithelial tumor, with one upgrade from Grade II to Grade IV glioma.
• Average length of stay was 3 days with one transient diplopia complication.

Conclusions:

• eLTOA provides a minimally invasive, direct route to medial temporal lobe gliomas.
• It reduces risks associated with reoperation, such as infection and temporalis muscle atrophy.
• eLTOA is valuable for restaging recurrent tumors and achieving GTR in select newly diagnosed cases.