OBJECTIVE: Exposure of the cavernous sinus is technically challenging. The most common surgical approaches use well-known variations of the standard frontotemporal craniotomy. In this paper the authors describe a novel ventral route that enters the lateral wall of the cavernous sinus through an interdural corridor that includes the removal of the greater sphenoid wing via a purely endoscopic transorbital pathway.METHODS: Five human cadaveric heads (10 sides) were dissected at the Laboratory of Surgical NeuroAnatomy of the University of Barcelona. To expose the lateral wall of the cavernous sinus, a superior eyelid endoscopic transorbital approach was performed and the anterior portion of the greater sphenoid wing was removed. The meningo-orbital band was exposed as the key starting point for revealing the cavernous sinus and its contents in a minimally invasive interdural fashion.RESULTS: This endoscopic transorbital approach, with partial removal of the greater sphenoid wing followed by a “natural” ventral interdural dissection of the meningo-orbital band, allowed exposure of the entire lateral wall of the cavernous sinus up to the plexiform portion of the trigeminal root and the petrous bone posteriorly and the foramen spinosum, with the middle meningeal artery, laterally.CONCLUSIONS: The purely endoscopic transorbital approach through the meningo-orbital band provides a direct view of the cavernous sinus through a simple and rapid means of access. Indeed, this interdural pathway lies in the same sagittal plane as the lateral wall of the cavernous sinus. Advantages include a favorable angle of attack, minimal brain retraction, and the possibility for dissection through the interdural space without entering the neurovascular compartment of the cavernous sinus. Surgical series are needed to demonstrate any clinical advantages and disadvantages of this novel route.

BACKGROUND: Feasibility and safety of spheno-orbital meningioma resection by means of endoscopic-assisted transorbital route. OBJECTIVE: To evaluate the feasibility and outcomes of the transorbital endoscopic management of selected spheno-orbital meningiomas. As secondary aims, symptom improvement and tumor volume removed were evaluated. METHODS: Retrospective chart evaluation of patients with spheno-orbital meningiomas treated by means of endoscopic transorbital superior eyelid approach in 3 referral centers over the last 4 yr. RESULTS: Fourteen cases were included in this study. In 4 patients, the transorbital endoscopic approach was combined with an endonasal route. Mean age was 51 and male-to-female ratio was 1:6. In 8 patients (57.1%), an intraorbital involvement was observed, 3 of them (21.4%) showed significant intraconal disease. No patient presented significant cavernous sinus infiltration. Main presenting symptoms were proptosis, diplopia, and visual impairment in 14, 6, and 6 patients, respectively. Mean proptosis improvement was 2 mm (standard deviation 2.3). We observed no major postoperative complications. CONCLUSION: Our preliminary clinical experience seems to demonstrate that selected spheno-orbital meningiomas can be safely managed by means of an endoscopic transorbital route through a superior eyelid approach. Patients with orbital or cavernous sinus infiltration are at highest risk of persistence.

Full-thickness tracheal lesions (FTTLs) and tracheoesophageal fistulas (TEFs) are serious but rare (0.3%-3%) complications of prolonged invasive mechanical ventilation (MV).^1-3 With the coronavirus disease 2019 (COVID-19) outbreak, however, we experienced an unprecedented increase in the incidence of FTTLs and TEFs in ventilated patients with COVID-19, the reasons for which are unknown. Additionally, a growing number of reports in these patients highlighted an increased incidence of pneumomediastinum, pneumothorax, and/or subcutaneous emphysema, which are potentially life-threatening complications of undiagnosed FTTLs.^4-7 Therefore, this study evaluated the incidence and features of patients with COVID-19 with tracheal complications who underwent prolonged invasive MV.

L'obiettivo di questo studio è analizzare le complicanze della decompressione orbitaria in pazienti affetti da oftalmopatia Basedowiana. Abbiamo analizzato 946 pazienti sottoposti a decompressione orbitaria per orbitopatia di Graves e le complicanze intra- e post-operatorie con un follow-up minimo di 6 mesi. Abbiamo eseguito inoltre un'estesa revisione della letteratura per comparare i risultati. Nel nostro studio le più frequenti complicanze sono state: atrofia della regione temporale (100%) nei pazienti sottoposti a decompressione con approccio coronale; ipoestesia permanente di V2 (13%) e V1 (8%) in pazienti sottoposti a decompressione con approccio transpalpebrale superiore. Un solo paziente ha avuto una lesione totale monolaterale di V2. Le complicanze più gravi sono state la riduzione dell'acuità visiva, che si è verificata in 5 pazienti, e la perdita di liquido cerebrospinale con complicanze cerebrali, verificatesi in 2 pazienti, entrambi operati con approccio endonasale non endoscopico. 3 pazienti hanno avuto un'emorragia intraoperatoria mentre 3 pazienti un'emorragia postoperatoria che ha richiesto un secondo intervento chirurgico. L'incidenza delle sinusiti/mucoceli sintomatici è stata dello 0,75%. In conclusione abbiamo evidenziato come la decompressione orbitaria eseguita con tecnica endoscopica endonasale e con accessi transpalpebrali sia una procedura chirurgica con una bassa incidenza di complicanze. La conoscenza delle cause delle possibili complicanze nei differenti approcci chirurgici può sicuramente aiutare a ridurre la loro incidenza.