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Cadaveric views and three-dimensional illustrations for cavernous sinus and surrounding neurovascular structures in the comparison with endoscopic transorbital approach (A, B), endoscopic endonasal approach (C, D), and transcranial approach (E, F). The white arrows indicate oculomotor nerve while the white arrowheads and black arrowheads indicate trochlear nerve and abducens nerve, respectively. ACP, anterior clinoid process; ICA, internal carotid artery; II, optic nerve; PA, petrous apex; PG, pituitary gland; V1, ophthalmic branch of trigeminal nerve; V2, maxillary branch of trigeminal nerve; V3, mandibular branch of trigeminal nerve.
Source publication
Objective
Cavernous sinus (CS) invasion is frequently encountered in the management of skull base tumors. Surgical treatment of tumors in the CS is technically demanding, and selection of an optimal surgical approach is critical for maximal tumor removal and patient safety. We aimed to evaluate the feasibility of an endoscopic transorbital approach...
Similar publications
Objective
With coronavirus disease 2019 (COVID-19) pandemic across the world, there had been an exponential increase in rhino-orbito-cerebral mucormycosis (ROCM). Extension of infection to cavernous sinus leads to cavernous sinus syndrome (CSS). This study aims to describe incidence, clinicoradiological profile, and outcome of CSS positive along wi...
Citations
... As this area is closely related to trigeminal ganglion, better understanding of the anatomy and related structures aids in easier access to ganglion, during microvascular decompression in cases of trigeminal neuralgia. 9,10 Posteromedial triangle provides pathway to access petroclival junction, and it allows to reach posterior fossa and brainstem. 11 Therefore, this part of the cranial fossa is important for procedures involving the internal auditory canal. ...
Introduction: middle group of triangles and paraclival group is particularly significant due to its role in providing access to deep-seated structures such as the internal carotid artery, the cavernous sinus, clival structures, brain stem and cranial nerves. The objectives of this study was to delineate the borders of parasellar middle group and paraclival group triangles and to morphometrically evaluate of these triangles. Methodology: in a cross-sectional observational study design, conducted in Department of Anatomy from May 2021 to August 2022, borders, morphometry and contents of middle group of triangles (anteromedial, anterolateral, posteromedial and posterolateral triangles) and paraclival group (inferomedial and inferolateral triangles) were studied in 65 cranial fossa specimens. Results: The medial border of anteromedial triangle formed by ophthalmic nerve was the longest with average measurement of 13.05 mm (± 1.49 mm). The lateral border of anterolateral triangle formed by mandibular nerve was the shortest with average length of 6.01 mm (± 1.4 mm) and medial border formed by maxillary nerve was the longest with average measurement of 11.55 mm (± 2.15 mm). The medial border of posteromedial triangle formed by GSPN was the longest with average measurement of 16.8 mm (± 2.56 mm). The base of posterolateral triangle formed by GSPN was the longest with average measurement of 17.13 mm (± 3.16 mm). The lateral border of inferolateral triangle was the shortest with average length of 9.85 mm (± 1.44 mm) and base was the longest with average measurement of 14.84 mm (± 1.83 mm) Conclusion: morphometric measurements of middle group of triangles and paraclival group triangles, namely, anteromedial, anterolateral, posteromedial, posterolateral, inferomedial and inferolateral triangles are presented. This normative value acts as guidance for surgeons for planning the surgeries in the middle cranial fossa, approaches to cavernous sinus, paraclival regions
... Paraclival, cavernous and paraclinoid segments of carotid artery and its relations are crucial for any skull base surgeries involving sellar region [20]. Though the endoscopic and transcranial view of the parasellar region differ significantly due to cavernous and clinoid segment of internal carotid artery hinders visualization of supratrochlear and infratrochlear triangles [12,21] in this study, the morphometric analysis of these triangles (in addition to clinoid and oculomotor triangles) is considered through transcranial views in order to generate the normative values and to understand the variations in the contents of these triangles. Exposure of clinoid segment of internal carotid artery and optic nerve delineates the clinoid triangle. ...
The objectives of this study were to delineate the borders of parasellar middle cranial fossa triangles and to morphometrically evaluate of these triangles. Methodology: in a cross-sectional observational study design, conducted in Department of Anatomy from May 2021 to August 2022, borders, morphometry and contents of parasellar middle cranial fossa triangles were delineated in fifteen cranial fossa specimens. Results: the medial border of clinoid triangle formed by optic nerve was the shortest with average length of 7.64 mm (± 0.59 mm) and lateral border formed by oculomotor nerve was the longest with average measurement of 14.5 mm (± 1.46 mm). The medial border of oculomotor triangle formed by interclinoid dural fold had average length of 9.05 mm (±1.07 mm) and lateral border formed by anterior petroclinoid dural fold had average measurement of 14.38 mm (±2.61 mm). The oculomotor nerve forming the medial limit of supratrochlear triangle measured 10.81 mm (±1.25 mm) and lateral trochlear nerve border measured 14.94 (±1.08 mm). Conclusion: morphometric measurements of parasellar middle cranial fossa triangles, namely, clinoid triangle, oculomotor triangle, supratrochlear and infratrochlear triangle are presented.
Разнообразие хирургических подходов к параселлярной области требует глубокого понимания микрохирургической анатомии. Целью данного исследования было определение границ параселлярных треугольников средней черепной ямки и морфометрическая оценка этих треугольников.Материалы и методы: в ходе перекрестного наблюдательного исследования, проведенного на кафедре анатомии с мая 2021 по август 2022 г., на пятнадцати образцах черепной ямки были определены границы, морфометрические параметры и содержимое параселлярных треугольников средней черепной ямки. Результаты: медиальная граница клиновидного треугольника, образованная зрительным нервом, была самой короткой, составляя в среднем 7,64 мм (± 0,59 мм) в длину, а латеральная граница, образованная глазодвигательным нервом, была самой длинной и достигала в среднем 14,5 мм (± 1,46 мм). Средняя длина медиальной границы глазодвигательного треугольника, образованной межклиновидной складкой твердой мозговой оболочки, составила 9,05 мм (±1,07 мм), а латеральной границы, образованной передней петроклиновидной складкой твердой мозговой оболочки, - 14,38 мм (±2,61 мм). Глазодвигательный нерв, формирующий медиальную границу супратрохлеарного треугольника, имел длину 10,81 мм (±1,25 мм), а латеральная граница по блоковому нерву - 14,94 мм (±1,08 мм). Заключение: представлены морфометрические параметры параселлярных треугольников средней черепной ямки: клиновидного треугольника, глазодвигательного треугольника, надблокового и подблокового треугольников.
... I n recent years, transorbital surgery has garnered considerable consideration and gained popularity. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] The notable evolution of this technique underscores the significance of detailed anatomical knowledge and clinical experience. These factors are instrumental in refining the procedure and broadening its indications within the armamentarium of skull base neurosurgeons. ...
... Its removal facilitates the extension of the dissection, allowing an interdural peeling of the lateral wall of the cavernous sinus, thereby enabling identification of the following critical structures: oculomotor nerve, trochlear nerve, trigeminal branches up to the gasserian ganglion, trigeminal root, and the intracavernous segment of the internal carotid artery, as well as the intracavernous sixth cranial nerve (Fig. 4). 10,[32][33][34] Moreover, the dura mater covering the temporal pole also becomes visible; it can be opened to explore the temporal lobe and reach the temporomesial regions up to the temporal horn of the lateral ventricle. ...
... An extensive number of anatomical studies demonstrating its safeness and feasibility have allowed its progressive growth, leading to an increasing number of indications for its use and clinical reports. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18]29,30,32,38,[41][42][43][44][45][46][47][48][49][50][51][52][53] Utilization of consistent anatomical landmarks in relation to the orbital contents facilitates a comprehensive systematization of the approach. This systematic framework allows for more effective treatment of diverse surgical pathologies within the confines of the operating room. ...
OBJECTIVE
The endoscopic superior eyelid transorbital approach has garnered significant consideration and gained popularity in recent years. Detailed anatomical knowledge along with clinical experience has allowed refinement of the technique as well as expansion of its indications. Using bone as a consistent reference, the authors identified five main bone pillars that offer access to the different intracranial targeted areas for different pathologies of the skull base, with the aim of enhancing the understanding of the intracranial areas accessible through this corridor.
METHODS
The authors present a bone-oriented review of the anatomy of the transorbital approach in which they conducted a 3D analysis using Brainlab software and performed dry skull and subsequent cadaveric dissections.
RESULTS
Five bone pillars of the transorbital approach were identified: the lesser sphenoid wing, the sagittal crest (medial aspect of the greater sphenoid wing), the anterior clinoid, the middle cranial fossa, and the petrous apex. The associations of these bone targets with their respective intracranial areas are reported in detail.
CONCLUSIONS
Identification of consistent bone references after the skin incision has been made and the working space is determined allows a comprehensive understanding of the anatomy of the approach in order to safely and effectively perform transorbital endoscopic surgery in the skull base.
... tive to traditional anterolateral skull base approaches for accessing lateral CS lesions. [5][6][7][8][9] In order to shed light on SETA's utility for accessing the CS, several previous studies have attempted to quantitatively compare exposure between SETA and traditional open anterolateral skull base approaches. 5,[10][11][12][13][14][15] However, these comparisons have been generally limited to the area and volume of exposure provided by the bone opening and trajectory and fail to account for the main avenues of exposure provided by subsequent requisite surgical maneuvers-including unlocking of the periclinoid neurovasculature from its osteodural encasements, mobilization and displacement of neurovasculature, and the fashioning of corridors through the lateral wall of the CS. ...
... [5][6][7][8][9] In order to shed light on SETA's utility for accessing the CS, several previous studies have attempted to quantitatively compare exposure between SETA and traditional open anterolateral skull base approaches. 5,[10][11][12][13][14][15] However, these comparisons have been generally limited to the area and volume of exposure provided by the bone opening and trajectory and fail to account for the main avenues of exposure provided by subsequent requisite surgical maneuvers-including unlocking of the periclinoid neurovasculature from its osteodural encasements, mobilization and displacement of neurovasculature, and the fashioning of corridors through the lateral wall of the CS. Insufficient application of these surgical techniques for access to the CS invalidates a meaningful comparison between approaches. ...
... These findings are in agreement with our colleagues Bander et al. 9 who suggest, in their clinical series of 6 patients, that this approach is suitable for purely CS lesions lateral to the cavernous ICA, especially cystic lesions requiring decompression. Similarly, Jung et al. 5 and Corvino et al. 12 found the supramaxillary (anteromedial) triangle to be the most suitable entry point into the CS in the SETA, and allowed for exposure of some aspects of the cavernous ICA and CN VI. However, we found that access to all of the CS entry corridors/triangle was substantially greater in the FTOZ approach compared to the SETA ( Table 2). ...
OBJECTIVE
Recently, the endoscopic superior eyelid transorbital approach (SETA) has emerged as a potential alternative to access the cavernous sinus (CS). Several previous studies have attempted to quantitatively compare the traditional open anterolateral skull base approaches with transorbital exposure; however, these comparisons have been limited to the area of exposure provided by the bone opening and trajectory, and fail to account for the main avenues of exposure provided by subsequent requisite surgical maneuvers. The authors quantitatively compare the surgical access provided by the frontotemporal-orbitozygomatic (FTOZ) approach and the SETA following applicable periclinoid surgical maneuvers, evaluate the surgical exposure of key structures in each, and discuss optimal approach selection.
METHODS
SETA and FTOZ approaches were performed with subsequent applicable surgical maneuvers on 8 cadaveric heads. The lengths of exposure of cranial nerves (CNs) II–VI and the cavernous internal carotid artery; the areas of the space accessed within the supratrochlear, infratrochlear, and supramaxillary (anteromedial) triangles; the total area of exposure; and the angles of attack were measured and compared.
RESULTS
Exposure of the extradural CS was comparable between approaches, whereas access was significantly greater in the FTOZ approach compared with the SETA. The lengths of extradural exposure of CN III, V1, V2, and V3 were comparable between approaches. The FTOZ approach provided marginally increased exposure of CNs IV (20.9 ± 2.36 mm vs 13.4 ± 3.97 mm, p = 0.023) and VI (14.1 ± 2.44 mm vs 9.22 ± 3.45 mm, p = 0.066). The FTOZ also provided significantly larger vertical (44.5° ± 6.15° vs 18.4° ± 1.65°, p = 0.002) and horizontal (41.5° ± 5.40° vs 15.3° ± 5.06°, p < 0.001) angles of attack, and thus significantly greater surgical freedom, and provided significantly greater access to the supratrochlear (p = 0.021) and infratrochlear (p = 0.007) triangles, and significantly greater exposure of the cavernous internal carotid artery (17.2 ± 1.70 mm vs 8.05 ± 2.37 mm, p = 0.001). Total area of exposure was also significantly larger in the FTOZ, which provided wide access to the lateral wall of the CS as well as the possibility for intradural access.
CONCLUSIONS
This is the first study to quantitatively identify the relative advantages of the FTOZ and transorbital approaches at the target region following requisite surgical maneuvers. Understanding these data will aid in selecting an optimal approach and maneuver set based on target lesion size and location.
... Despite extensive dissection and sectioning in cadavers, interpreting three-dimensional images of these structures remains difficult. An alternative approach using endoscopic visualization in cadavers has shown promise in demonstrating and comprehending the normal anatomy in this region [1,2]. ...
The study aims to evaluate the advantages of using endoscopic demonstrations to teach nose, paranasal sinuses, and skull base anatomy compared to traditional cadaveric demonstrations. Traditional dissection methods do not provide an accurate representation of in vivo visualization of these anatomical areas. The goal is to align the teaching approach with the perspective students will have during clinical practice for better clinical orientation. In this study, 100 first-year medical students were split into two groups: Group A and Group B, each with 50 students. Group A received teaching through endoscopic demonstrations, while Group B had cadaveric demonstrations, both focused on nose, paranasal sinuses, and skull base anatomy. To assess comprehension and clinical orientation, both groups completed a questionnaire with clinically relevant questions, and their responses were collected and compared for analysis. Students who received endoscopic training showed better accuracy in addressing clinical queries than those only exposed to cadaveric dissection. Many participants favored incorporating endoscopic instruction, either as a replacement or addition to traditional cadaveric dissection, for the studied topics. The endoscopically trained group performed better in understanding anatomical landmarks, mentally reconstructing 3D images, and conceptualizing surgical approaches for the targeted anatomical areas. Incorporating endoscopic training for the nasal cavity, paranasal sinuses and skull base into the undergraduate medical curriculum would substantially augment students’ clinical understanding and provide a more profound grasp of the dynamic anatomy in these areas.
... Bleeding control is also an important issue for maintaining a clear surgical field and enhancing patient safety, and it relies on meticulous dissection and careful hemostasis. While facing the cavernous sinus bleeding, early recognition and sharp dissection of the meningo-orbital band in an interdusal fashion allows the operator to expose the lateral wall of the cavernous sinus without entering its neurovascular compartment for achieving bleeding control [25,26]. This study is the first to report the application of the ETOA in the management of tSOFS. ...
Purpose
The endoscopic endonasal approach (EEA) is a minimally invasive and promising modality for treating traumatic superior orbital fissure (SOF) syndrome (tSOFS). Recently, the endoscopic transorbital approach (ETOA) has been considered an alternative method for reaching the anterolateral skull base. This study accessed the practicality of using the ETOA to treat SOF decompression using both cadaveric dissection and clinical application.
Methods
Bilateral anatomic dissections were performed on four adult cadaveric heads using the ETOA and EEA to address SOF decompression. The ETOA procedure for SOF decompression is described, and the extent of SOF decompression was compared between the ETOA and EEA. The clinical feasibility of the ETOA for treating SOF decompression was performed in two patients diagnosed with tSOFS.
Results
ETOA allowed for decompression over the lateral aspect of the SOF, from the meningo-orbital band superolaterally to the maxillary strut inferomedially. By contrast, the EEA allowed for decompression over the medial aspect of the SOF, from the lateral opticocarotid recess superiorly to the maxillary strut inferiorly. In both patients treated using the ETOA and SOF decompression, the severity of ophthalmoplegia got obvious improvement.
Conclusions
Based on the cadaveric findings, ETOA provided a feasible access pathway for SOF decompression with reliable outcomes, and our patients confirmed the clinical efficacy of the ETOA for managing tSOFS.
... Following this virtually bloodless interdural plane, the nerves enclosed in the lateral wall of the cavernous sinus can be detected starting from V1 (Fig. 5B). The third and the fourth cranial nerves come then into view superomedially ( Fig. 5C): posteriorly the oculomotor nerve is superior to the trochlear nerve but approximately at the level of the optic strut the latter crosses the third nerve passing laterally and superiorly for gaining the superior orbital fissure above the annular tendon (Jung et al., 2022). Visualization of the oculomotor and trochlear nerves may help to infer the anterior borders of the supratrochlear and infratrochlear triangles (Parkinson triangle). ...
Introduction
The transorbital route has been proposed for addressing orbital and paramedian skull base lesions. It can be complemented by further marginotomies, as per “extended-transorbital approach” and combined with others ventro-basal approaches featuring the concept of “multiportal surgery”. Nevertheless, it cannot address some anatomical regions like the clinoid, carotid bifurcation and the Sylvian fissure. Therefore, we propose a combined transorbital and a supraorbital approach, attainable by a single infra-brow incision, and we called it “Uniportal multicorridor” approach.
Research question
The aim of our study is to verify its feasibility and deep anatomical targets through a cadaveric study.
Materials and methods
Anatomic dissections were performed at the Laboratory of ICLO Teaching and Research Center (Verona, Italy) on four formalin-fixed cadaveric heads injected with colored neoprene latex (8 sides). A stepwise dissection of the supraorbital and transorbital approaches (with an infra-brow skin incision) to the anterior tentorial incisura, clinoid area, lateral wall of the cavernous sinus, middle temporal fossa, posterior fossa, and Sylvian fissure is described.
Results
We analyzed the anatomic areas reached by the transorbital corridor dividing them as follow: lateral wall of the cavernous sinus, middle temporal fossa, posterior fossa, and Sylvian fissure; while the anatomic areas addressed by the supraorbital craniotomy were the clinoid area and the anterior tentorial incisura.
Conclusions
The described uniportal multi-corridor approach combines a transorbital corridor and a supraorbital craniotomy, providing a unique intra and extradural control over the anterior, middle, and posterior fossa, tentorial incisura and the Sylvian fissure, via an infra-brow skin incision.
... However, these approaches have the disadvantage of extensive bone loss, vidian nerve injury, and risk of vascular injury to the sphenopalatine artery or its branches. 2,5 Historically, the transorbital route has been applied in neurosurgery for at least 60 years. 6 Although it was mostly popularized for frontal lobotomies in conjunction with psychiatric care, it has evolved to a useful tool in minimally invasive neuroendoscopic surgery. ...
... Practitioners can obtain ample visualization via this approach since the entire lateral CS wall, including the oculomotor, trochlear, and trigeminal nerves, corresponding branches, and the middle meningeal artery, is exposed. 3,5 On the other hand, an endonasal approach is more limited by the trajectory of the ICA. 5 This corridor allows a unique perspective on the anteromedial and anterolateral triangles of the middle cerebral fossa to conduct a biopsy of the CS. 5,18 Moreover, lateral transorbital approach provides a direct route to MC, which lies directly adjacent to the CS. ...
... 3,5 On the other hand, an endonasal approach is more limited by the trajectory of the ICA. 5 This corridor allows a unique perspective on the anteromedial and anterolateral triangles of the middle cerebral fossa to conduct a biopsy of the CS. 5,18 Moreover, lateral transorbital approach provides a direct route to MC, which lies directly adjacent to the CS. ...
The aim of this report is to describe Transorbital Neuroendoscopic Surgery (TONES) as a safe alternative for obtaining a cavernous sinus biopsy. We describe this technique in a patient with a diffuse Large B-cell Lymphoma mimicking Tolosa-Hunt Syndrome. Articles were gathered querying PubMed, EMBASE, and SCOPUS databases with the following terms: (“Transorbital neuroendoscopic approach” OR “Transorbital neuroendoscopic surgery” OR “TONES” OR “transorbital approach” OR “endoscopic transorbital approach”) AND (“cavernous sinus”). The literature search was performed by two independent authors (N.F. and J.R.), with inconsistencies resolved by the senior author (M.M.). After screening abstracts for relevance, full-length articles were reviewed for pertinent variables. A comparison was conducted with the illustrative case of a 69-year-old woman who presented to the emergency department with vertigo, ophthalmoplegia, and diplopia for two months. A Brain MRI revealed an infiltrative lesion at the left cavernous sinus. A presumptive diagnosis of Tolosa-Hunt was made but a confirmatory biopsy was performed using TONES. Based on our cadaveric study, literature review, and case report the TONES approach was safe, effective for tissue diagnosis and associated with minor morbidity and reduced hospital stay. Additional prospective studies are required to study its viability and safety in a larger group of patients.
... Since the first pioneering work of Parkinson [3], which describes the surgical approach to a carotid-cavernous fistula, several anatomical studies [4][5][6][7][8][9][10] and surgical series [11][12][13][14], have provided a detailed description of this dural envelope and its safe entry zones from different routes, both transcranial [3,[15][16][17] and endonasal [16][17][18][19][20], and most recently endoscopic transorbital [21][22][23], each of them with related pro and cons. ...
Background: The cavernous sinus (CS) is a highly vulnerable anatomical space, mainly due to the neurovascular structures that it contains; therefore, a detailed knowledge of its anatomy is mandatory for surgical unlocking. In this study, we compared the anatomy of this region from different endoscopic and microsurgical operative corridors, further focusing on the corresponding anatomic landmarks encountered along these routes. Furthermore, we tried to define the safe entry zones to this venous space from these three different operative corridors, and to provide indications regarding the optimal approach according to the lesion’s location. Methods: Five embalmed and injected adult cadaveric specimens (10 sides) separately underwent dissection and exposure of the CS via superior eyelid endoscopic transorbital (SETOA), extended endoscopic endonasal transsphenoidal-transethmoidal (EEEA), and microsurgical transcranial fronto-temporo-orbitozygomatic (FTOZ) approaches. The anatomical landmarks and the content of this venous space were described and compared from these surgical perspectives. Results: The oculomotor triangle can be clearly exposed only by the FTOZ approach. Unlike EEEA, for the exposure of the clinoid triangle content, the anterior clinoid process removal is required for FTOZ and SETOA. The supra- and infratrochlear as well as the anteromedial and anterolateral triangles can be exposed by all three corridors. The most recently introduced SETOA allowed for the exposure of the entire lateral wall of the CS without entering its neurovascular structures and part of the posterior wall; furthermore, thanks to its anteroposterior trajectory, it allowed for the disclosure of the posterior ascending segment of the cavernous ICA with the related sympathetic plexus through the Mullan’s triangle, in a minimally invasive fashion. Through the anterolateral triangle, the transorbital corridor allowed us to expose the lateral 180 degrees of the Vidian nerve and artery in the homonymous canal, the anterolateral aspect of the lacerum segment of the ICA at the transition zone from the petrous horizontal to the ascending posterior cavernous segment, surrounded by the carotid sympathetic plexus, and the medial Meckel’s cave. Conclusions: Different regions of the cavernous sinus are better exposed by different surgical corridors. The relationship of the tumor with cranial nerves in the lateral wall guides the selection of the approach to cavernous sinus lesions. The transorbital endoscopic approach can be considered to be a safe and minimally invasive complementary surgical corridor to the well-established transcranial and endoscopic endonasal routes for the exposure of selected lesions of the cavernous sinus. Nevertheless, peer knowledge of the anatomy and a surgical learning curve are required.
... This nally led to the appearance and publication of several series of cases around 2018-2019, which is the last key moment identi ed in our analyses, causing a new increase in the number of publications. In 2019, 92 publications related to the transorbital approach were identi ed, being the year with the highest annual number of publications in our analysis 7,9,11,[15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34] (see Fig. 1). ...
... The revolution in this approach that began with the incorporation of the endoscope allowed its progressive growth during the following years thanks to several anatomic and cases reports 31,35,[49][50][51][52][53][54][55][56][57][58] . This progressive growth can be identi ed in our analysis, achieving in the following years, an annual It is expected that the use of the transorbital approach will continue to grow in the future, introducing new knowledge about the safety of this technique and speci c pathologies treated by this approach. ...
Background: Transorbital approach has gained significant consideration over the last few years, as evidenced by the growing number of publications. The present study aims to describe and quantify the number of publications and citations over the years in order to identify key moments in its history.
Methods: Data from annual publications and citations of the transorbital approach between 1950 and 2022 have been extracted from the Web of Science and later uploaded to Microsoft Excel. Three parameters were analyzed: 1) absolute number of publications; 2) annual absolute growth of citations; 3) trend of publications.
Results: Results showed an average number of publications of 18.6 with 266 citations per year. Regarding the number of publications, the analysis showed four key moments in history: 1985, 2001, 2010-2011, and 2018-2019. Around 1985, related to studies on transorbital lobotomy. Around 2001, due to experimental studies in vascular pathology. During 2010-2011, when the concept of transorbital neuroendoscopic surgery was introduced. Around 2018-2019, when different case series were published. However, analyzing the annual absolute growth of citations, one key moment was detected: 2019, achieving a significant positive annual growth of +522 citations. The analysis of the publication trend shows a positive trend line, forecasting 60-63 publications per year in the next 3-5 years.
Conclusions: Despite the inherent limitation of this study, this analysis showed that the recent 2019 is a turning point for transorbital surgery being the year with the most citations and publications. The following years will determine the exact place of this technique in the skull base armamentarium.