Endoscopic transventral natural corridors resection for lateral skull base lesions

Objective To evaluate the clinical application of endoscopic transorbital and transoral approaches for lateral skull base lesion resection. Methods and Results A retrospective analysis was conducted on 17 patients undergoing endoscopic transorbital or transoral lateral skull base surgery at General Hospital of Eastern Theater Command from June 2021 to September 2024. Eight cases underwent endoscopic transorbital approach surgery, with lesions mainly located in the orbit, lateral orbital apex or spheno⁃orbital region. Seven cases underwent gross total resection, and one case underwent subtotal resection; postoperative exophthalmos all relieved (4/4), improvement of vision and ocular motility disorders occurred in 4 cases (4/7) and 2 cases (2/4) respectively. There were no postoperative complications such as bleeding, new developed neurological dysfunction, cerebrospinal fluid leakage, intracranial infection, etc., but all patients had significant swelling around the eyelids, which subsided on its own after about 7 d. Nine cases underwent endoscopic transoral approach surgery for lesions in the pterygopalatine fossa, infratemporal fossa, or anterior region of Meckel cave, with gross total resection in 7 cases and subtotal resection in 2 cases; facial numbness improved in 4 cases (4/6) after surgery; no surgery ⁃ related complications were observed. One patient with subtotal resection showed tumor progression 3 months after surgery. Conclusions Endoscopic transorbital and transoral approaches are minimally invasive techniques utilizing ventral natural corridors. They provide effective options for specific skull base regions, expanding the armamentarium of endoscopic skull base surgery.