Superior Incision Research Articles

Cerebellar mutism syndrome: From pathophysiology to rehabilitation.

Cerebellar mutism syndrome (CMS) is a common complication following surgical resection of childhood tumors arising in the posterior fossa. Alteration of linguistic production, up to muteness and emotional lability, generally reported at least 24h after the intervention, is the hallmark of post-operative CMS. Other associated traits include hypotonia and other cerebellar motor signs, cerebellar cognitive-affective syndrome, motor deficits from the involvement of the long pathways, and cranial neuropathies. Recovery usually takes 6 months, but most children are burdened with long-term residual deficits. The pathogenic mechanism is likely due to the damage occurring to the proximal efferent cerebellar pathway, including the dentate nucleus, the superior cerebellar peduncle, and its decussation in the mesencephalic tegmentum. Proven risk factors include brain stem invasion, diagnosis of medulloblastoma, midline localization, tumor size, invasion of the fourth ventricle, invasion of the superior cerebellar peduncle, left-handedness, and incision of the vermis. Currently, rehabilitation is the cornerstone of the treatment of patients with cerebellar mutism syndrome, and it must consider the three main impaired domains, namely speech, cognition/behavior, and movement.

Correction of pre-existing astigmatism by on-axis incision size modulation in manual small-incision cataract surgery.

To study the effect of wound size modulation on pre-existing astigmatism by on-axis placement of incision in manual small-incision cataract surgery (MSICS). In this prospective interventional study conducted at a tertiary care centre, 40 eyes of 40 consecutive senile cataract patients with 1.00-3.00 D corneal astigmatism were enrolled for the study. MSICS by modified Blumenthal's technique was performed through 6.0, 6.5, and 7.0 mm on-axis incision in 1.0-1.49 D (group A), 1.50-1.99 D (group B), and 2.00-3.00 D (group C) astigmatism, respectively. Surgically induced astigmatism (SIA) was calculated by vector analysis and double angle plots (DAP) at 12 weeks postoperatively. There were 22 males and 18 females with mean age of 58.12 ± 1.18 years. The mean SIA at 12 weeks was 0.85 ± 0.28 D in group A (17 eyes), 1.32 ± 0.65 D in group B (10 eyes), and 1.91 ± 0.69 D in group C (13 eyes). The overall median uncorrected visual acuity was 0.18 (IQR = 0 to 0.2). The mean astigmatism decreased from 1.95 ± 0.74 D to 1.04 + 0.57 D (P = 0.00) in superior incision and from 1.70 + 0.50 D to 0.92 ± 0.45 D (P = 0.00) in temporal incision group with central shift of centroid in all cases. The customization of on-axis external incision size can be used to manage pre-existing corneal astigmatism of less than 3.00 D using both temporal and superior incisions effectively.

Analysis of difficulties and influencing factors in treatment of appendiceal abscess in children with laparoscopic surgery.

The purpose of this study was to investigate and analyze the difficulties and the influencing factors in the laparoscopic surgery for appendiceal abscess in children. Forty-six patients with appendiceal abscess receiving laparoscopic surgery (laparoscopic surgery group) in Xuzhou Children's Hospital from January 2012 to March 2017 were retrospectively analyzed. The surgery was performed using the 3-hole method, the 30° lens was placed in umbilical region, and the left lower abdomen and superior pubis were the operating holes. If the appendix was thick and big, 10 mm trocar was replaced on the superior pubis and the appendix was removed, followed by pelvic or lower abdominal drainage via the superior pubis incision. The laparoscopic surgery group was compared with 45 cases of laparotomy (traditional surgery group) for appendiceal abscess performed by the same group of operators in the past, and the perioperative period and postoperative complications between the two groups were compared. The child patients' age, history of abdominal pain and prediagnosis treatment were compared within the laparoscopic surgery group. Compared with those in traditional surgery group, the surgery time in laparoscopic surgery group had no statistically significant difference (P>0.05), the incidence rate of complications was lower, and the difference was statistically significant (P<0.05). In laparoscopic surgery group, the surgery time of child patients aged ≥6 years old with the medical history for more than 5 days and unreasonable preoperative treatment was longer than that of child patients aged <6 years old with the medical history for less than or equal to 5 days and reasonable preoperative treatment, and the difference was statistically significant (P<0.05). Compared with the traditional surgery, laparoscopic surgery for appendiceal abscess in children can significantly reduce the postoperative complications; at the same time, the history of abdominal pain and preoperative treatment are the influencing factors of surgery.

Comparison of Long-Term Corneal Astigmatic Changes After Cataract Surgery in Eyes With Superior or Horizontal Clear Corneal Incisions

To compare long-term corneal astigmatic changes after stabilization of surgically induced astigmatism (SIA) subsequent to phacoemulsification between eyes that underwent superior clear corneal incision (CCI) or horizontal CCI. Retrospective, comparative case series. We examined the anterior corneal astigmatism of eyes that underwent a 2.4-mm superior CCI (superior CCI group, n=43) or horizontal CCI (horizontal CCI group, n=43) preoperatively, on the postoperative day that SIA stabilized (baseline), and at ≥7 years post-baseline using an autokeratometer. Corneal astigmatic changes from baseline to ≥7 years post-baseline (mean duration 8.74 years in the superior CCI group and 9.05 years in the horizontal CCI group) were decomposed to vertical/horizontal (Rx) and oblique astigmatic change components (Ry) and were compared between the 2 groups. The mean corneal astigmatism components changed significantly toward against-the-rule (ATR) astigmatism in the superior CCI group and with-the-rule astigmatism in the horizontal CCI group within 6 months postoperatively. After stabilization of the SIA, both groups showed a significant increase in the mean Rx and no significant change in the mean Ry over approximately 9 years, indicating a long-term ATR shift. The mean changes in the Rx and Ry did not differ significantly between the superior and horizontal CCI groups. Double-angle plots revealed a similar degree of ATR shift between the 2 groups over the 9 years. After stabilization of the SIA, a similar degree of ATR change occurred subsequent to superior and horizontal CCIs over approximately 9 years, suggesting that CCI direction does not affect long-term astigmatic changes.

Multiple Bilobed Orbital Schwannomas: A Rare Sight.

A 60-year-old lady presented with long-standing progressive, non-axial proptosis of 8-year duration associated with superior sulcus fullness, significant upper and lower eyelid retraction, and an early grade of cataract in the OD (Fig. A and B). Visual acuity had reduced to 20/100 in the OD with choroidal folds on the posterior pole on fundus examination. The other eye showed a mild grade of upper eyelid retraction with an early grade of cataract with the normal posterior segment. CT-scan of the orbit revealed 2 well-defined heterogenous ovoid lesions in the right intraconal space indenting the globe (dotted lines, Fig. C and D). The optic nerve was made out separately in few cuts. She was planned for an excision biopsy of the orbit via the superior lid crease incision. There were 2 separate lesions an intact capsule. The lesions were removed in toto with the aid of a cryoprobe one after the other. Both the excised lesions were bilobed having different dimensions (*, Fig. E and F). Histopathology showed solid areas within the 2 well-encapsulated solid cystic lesions which were hypercellular with Antoni type A and hypocellular with Antoni type B like areas. The hypercellular areas showed spindle cells with tapering ends and elongated nuclei whereas the hypocellular areas showed numerous foamy macrophages consistent with the diagnosis of Orbital Schwannoma. The proptosis resolved with improvement in the visual acuity to 20/50 at 6 weeks. Orbital schwannomas are known to be isolated in presentation and most commonly arise from the sensory branch of the ophthalmic division of the trigeminal nerve. Bilobed schwannomas and more so, multiple in the same orbit are a rare occurrence. To the best of our knowledge, there has been no report of multiple orbital intraconal bilobed schwannomas in literature.FIG.: Multiple bilobed orbital schwannomas.

Roadmap to Ventral Craniocervical Junction Through the Endonasal Corridor: Anatomic Evaluation of Inverted U-Shaped Nasopharyngeal Flap Exposure in a Cadaveric Study.

There is a paucity of data in the literature describing quantitative exposure of the ventral craniocervical junction through the endonasal corridor in a safe manner mindful of locoregional anatomy. To quantify ventromedial exposure of O-C1 and C1-2 articular structures after turning an inverted U-shaped nasopharyngeal flap (IUNF) and to obtain measurements assessing the distance of flap margins to adjacent neurovascular structures. In 8 cadaveric specimens, an IUNF was fashioned using a superior incision below the level of the pharyngeal tubercule of the clivus and lateral incisions in the approximate region of Rosenmuller fossae bilaterally. Measurements with calipers and/or neuronavigation software included flap dimensions, exposure of O-C1 and C1-2 articular structures, inferior reach of IUNF, and proximity of the internal carotid artery (ICA) and hypoglossal nerve to IUNF margins. The IUNF facilitated exposure of an average of 9 mm of the medial surfaces of the right/left O-C1 joints without transgression of the carotid arteries or hypoglossal nerves. The C1-2 articulation could not be routinely accessed. The margins of the IUNF were not in close (<5 mm) proximity to the ICA in any of the 8 specimens. In 6 of 8 specimens, the dimensions of the IUNF were in close (<5 mm) horizontal or vertical proximity to the hypoglossal foramina. The IUNF provided safe and reliable access to the medial O-C1 articulation. Given the close proximity of the exocranial hypoglossal foramen, neuronavigation assistance and neuromonitoring with attention to the superolateral IUNF margin are recommended.

Effect of depth of the sclerocorneal incision on postoperative corneal astigmatism in manual small-incision cataract surgery.

Purpose:To determine the effect of depth of scleral tunnel incision measured by anterior segment OCT on postoperative corneal astigmatism by comparing the change of magnitude of corneal astigmatism between superficial and deep sclerocorneal tunnel incision in manual small-incision cataract surgery (SICS).Methods:Depths of sclerocorneal incision of 72 eyes of patients undergoing uncomplicated manual SICS and attending regular follow-up schedule were assessed with anterior segment OCT at 6-week post-op follow-up.Results:The overall mean ± standard deviation (SD) change of astigmatism for superficial incision, that is, ≤399 mm, was 0.44 ± 0.30 and that for deeper, that is, ≥400 mm, was 0.13 ± 0.48 and the change was significantly higher in ≤399 mm group than in ≥400 mm group (P = 0.003). In both superior and temporal incision locations, the mean ± SD change of astigmatism for ≤399 mm incision was 0.48 ± 0.29 and 0.40 ± 0.30, respectively, and that for ≥400 mm was 0.03 ± 0.34 and 0.23 ± 0.57, respectively. The change of astigmatism was significantly higher in ≤399 mm incision group overall (P = 0.003) and also higher in both superior and temporal incision location groups (P = 0.001 and P = 0.479, respectively).Conclusion:The depth of sclerocorneal incision had a statistically significant effect on the change of astigmatism following manual SICS, with superficial incision (≤399 μm) causing a higher change than deeper incision (≥ 400 μm).

PREOPERATIVE AND POSTOPERATIVE KERATOMETRY COMPARISON OF PHACOEMULSIFICATION SURGERY WITH RIGID POSTERIOR CHAMBER INTRAOCULAR LENS IMPLANTATION (PCIOL)

OBJECTIVES:To study and compare pre and post-operative keratometry in phacoemulsication surgery with rigid posterior chamber intraocular lens (PCIOL) implantation. METHOD:Hospital based prospective observational study which included 100 presenile and senile cataract cases with superior scleral incision(5.5mm) phacoemulsication surgery and rigid PCIOL implantation. The data was analyzed by paired 't' test and 'p' value &lt;0.05 considered signicant. The preoperative and postoperative keratometry was compared at 6 weeks. RESULT: There was signicant difference between pre operative and post operative Keratometry (P&lt;0.05) at 6 weeks. Postoperatively majority of patients developed against the rule astigmatism (76% of patients).

Analysis of postoperative visual and surgical outcome following surgery for absorbed cataract in pediatric age group and the intraoperative difficulties

Purpose:To analyze the postoperative visual and surgical outcomes following surgery for pediatric-absorbed cataracts and intraoperative difficulties.Methods:This prospective longitudinal study included 43 eyes (30 children) with absorbed cataracts aged between 6 months and 18 years (either sex). All children underwent best-corrected visual acuity (BCVA), anterior and posterior segment evaluation, rubella titer estimation, intraocular lens (IOL) power calculation, superior small incision cataract surgery with or without posterior capsulotomy/anterior vitrectomy/IOL implantation under general anesthesia, visual rehabilitation, and were followed up for 1 year.Results:The mean age was 7.89 ± 4.84 years. Preoperative BCVA distance: 39 eyes had either perception of light (PL) or counting finger close to face (CFCF); near BCVA: all eyes had either PL or N36. Postoperative (12 months) distant BCVA: a majority of the eyes (27) had 6/60–1/60, 11 eyes had 6/18–6/36; near: N18 in 19 eyes, N6 in 7 eyes. Anterior continuous curvilinear capsulorrhexis (ACCC) was possible in eight eyes. Cortical aspiration was difficult in 16 eyes (peripheral calcified ring). A majority (32 eyes) underwent in the sulcus implantation (in-the-bag: eight eyes); two eyes: no IOL, one eye: secondary IOL. Eleven eyes had early postoperative inflammation. At 12 months, one eye underwent membranectomy for visual axis opacification and 38 eyes had well-centered IOLs.Conclusion:Surgery in absorbed cataracts is challenging because of the anatomic disorganization of the absorbed lens. By adopting appropriate surgical methods and good visual rehabilitation, one can achieve satisfactory surgical and visual outcomes, highlighting the need for surgical intervention.

Comparison of postoperative astigmatism in small incision cataract surgery based on size and shape of the incision

Study of comparison of postoperative astigmatism in small incision cataract surgery depending on size and shape of incision A prospective study of 50 eyes of 50 patients who underwent manual SICS under local anaesthesia between December 2020 and May 2021 conducted by single surgeon and followed up on post op day 1 day 7 and 6 weeks. Patients selected were having grade 1 to 2 nuclear sclerosis the size and shape of incision was decided depending upon the grade of cataract. On follow ups thorough ocular examination was done especially looking for corrected visual acuity and correction needed for that. Keratometry was done in each follow up visits. At the end surgically induced astigmatism (SIA) was calculated. Surgically Induced Astigmatism (SIA) calculated by SIA calculator SIA was 0.5 - 1 D in 38 patients with frown incision of 4 to 5mm,1.0 - 1.5 D in 10 patients with frown incision size of 5 to 6mm 2D in patients with straight incision size of 6mm and more In all cases. The less average SIA was noted in group with smaller incision of about 4 to 5mm. Frown superior incision has got added advantage of early wound stabilization than straight incision. It is possible to reduce the amount of post-operative astigmatism significantly by choosing the incision shape and size.

Vertically Fixated Posterior Chamber Phakic Intraocular Lens Implantation Through a Superior Corneal Incision.

IntroductionTo assess the 1-year outcomes of vertically fixated posterior chamber phakic intraocular lens implantation through a superior corneal incision.MethodsThis pilot study comprised 78 eyes of 53 consecutive patients undergoing vertically fixated implantable collamer lens (ICL) implantation through a superior corneal incision to correct moderate to high myopia and myopic astigmatism. We prospectively determined the safety, efficacy, predictability, stability, and adverse events preoperatively, and at 1 week and 1, 3, and 12 months postoperatively.ResultsThe mean follow-up period was 10.4 ± 5.4 months. Uncorrected and corrected visual acuity were −0.20 ± 0.10 and −0.25 ± 0.07 logMAR, respectively, at 1 year postoperatively. At 1 year postoperatively, 98% and 100% of eyes were within 0.5 and 1.0 D, respectively, of the targeted correction. A nonsignificant change in manifest refraction of −0.01 ± 0.08 D occurred from 1 week to 1 year. The manifest astigmatism decreased significantly, from 0.69 ± 0.73 D preoperatively to 0.21 ± 0.27 D at 1 year postoperatively (Mann–Whitney U test, p < 0.001). No vision-threatening complications occurred at any time in this series.ConclusionsAccording to our experience, the vertically fixated ICL through a superior incision achieved good results, without significant complications. Considering that younger patients requiring ICL surgery tend to have with-the-rule astigmatism, this surgical technique may be a viable option for reducing astigmatism without using toric ICLs.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40123-022-00470-6.

Comparison of Visual Acuity and Surgically Induced Astigmatism after Phacoemulsification by Temporal Clear Corneal Incision &amp; Superior Clear Corneal Incision

Background- The primary goal of cataract extraction surgery is immediate visual recovery and the best uncorrected visual acuity (UCVA) post operatively. Aim: To compare the surgically induced astigmatism (SIA) after phacoemulsification surgery with superior clear corneal incision (SCCI) and temporal clear corneal incision (TCCI). Materials &amp; method: 11 articles were reviewed on PubMed related to SIA &amp; a review was made on the factors that are responsible to reduce the post-operative astigmatism. The outcome measures were SIA and UCVA at 2 and 6 weeks, post‐operatively. Results - In this study we expect to have better visual outcome and reduce incidence of SIA in TCCI than SCCI. Conclusion: TCCI appears to have better visual outcome and reduced incidence of SIA.

Preoperative Biometry and Uncorrected Visual Outcome Following Cataract Surgery at a Teaching Hospital at Western Part of Nepal

Introduction: Proper preoperative biometry in cataract surgery provides expected postoperative uncorrected visual outcome. Astigmatism is one of the major problems to achieve best postoperative unaided visual acuity. Aims: To determine the distribution of biometric parameter and unaided visual outcome in the cataract patients operated at Nepalgunj medical college, Banke, Nepal. Methods: The patients who underwent cataract surgery between January 2019 and December 2020 at Nepalgunj medical college were studied. Patient’s demographic parameter, keratometric value, anterior chamber depth, lens thickness and axial length data, type of surgery, preoperative and post-operative visual acuity and other clinical details were collected and analyzed. Results: This study enrolled 261 eyes of 261 patients who had undergone cataract surgery. The mean age of patients was 60.8 ± 14.62 years. The mean corneal astigmatism was 1.30±1.43 D. Corneal astigmatism was higher than 1.00 D in almost 40% of cases. With-therule astigmatism was the most common type (46.4%) of astigmatism observed in this study. The mean average keratometry was 44.83±2.05 D. The mean preoperative LogMAR VA of 1.52±0.83 improved to 0.48 ± 0.48 postoperatively without statistically significant differences between manual small incision cataract surgery and phacoemulsification technique (p=0.496). Conclusion: The biometric data helps to improve surgical procedure and select most appropriate intraocular lens to attain maximal postoperative uncorrected visual acuity following cataract surgery. This study found superior convention incision is better for cataract surgery with equivalent visual outcome following manual small incision cataract surgery and phacoemulsification.

Systematic review of olfactory outcomes after nasoseptal flap harvest for endoscopic skull base surgery: Does using cold steel or olfactory strip preservation matter?

Several studies have described techniques aimed at mitigating olfactory dysfunction after nasoseptal flap (NSF) harvest for endoscopic skull base surgery (ESBS). No consensus exists as to whether popular methods including using cold steel (CS) versus electrocautery (EC) or septal olfactory strip (SOS) preservation offer an advantage. This systematic review was performed to examine the impact of these two technical variations of NSF harvest on postoperative olfactory outcomes. Following PRISMA guidelines, PubMed, Scopus, and Web of Science were searched for articles reporting olfactory outcomes in ESBS cases employing an NSF. Original articles focusing on technique variations of the NSF and reporting at least one objective olfactory measure were included. Nine studies comprising 610 patients were included. Various, olfactory testing outcomes were reported, and postoperative follow-up ranged from 6weeks to 12 months. Three studies, including a randomized controlled trial, compared the use of CS and EC for the superior incision of the NSF. No significant difference was found in objective olfactory function (p>0.05) when comparing these techniques. Five studies comprising 504 patients reported results from SOS-sparing. SOS-sparing technique in NSF harvest demonstrated smell preservation in the postoperative setting when compared with preoperative measures (p>0.05); however, no direct comparison to non-SOS-sparing techniques was made. The use of CS as opposed to EC for the superior NSF incision does not appear to confer an advantage in preserving postoperative olfactory function (grade B evidence). SOS preservation may be associated with better olfactory outcomes in NSF harvest (grade C evidence).

A COMPARATIVE STUDY ON THE SUPERIOR, SUPEROTEMPORAL, AND TEMPORAL INCISION IN MANUAL PHACOEMULSIFICATION FOR POSTOPERATIVE ASTIGMATISM

Aim: To compare the amount of astigmatism in superior, superotemporal, and temporal incisions in manual phacoemulsication. Methods: Three hundred patients were studied. The patients were randomly assigned to any of the three groups. The three groups had 100 patients each. The patients in group Aunderwent manual phaco with a superior incision, the patients in group B underwent manual phaco with a supero-temporal incision and the patients in group C underwent manual phaco with a temporal incision. The patients were examined on postoperative days 1,7,21 and 45. The uncorrected and the best-corrected visual acuity was recorded and a slit-lamp examination and autorefractometer and keratometry examinations were also done. Results:The mean SIAin group Awas found to be 1.572 ± 0.651, in group B, it was 0.532 ± 0.317and in group C, it was 0.435 ± 0.338. The F score which was applied was found to be 186.44. This value was more than the standard value. The p-value accordingly was &lt; 0.001, which was highly signicant. Conclusion: Manual phaco which is done with a temporal and a supero-temporal approach provides a better quality of vision due to a signicantly less SIAthan the superior approach.

Study the Possibility of Creating Mucosal Valve Mechanism at Ureteric Orifice without Obstructing the Urine Outflow but Preventing the Urine Backflow into the Ureters.

Objective:To study the possibility of creating mucosal valve mechanism at ureteric orifice without obstructing the urine outflow but preventing the urine backflow into the ureters.Materials and Methods:Ethical waiver was obtained from the institutional ethical committee. Prospective experimental study was conducted on the post-mortem specimen of intact bladder with urethra and bilateral ureters retrieved from the already slaughtered lamb available in the meat market. Feeding tube inserted via urethral opening into the bladder lumen and bladder inflated with saline demonstrated no reflux of urine via transverse cut opening of ureters. Bladder lumen opened, ureteric orifices incised backwards to eliminate the obliquity. After closing the bladder opening, saline inflation test demonstrated bilateral reflux of saline via cut openings of bilateral ureters. Bladder was re-opened. The upper limb of horizontal U started 10 mm lateral and 8 mm above the refluxing ureteric orifice. Distal most curvature of horizontal U was kept 5 mm medial to ureteric orifice continuing along the lower limb of horizontal U terminating 10 mm lateral and 8 mm below the refluxing ureteric orifice, mucosal flaps from superior and inferior incision mobilized and edges joined to cover the ureteric orifice creating a flap valve mechanism. Influx of saline via cut end of ureters demonstrated no obstruction. Bladder was closed. Saline inflation test and contrast study demonstrated abolition of reflux on flap side and persistence of reflux on another side.Results:Five such experiments were conducted. On the side where the valve was created, Vesicoureteral reflux was abolished in four but in one minimal reflux still persisted.Conclusion:Creating a mucosal flap valve around the ureteric orifice can prevent reflux in 80% of cases without obstruction and without the necessity of ureteric mobilization or creating submucosal tunnel.

Comparative study of surgically induced astigmatism in superior and temporal scleral incisions in manual small-incision cataract surgery patients

Background: The purpose of the study is to evaluate surgically induced corneal astigmatism and visual outcome in patients undergoing small-incision cataract surgery (SICS) by modifying incision site on the basis of type of regular astigmatism. Material and Methods: This is a prospective study including 100 patients, having senile immature cataract, divided in two groups of 50 patients each according to the type of preoperative corneal astigmatism over a period of January 2018 to June 2019. A detailed preoperative evaluation was done including automated refractokeratometry, on the basis of which patients having steeper vertical axis (90° ±30°), i.e., “with the rule” astigmatism placed in Group A and subjected to superior SICS, and those having horizontal steeper axis (150°–180° and 0°–30°), i.e., “against the rule” astigmatism, were placed in Group B and subjected to temporal SICS. All surgeries were performed by a single ophthalmic surgeon with a similar technique of a 6.00 mm superior or temporal scleral straight incision. Surgically induced astigmatism (SIA) was calculated by a computer application SIA calculator version 2.0 on the 45th postoperative day and compared. Results: Present study showed mean SIA was significantly less in the temporal group (1.09 ± 0.42 D) as compared to the superior group (1.38 ± 0.62 D). Conclusion: Modification of incision site in SICS as per preoperative astigmatism produces comparable results to other sophisticated techniques such as phacoemulsification, and hence, it provides an alternative path to attain better visual outcome and reduced SIA with limited resources available in most of the developing countries.

Transeptal Approach to the Maxillary Sinus and Pterygopalatine Fossa.

Transeptal Approach to the Maxillary Sinus and Pterygopalatine Fossa.

Internal Angular Dermoid Indenting on the Globe

Angular dermoid cysts are common periorbital tumours in children. They are tumours of embryonic origin that arise along bony sutures as a result of abnormal ectodermal sequestration during development. Angular dermoid cysts usually present in early childhood, are characteristically small benign and slow growing lesion. External angular dermoid present in the superotemporal quadrant is more common compared to internal angular dermoid in the superonasal quadrant. Early surgical excision is recommended and performed in the majority of cases, particularly to restore facial cosmesis.&#x0D; Here we report an unusual case of a large internal angular dermoid cyst indenting the globe in a 3-year-old girl presented with left upper eyelid mass at medial angle since one year of age. The cyst was excised completely by anterior orbitotomy through a small superior lid crease incision.

Endoscopic Transorbital Approach to Mesial Temporal Lobe for Intra-Axial Lesions: Cadaveric Study and Case Series (SevEN-008).

Endoscopic transorbital approach (ETOA) has been proposed as a minimally invasive technique for the treatment of skull base lesions located around mesial temporal lobe (MTL), mostly extra-axial pathology. To explore the feasibility of ETOA in accessing intraparenchymal MTL with cadaveric specimens and describe our initial clinical experience of ETOA for intra-axial lesions in MTL. Anatomic dissections were performed in 4 adult cadaveric heads using a 0° endoscope. First, a stepwise anatomical investigation of ETOA to intraparenchymal MTL was explored. Then, ETOA was applied clinically for 7 patients with intra-axial lesions in MTL, predominantly high-grade gliomas (HGGs) and low-grade gliomas (LGGs). The extradural stage of ETOA entailed a superior eyelid incision followed by orbital retraction, drilling of orbital roof, greater and lesser wing of sphenoid bone, and cutting of the meningo-orbital band. For the intradural stage, the brain tissue medial to the occipito-temporal gyrus was aspirated until the temporal horn was opened. The structures of MTL could be aspirated selectively in a subpial manner without injury to the neurovascular structures of the ambient and sylvian cisterns, and the lateral neocortex. After cadaveric validation, ETOA was successfully performed for 4 patients with HGGs and 3 patients with LGGs. Gross total resection was achieved in 6 patients (85.7%) without significant surgical morbidities including visual field deficits. ETOA provides a logical line of access for intra-axial lesions in MTL. The safe and natural surgical trajectory of ETOA can spare brain retraction, neurovascular injury, and disruption of the lateral neocortex.