TransOrbital NeuroEndoscopic Surgery for Biopsy of the Left Cavernous Sinus: A Literature Review, Case Report, and Cadaveric Proof of Concept.

• Type of Material: Article
• Authors: Natasha L. Frontera, University of Puerto Rico; Julio Rosado-Philippi, University of Puerto Rico; Francisco Del Valle Díaz, University of Puerto Rico; Alejandra Santiago Díaz, University of Puerto Rico; Adriana Vazquez Medina, University of Puerto Rico; Arnaldo Figueroa, University of Puerto Rico; Natalia González, University of Puerto Rico; Gustavo Pradilla, Emory University; Tomas Garzón, Emory University; Julio Rodríguez, Emory University; Luisam Tarrats, University of Puerto Rico; Miguel Mayol del Valle, University of Puerto Rico
• Language: English
• Date: 2023-07
• Publisher: Thieme
• Publication Version: Final Published Version
• Copyright Statement: The Author(s). This is an open access article published by Thieme
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1055/a-2155-2419
• Title of Journal or Parent Work: J Neurol Surg Rep
• Volume: 84
• Issue: 3
• Start Page: e116
• End Page: e123
• Keywords: cavernous sinus; TransOrbital NeuroEndoscopic Surgery; systematic review; lymphoma; biopsy
• Research Categories: Health Sciences, Medicine and Surgery; Biology, Neuroscience

Abstract

The aim of this report is to describe TransOrbital NeuroEndoscopic Surgery (TONES) as a safe alternative for obtaining a cavernous sinus (CS) biopsy. We describe this technique in a patient with a diffuse large B cell lymphoma mimicking Tolosa-Hunt's syndrome. Articles were gathered querying PubMed, Embase, and Scopus databases with terms related to a "transorbital neuroendoscopic approach." The literature search was performed by two independent authors (N.L.F. and J.R.), with inconsistencies resolved by the senior author (M.M.D.V.). 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 2 months. A brain magnetic resonance imaging revealed an infiltrative lesion at the left CS. A presumptive diagnosis of Tolosa-Hunt syndrome 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.