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CC BY-NC-ND 4.0 · J Neurol Surg Rep 2023; 84(03): e116-e123
DOI: 10.1055/a-2155-2419
Case Report

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

Natasha L. Frontera
1   School of Medicine, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
,
Julio Rosado-Philippi
1   School of Medicine, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
,
Francisco Del Valle Díaz
1   School of Medicine, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
,
Alejandra Santiago Díaz
1   School of Medicine, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
,
Adriana Vázquez Medina
1   School of Medicine, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
,
Arnaldo Figueroa
1   School of Medicine, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
,
Natalia González
1   School of Medicine, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
,
Gustavo Pradilla
2   Department of Neurosurgery, Emory University, Atlanta, Georgia, United States
,
Tomas Garzón
2   Department of Neurosurgery, Emory University, Atlanta, Georgia, United States
,
Julio Rodríguez
2   Department of Neurosurgery, Emory University, Atlanta, Georgia, United States
,
Luisam Tarrats
1   School of Medicine, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
,
Miguel Mayol del Valle
1   School of Medicine, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
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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.

Keywords

TransOrbital NeuroEndoscopic Surgery - cavernous sinus - biopsy - lymphoma - systematic review


Publication History

Received: 26 May 2023

Accepted: 03 August 2023

Accepted Manuscript online:
16 August 2023

Article published online:
27 September 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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