Parc Taulí continues to consolidate its surgical program, with the incorporation of transorbital surgery, an effective surgical technique for the treatment of patients with tumors at the base of the skull. This type of minimally invasive surgery is performed through the eye socket, thus avoiding an open transcranial approach to access the brain. In this way, having to make a larger excision, with all the possible associated complications, is avoided.
Last October, the Neurosurgery service at Parc Taulí performed the first transorbital neuroendoscopy on a young patient with a benign tumor lodged between the brain and the orbital cavity.
"The patient had already undergone transcranial surgery, about ten years ago, at another center. But the tumor had grown again and was now pressing on his eye and causing epileptic seizures. The patient's quality of life was deteriorating and complicating his family life.”, explains Dr. Jorge Herrería, neurosurgeon in charge of the operation.
Before proposing this intervention, the team of the neurosurgery skull base unit studied the case for months to offer the best solution to the patient. They worked together with the Lab3D of the Institute of Research and Innovation (I3PT) to obtain a three-dimensional model of the patient's skull and his injury, to see more precisely how to approach it. The skull base is the support of the brain: it is the area between the eyes, behind the nose until reaching the spine. It is one of the most complex areas of human anatomy, since all the cranial nerves and blood vessels of the brain, head and neck pass through it.
"We proposed to perform surgery in two stages, transorbital and endonasal. In this way, 95% of the tumor was removed. As this approach is minimally invasive, the patient's quality of life has improved.”, says Dr. Herreria.
But the most challenging part of this surgery is the repair and closure of the skull base. “By opening holes that do not exist at the base of the skull, the nasal cavity or orbit is brought into contact with the brain. A good closure must be made to avoid leakage of cerebrospinal fluid. It is estimated that 4% of interventions of this type have some loss of fluid, but at the Neurosurgery service of Parc Taulí we are at 0. Our closure is one of the safest”, emphasizes Dr. Jorge Herreria.
The success of the operation was the teamwork with the professionals from different services of the Parc Taulí who participated. During the operation, Dr. Jorge Herrería, Dr. Paula Vázquez and Dr. Sebastian Menéndez; Dr. Alda Cardesín and Dr. Mariana Campos, from the Otorhinolaryngology service; the neuroanesthesia service, the nursing and neurophysiology team participated.
"This approach has opened the door for us to offer other options for treating skull base injuries. However, the success of the intervention is the trust between the team of professionals at Parc Taulí and the collaboration”, says Dr. Vázquez.
Transorbital surgeries are very complex surgical procedures that are gradually being introduced into different neurosurgery services, although very few hospitals still offer this option to their patients.
