neurosurgeryНейрохирургияRussian journal of neurosurgery1683-32952587-7569Издательский дом "МедИНК"10.17650/1683-3295-2020-22-4-123-128neurosurgery-971Research ArticleОБЗОРЫ ЛИТЕРАТУРЫLITERATURE REVIEWАнатомическое обоснование и варианты трансорбитальных эндоскопических доступов (обзор литературы)Anatomical justification and types of transorbital endoscopic approaches (review)https://orcid.org/0000-0003-0857-9398ЛевченкоО. В.LevchenkoO. V.

127473 Москва, ул. Делегатская, 20, стр. 1

Bld. 1, 20 Delegatskaya St., Moscow 127473

https://orcid.org/0000-0003-0399-2909РевазянК. В.RevazyanK. V.

Карен Валодович Ревазян

127473 Москва, ул. Делегатская, 20, стр. 1

Bld. 1, 20 Delegatskaya St., Moscow 127473

7karen7@inbox.ruhttps://orcid.org/0000-0003-4161-0940КаландариА. А.KalandariA. A.

127473 Москва, ул. Делегатская, 20, стр. 1

Bld. 1, 20 Delegatskaya St., Moscow 127473

ФГБОУ ВО Московский государственный медико-стоматологический университет им. А.И. Евдокимова Минздрава РоссииРоссияA.I. Evdokimov Moscow State University of Medicine and Dentistry, Ministry of Health of RussiaRussian Federation202017012021224123128Copyright © Левченко О.В., Ревазян К.В., Каландари А.А., 20212021Левченко О.В., Ревазян К.В., Каландари А.А.Levchenko O.V., Revazyan K.V., Kalandari A.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.therjn.com/jour/article/view/971

Для лечения заболеваний и травм глазницы и основания черепа наиболее часто используют транскраниальные и трансназальные доступы. Однако развитие эндоскопических технологий, микрохирургической техники и малоинвазивных методик способствует усилению интереса к трансорбитальным эндоскопическим доступам, которые позволяют провести манипуляции не только на содержимом орбиты, но и на структурах основания черепа, в частности передней и средней черепных ямок. Выделяют 4 варианта таких доступов: прекарункулярный, верхний транспальпебральный, латеральный ретрокантальный и нижний пресептальный. В настоящее время точные показания к применению трансорбитальных доступов не определены, а алгоритм выбора того или иного варианта не создан. В статье описаны результаты применения этих доступов при заболеваниях и травмах орбиты и основания черепа.

При травмах и новообразованиях орбиты и основания черепа, ликворее, инфекционных заболеваниях, эндокринной офтальмопатии применение трансорбитальных эндоскопических методов приносит хорошие функциональные и косметические результаты. Преимуществами этих доступов считаются большая площадь орбитотомии и сохранность околоносовых структур, отсутствие крупных нервно-сосудистых пучков на траектории доступа, маленький разрез, минимальная ретракция головного мозга, хороший обзор и освещение структур.

Трансорбитальные эндоскопические доступы к основанию черепа не связаны со значительными неврологическими или сосудистыми осложнениями, кровотечениями, гематомами, инфекциями. Диплопия, птоз, энофтальм встречаются достаточно редко. Не было описано ни одного случая потери зрения и послеоперационной ликвореи.

Transcranial and transnasal approaches are the most common techniques for treatment of diseases and injuries of the eye socket and the base of the skull. However, development of endoscopic technology, microsurgical devices and minimally invasive techniques promotes increased interest in transorbital endoscopic approaches which allow to perform manipulations in the eye socket and structures of the base of the skull, namely, the anterior and middle cranial fossa. There are 4 types of such approaches: pre-caruncular, superior transpalpebral, lateral retro-canthal and inferior preseptal. Currently, precise indications for transorbital approaches are not formulated, and there are no algorithms for approach selection. The article describes the results of using these approaches in treatment of diseases and injuries of the orbit and the base of the skull.

In injuries and tumors of the orbit and the base of the skull, cerebrospinal liquid leakage, infectious diseases, endocrine ophthalmopathy, transorbital endoscopic techniques provide good functional and cosmetic results. Among the advantages of these approaches are larger orbitotomy area and preservation of nasal structures, absence of large neurovascular bundles in the way of the approach, small incision, minimal brain retraction, good visibility and illumination of the structures.

Transorbital endoscopic approaches to the base of the skull aren’t associated with significant neurological or vascular complications, hemorrhage, hematomas, infections. Diplopy, ptosis, enophthalmia are also quite rare. In literature, there are no descriptions of cases of loss of vision or postoperative cerebrospinal liquid leakage.

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The authors declare that there are no conflicts of interest present.