Endoscopic transorbital approach [Neurosurgery Wiki]

This page is read only. You can view the source, but not change it. Ask your administrator if you think this is wrong.
====== Endoscopic transorbital approach ======

===== Cadaveric anatomical dissection studies =====
In a [[cadaveric anatomical dissection study]] Gagliano et al.
((Gagliano D, Manfrellotti R, Lasunin N, Prats-Galino A, Somma AD, Enseñat J. Endoscopic 360° Vision of the Orbit: A Comparative Anatomical Study of Endonasal and Transorbital Approaches. Neurocirugia (Engl Ed). 2025 Jun 13:500704. doi: 10.1016/j.neucie.2025.500704. Epub ahead of print. PMID: 40517903.))
anatomically demonstrate and compare the surgical perspectives offered by the endoscopic endonasal approach (EEA) and the [[endoscopic]] [[transorbital approach]] (ETOA), and explore their combined potential to provide a circumferential (360°) view of the [[orbit]] and its neurovascular contents.
----
==== 1. Sample Size Fallacy ====  
The study uses only **5 cadavers**, raising serious questions about the [[reproducibility]] and [[generalizability]] of the findings.  
> **Small N ≠ Big Insight.**  
No statistical validation or anatomical variability analysis is presented, reducing this to a **surgical demonstration**, not a scientific study.

Terms like *“360° vision”*, *“optimal exposure”*, and *“essential baseline”* are **marketing language**, not objective findings. There is no quantification of exposure or comparison of outcomes between EEA/ETOA and traditional approaches.  
> “360°” is **symbolic**, not **measured**.

Demonstrating that two endoscopic routes can “communicate” does not imply that such corridors are **safe**, **practical**, or **indicated** in real patients.  
> The leap from **anatomical potential** to **surgical application** is unjustified.

The study is more of a **neuroanatomical teaching tool** than a rigorous contribution to surgical science. The authors offer no discussion on:  
  * Intraoperative navigation  
  * Reconstruction strategies  
  * Risk of orbital compartment syndrome  
  * Learning curve or instrumentation limits  

===== 🧠 Neurosurgical Relevance =====  
While the [[endoscopic endonasal approach]] (EEA) and ETOA are of growing interest in skull base and orbital surgery, this paper does not **move the field forward**. It reaffirms already known anatomic exposures without addressing the **real-world challenges** of adopting these approaches.

===== 📉 Bottom Line =====  
A visually interesting but **clinically shallow** cadaveric [[report]] that fails to deliver on its promise of surgical [[innovation]]. Before quoting “360° vision” in [[orbital surgery]], the field needs **comparative outcome studies**, **technical feasibility in live surgery**, and **functional results**.

> ❝ [[Dissection]] is not [[demonstration]]. [[Exposure]] is not execution. And anatomical access ≠ clinical value. ❞