{"id":17718,"date":"2025-11-14T09:57:19","date_gmt":"2025-11-14T08:57:19","guid":{"rendered":"https:\/\/www.neurochirurgie-lariboisiere.com\/?p=17718"},"modified":"2026-03-30T10:33:02","modified_gmt":"2026-03-30T08:33:02","slug":"transorbital-eyebrow-lacrimal-keyhole-approach-telka","status":"publish","type":"post","link":"https:\/\/www.neurochirurgie-lariboisiere.com\/en\/2025\/11\/14\/transorbital-eyebrow-lacrimal-keyhole-approach-telka\/","title":{"rendered":"Transorbital Eyebrow Lacrimal Keyhole Approach (TELKA)"},"content":{"rendered":"\n<p class=\"wp-block-paragraph\"><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Case highlight:<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A 64-year-old man with partial seizures underwent resection of a meningioma arising from the lateral wall of the cavernous sinus using a <strong>transorbital eyebrow lacrimal keyhole approach (TELKA)<\/strong>. By removing the lip of the superolateral orbital rim (\u201clacrimal keyhole\u201d) through an eyebrow incision, the surgical team achieved optimal microscopic and endoscopic visualization without hazardous globe retraction.<br><\/p>\n\n\n\n<h3 class=\"wp-block-heading\">What is the TELKA approach?<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">TELKA is a minimally invasive transorbital route via a discreet eyebrow incision. A targeted osteotomy of the superolateral orbital rim creates an efficient corridor to the lateral cavernous sinus, limiting soft-tissue dissection and brain retraction.<br><\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Indications and targets<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Meningiomas of the <strong>lateral wall of the cavernous sinus<\/strong><\/li>\n\n\n\n<li>Spheno-orbital and anterolateral skull base lesions<\/li>\n\n\n\n<li>Selected extradural or interdural lesions<\/li>\n\n\n\n<li>Patients for whom minimal soft-tissue disruption and cosmetic benefits are priorities<br><\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Patient presentation<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Partial seizures with MRI demonstrating a lesion along the lateral cavernous sinus wall. Neuro-ophthalmologic evaluation is essential before surgery.<br><\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Surgical steps (summary)<\/h3>\n\n\n\n<ol start=\"1\" class=\"wp-block-list\">\n<li>Eyebrow incision and subperiosteal exposure of the superolateral rim<\/li>\n\n\n\n<li>Lacrimal keyhole osteotomy removing the orbital rim lip<\/li>\n\n\n\n<li>Combined microscopic and angled endoscopic visualization<\/li>\n\n\n\n<li>\u201cChopstick technique\u201d with malleable rotative suction<\/li>\n\n\n\n<li>Interdural dissection and tumor debulking<\/li>\n\n\n\n<li>Hemostasis and reconstruction preserving orbital anatomy<br><\/li>\n<\/ol>\n\n\n\n<h3 class=\"wp-block-heading\">Why choose TELKA?<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Excellent panoramic and close-up visualization<\/li>\n\n\n\n<li>Minimal brain and globe retraction<\/li>\n\n\n\n<li>Small, cosmetically discreet incision<\/li>\n\n\n\n<li>Direct lateral-to-medial access to the cavernous sinus<br><\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Risks and considerations<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Diplopia, ptosis, or cranial nerve III\u2013VI palsy<\/li>\n\n\n\n<li>Transient orbital edema or alignment disorders<\/li>\n\n\n\n<li>CSF leak, infection, bleeding<\/li>\n\n\n\n<li>Possible need for postoperative radiotherapy<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\"><br>Postoperative course &amp; follow-up<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Early ophthalmologic and neurologic assessment<\/li>\n\n\n\n<li>Typically mild postoperative pain and swelling<\/li>\n\n\n\n<li>MRI follow-up and seizure management<\/li>\n\n\n\n<li>Often faster recovery compared to larger craniotomies<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\"><br>Technical pearls<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Precise drilling of the lacrimal keyhole to avoid eye retraction<\/li>\n\n\n\n<li>Use of angled endoscopes and chopstick technique<\/li>\n\n\n\n<li>Respect for interdural anatomy of the lateral cavernous sinus<br><\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">FAQ <\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Is TELKA always possible?<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">No\u2014depends on tumor size, extension, and neuro-vascular relationships.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Is the scar visible?<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Often very discreet, hidden in the eyebrow.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Is the eye retracted?<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The keyhole removes the rim lip specifically to <em>avoid<\/em> globe traction.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Hospital stay?<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Usually shorter than with traditional craniotomies.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Will I need radiotherapy?<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Sometimes, depending on residual tumor and pathology.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">source: <a href=\"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/j-neurosurg-overview.xml\" target=\"_blank\" rel=\"noopener\">https:\/\/thejns.org\/view\/journals\/j-neurosurg\/j-neurosurg-overview.xml<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Case highlight: A 64-year-old man with partial seizures underwent resection of a meningioma arising from the lateral wall of the cavernous sinus using a transorbital eyebrow lacrimal keyhole approach (TELKA). By removing the lip of the superolateral orbital rim (\u201clacrimal&#8230;<\/p>\n","protected":false},"author":5,"featured_media":17717,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[1],"tags":[],"class_list":["post-17718","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-research"],"acf":[],"_links":{"self":[{"href":"https:\/\/www.neurochirurgie-lariboisiere.com\/en\/wp-json\/wp\/v2\/posts\/17718","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.neurochirurgie-lariboisiere.com\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.neurochirurgie-lariboisiere.com\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.neurochirurgie-lariboisiere.com\/en\/wp-json\/wp\/v2\/users\/5"}],"replies":[{"embeddable":true,"href":"https:\/\/www.neurochirurgie-lariboisiere.com\/en\/wp-json\/wp\/v2\/comments?post=17718"}],"version-history":[{"count":2,"href":"https:\/\/www.neurochirurgie-lariboisiere.com\/en\/wp-json\/wp\/v2\/posts\/17718\/revisions"}],"predecessor-version":[{"id":17722,"href":"https:\/\/www.neurochirurgie-lariboisiere.com\/en\/wp-json\/wp\/v2\/posts\/17718\/revisions\/17722"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.neurochirurgie-lariboisiere.com\/en\/wp-json\/wp\/v2\/media\/17717"}],"wp:attachment":[{"href":"https:\/\/www.neurochirurgie-lariboisiere.com\/en\/wp-json\/wp\/v2\/media?parent=17718"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.neurochirurgie-lariboisiere.com\/en\/wp-json\/wp\/v2\/categories?post=17718"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.neurochirurgie-lariboisiere.com\/en\/wp-json\/wp\/v2\/tags?post=17718"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}