Expanding the limits of endoscopic intraorbital tumor resection using 3-dimensional reconstruction

Gregório, Luciano Lobato; Busaba, Nicolas Y.; Miyake, Marcel M.; Freitag, Suzanne K.; Bleier, Benjamin S.

doi:10.1016/j.bjorl.2017.11.010

Cited by 8 publications

(7 citation statements)

References 11 publications

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“…Generally, the optic nerve is considered to be the lateral limit of dissection from an endonasal perspective; however, in certain circumstances, dissection beyond this border may be possible. 14,15 The oculomotor nerve (OMN) enters the orbit through the lateral compartment of the annulus of Zinn and immediately branches into superior and inferior rami. The inferior ramus ultimately gives off two branches that travel anteroinferiorly to innervate the IRM and inferior oblique muscle as well as one branch that passes medially below the optic nerve to innervate the MRM.…”

Section: Anatomic Locationmentioning

confidence: 99%

Endoscopic Endonasal Approach for Intra- and Extraconal Orbital Pathologies

Melder

Zwagerman

Gardner

et al. 2020

J Neurol Surg B Skull Base

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Endoscopic endonasal approaches offer an important alternative in the management of posterior inferomedial orbital pathology. Beginning with endoscopic orbital decompressions for Graves' disease, the endonasal corridor for the management of intra- and extraconal pathologies has continued to evolve. Endonasal removal of orbital cavernous hemangiomas is well described in the literature; however, many other benign and malignant pathologies of the medial orbit can be accessed through this approach. Advantages of the endonasal approach include improved visualization and decreased manipulation of orbital contents in the medial and posterior orbit. Additionally, for tumors that extend from the paranasal sinuses into the orbit, this corridor may be ideal for concurrent management. The current literature for this approach will be reviewed including the oncologic results, complications, limitations, and reconstructive needs along with pertinent anatomy. In addition, data from our own institution will be reviewed.

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Section: Anatomic Locationmentioning

confidence: 99%

Endoscopic Endonasal Approach for Intra- and Extraconal Orbital Pathologies

Melder

Zwagerman

Gardner

et al. 2020

J Neurol Surg B Skull Base

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“…Our group has previously reported that 3D reconstruction can be an invaluable tool in the analysis of orbital pathology, as it may reveal unexpected relationships between the lesion and the surrounding orbital structures which may influence surgical planning. 23 Furthermore, this enables that image guidance can be utilized within the dissection lab to assist with localization and trajectory planning.…”

Section: Discussionmentioning

confidence: 99%

Development of a Modular Cadaveric Endoscopic Orbital Surgery Model

Banks

Husain

Sacks

et al. 2019

Am J Rhinol�Allergy

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Introduction Endoscopic orbital surgery requires the acquisition of unique skill set including endoscopic bimanual dissection of intra/extraconal lesions adherent to orbital fat and neurovascular structures. Our goal was to develop a modular cadaveric model used to train surgeons to resect orbital pathology within any desired orbital compartment. Methods Expansile superabsorbent polymer (SAP) beads (2 mm) were soaked in Omnipaque™ (Iohexol) solution for 15 minutes prior to transcaruncular orbital implantation using 10-gauge angiocath. Insertion depth was designed to implant beads in predetermined intraconal compartments corresponding to established orbital tumor stages. Beads were left to expand in situ over a period of 1 to 5 hours. Computed tomography scans were performed using the FUSION image guidance protocol. Model utility and learning curves were assessed by quantifying resection time over 8 sequential attempts. Results All 24 beads were successfully implanted in 8 orbits corresponding to CHEER stage II to IV lesions (n = 3 per orbit). Beads expanded from 2 mm to an average of 5.2 mm within 1 hour. During expansion, the beads interpolated into the adjacent fascia similar to in vivo tumors. Average insertion time was 5:53 minutes per orbit (range, 3:24–10:33 min) and average time to bead identification was 10:47 minutes. Across all beads, dissection times decreased in a nonsignificant manner over 8 consecutive attempts. Conclusion The directed implantation of expansile SAP beads in this cadaveric model accurately replicates the approach, identification, and resection of isolated orbital lesions. This orbital model can assist the endoscopic surgical team to develop further knowledge and technical skill sets to approach orbital lesions. Further ongoing studies to validate this model are currently underway.

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“…Access to the medial intraconal orbit has posed great challenges, and different approaches have been described including medial orbitotomy and transconjunctival approaches . The endoscopic endonasal approach provides a direct route to the medial orbit, making this the preferred approach among endoscopic skull base surgeons . Some advantages include lack of external incisions, no brain retraction, no displacement of orbital structures including the globe, no need for reconstruction when ocular muscle detachment is not performed, and shorter hospitalization time .…”

Section: Discussionmentioning

confidence: 99%

“…It requires extensively trained surgeons because 3‐dimensionl (3D) perception of the orbit can be difficult. Depending on the histology type, stage, or grade of some lesions, an additional open approach may also be necessary …”

Section: Discussionmentioning

confidence: 99%

“…The endoscopic approach to the orbit was first described in the early 1980s with and without a concurrent external approach . The approach has since been used for biopsies, resection of malignancies or foreign bodies, and optic decompression of the posteromedial orbit with positive outcomes . Nevertheless, endoscopic intraconal surgery is still in its infancy with the need for new techniques for enhanced exposure.…”

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confidence: 99%

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Analysis of anterior and posterior maneuvers to enhance intraconal exposure

Lemos-Rodriguez

Farzal

Overton

et al. 2018

Int Forum Allergy Rhinol

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Background:The medial and inferior recti encompass the ideal surgical corridor to approach the intraconal space endonasally. Here, we describe 3 different maneuvers to achieve greater access to orbital contents through an expanded endonasal approach (EEA). Methods:Four human cadaver heads were dissected bilaterally (n = 8). EEA to the medial intraconal orbit was executed. The following 3 maneuvers were performed: (1) anterior: extraocular muscles control (EOM); (2) posterior: annulus of Zinn (AZ) release; and (3) anterior/posterior combined. Measurements of the inferior and medial rectus corridor at the level of anterior ethmoidal artery (AEA) and posterior ethmoidal artery (PEA) and extent of optic nerve and medial rectus visualization was performed before and a er each maneuver.Results: Medial rectus length (MRL) and optic nerve length (ONL) achieved were 1.72 ± 0.28 cm and 0.85 ± 0.2 cm, respectively. Mean caudal-rostral distances between the rectus muscles at the level of the AEA and PEA were 3.45 ± 0.7 mm and 1.30 ± 0.3 mm, respectively. A er EOM control, mean caudal-rostral distances at the same level were as follows: AEA 4.90 ± 1.15 mm (p = 0.009) and PEA 1.70 ± 0.20 mm (p = 0.016). With AZ release, MRL was 2.20 ± 0.7 cm (p = 0.002) and ONL was 1.30 ± 0.2 cm (p = 0.003), with mean rostral-caudal distance at the level of AEA at 4.03 ± 0.8 mm (p = 0.16) and PEA at 1.71 ± 0.36 mm (p = 0.039). Mean caudal-rostral distances achieved with AZ release and EOM control were as follows: AEA 5.6 ± 1.2 mm (p = 0.001) and PEA 2.15 ± 0.4 mm (p = 0.001). Conclusion:Progressive access to the orbital contents is afforded with the 3 delineated maneuvers. The magnitude of access is optimized with the combined maneuver. The actual anterior/posterior location of the target will determine which maneuvers are required. C 2018 ARS-AAOA, LLC. Key Words: orbital/ocular; endoscopy; endoscopic minimally invasive surgery of the skull base; FESS; endoscopic skull base surgery How to Cite this Article: Lemos-Rodriguez AM, Farzal Z, Overton LJ, et al. Analysis of anterior and posterior maneuvers to enhance intraconal exposure. Int Forum Allergy Rhinol. 2019;9:556-561. E ndoscopic endonasal approaches have evolved through the years, from the resection of pituitary and transsellar

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Expanding the limits of endoscopic intraorbital tumor resection using 3-dimensional reconstruction

Abstract: Three-dimensional reconstruction enhances preoperative planning for endoscopic orbital surgery. Tumors that extend lateral to the optic nerve may still be candidates for a purely endoscopic resection as long as they do not extend above the plane of resectability described herein.

Cited by 8 publications

References 11 publications

Endoscopic Endonasal Approach for Intra- and Extraconal Orbital Pathologies

Endoscopic Endonasal Approach for Intra- and Extraconal Orbital Pathologies

Development of a Modular Cadaveric Endoscopic Orbital Surgery Model

Analysis of anterior and posterior maneuvers to enhance intraconal exposure

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