Combined transconjunctival–eyebrow approach providing minimally invasive access to all orbital quadrants

Abstract

<jats:p>✓Surgical approaches to treat orbital disease should provide a good exposure of intraorbital anatomical structures, allow their functional preservation, and provide good cosmetic results. The authors describe a minimally invasive, combined transconjunctival–eyebrow approach to all orbital quadrants in a step-wise manner. The indications, advantages, and limitations of the technique are highlighted.</jats:p> <jats:p>A transconjunctival approach via the postseptal area is described. It allows exposure of the medial, inferior, and lateral parts of the orbit. Depending on the orbital space to be exposed, a lateral or a medial eyebrow incision is then made. The eyebrow and the conjunctival incisions are connected by subperiosteal dissection. This combined access provides exposure to all intraconal muscles and to the superior, medial, lateral, and inferior portions of the optic nerve.</jats:p> <jats:p>The combined transconjunctival–eyebrow approach provides an excellent orbital exposure, with minimal damage to the circumjacent structures. It requires less operative time than other approaches and yields good cosmetic results. Intracranial or intrafacial tumor extension and tumors located purely in the orbital apex are limitations for the use of this technique.</jats:p>

Surgical Approaches to the Orbital Apex: Comparison of Endoscopic Endonasal and Transcranial Approaches using a Novel 3D Endoscope

“…(D) 3D picture of the area described in (C). transantral, and transnasal transethmoidal approaches (Chang et al, 2003;Delfini et al, 1992;Goldberg et al, 2007;Graham et al, 2002;Karaki et al, 2006;Kingdom and Delgaudio, 2003;Kiratli et al, 2005;Koerbel et al, 2007;Metson and Pletcher, 2006;Monin et al, 2005;Numa and Kawamoto, 2007;Perry, 2006;Schick et al, 2003;Hassler, 2004, 2005;Tsirbas et al, 2005). Karaki et al (2006) presented the advantages and disadvantages of various approaches, and underlined the importance of the endoscopic endonasal approaches to lesions situated in the inferomedial aspect of the orbital apex.…”

Orbital Cavernous Hemangioma Presenting With Atypical Appearance -Case Report-

“…Transconjunctival approach combined with eyebrow incision can provide less invasive access to all orbital quadrants except for lesions with intracranial or intrafacial tumor extension and pathological entities located purely in the orbital apex. 1,5) In the present case, preoperative neuroimaging revealed that the lesion involved all orbital quadrants, although mainly the medial compartment, and extended to the orbital apex. In addition, the tumor was irregularly shaped O. Akiyama et al…”

“…1,3,5,10) In contrast, conservatively managed patients remained stable during a followup period of 3-10 years. 7) Present case showed progressive ocular symptoms caused by the orbital lesion and underwent a surgical exploration.…”

“…8) Surgical resection is indicated in symptomatic patients presenting impaired visual function or ocular movements, progressing exophthalmos, and symptoms of increased intraorbital pressure. 1,5,7,10) Orbital CH has specific neuroimaging findings of circumscribed enhanced mass, which indicates that total resection is feasible without postoperative worsening of visual impairment. 3,7,8) However, some orbital CHs have had tight adhesion with the surrounding tissue without the circumferential capsule, which makes surgical resection hazardous.…”

The Anatomical Relationships of the Ocular Motor Nerves with an Emphasis on Surgical Anatomy of the Orbit

“…The central approach has two variants and may be selected for biopsy or removal of lesions located in the intraorbital segment of the optic nerve or located in the midportion of the orbit. Modern neurosurgery targets the best possible minimal invasive surgical outcome with minimal tissue damage and maximal patients' cosmetic satisfaction, pain, and functional outcomes (Koerbel et al, ; Abdel Aziz et al, ; Reisch et al, ; Tatarli et al, ; Ulutas et al, ). The recently introduced endoscopic approaches to the orbit apex offers significant advantages and better surgical outcomes over external approaches, and was suggested to be the preferred approach for all medial and inferior lesions (Stokken et al, ).…”