Endoscopic Endonasal Intraconal Approach for Orbital Tumor Resection: Case Series and Systematic Review

Abstract

Intraorbital tumor could be approached by numerous surgical methods. The neuroendoscopic endonasal approach could provide a feasible corridor for indicated tumors. Herein we present a series of 6 consecutive intraorbital tumors from April 2018 to October 2020, which received endonasal endoscopic resection. Cadaveric dissection was performed for the intraconal approach, and the literature was also reviewed. Five tumors were located intraconally, while one extraconally. The pathology revealed 1 angioleiomyoma, 1 cavernous hemangioma, 1 pilocytic astrocytoma, 1 meningioma, and 2 schwannomas. Five of the six achieved gross total resection, including 3 tumors with lateral extension beyond the optic nerve. Preoperative visual deterioration was observed in 4 of the 6 patients, and all got improvement postoperatively. Transient oculomotor nerve palsy was presented in one patient postoperatively. No cerebrospinal fluid leakage, enophthalmos, or strabismus was observed. The median follow-up time is 27 months (11~41 months). At the 6-month follow-up, the visual acuity remained unchanged compared with that at discharge. Proptosis was resolved in 2 of the 3 patients; diplopia was improved in one patient. In conclusion, endoscopic endonasal intraconal approach could be suitable for selected pathological conditions, and for both medial or beyond medial extraconal and intraconal orbital tumors.

A case of intraorbital malignant lymphoma biopsied using an endoscopic transnasal approach

“…Recently, the total resection of intraorbital tumors has shown low complication rates. [11] Shin et al stated that gross-total resection of extraperiosteal tumors is generally possible without neurological complications, whereas surgical indications should be considered carefully for intraperiosteal tumors. [9]…”

Combined endoscopic transethmoid and transconjunctival en bloc resection of optic nerve tumors in patients lacking functional vision

“…These risks have led clinicians to seek ways of reducing the invasiveness of the procedure where possible, for example, by the removal of optic nerve tumors via nasal endoscopy (8) and a lateral orbital approach. While both of these approaches can effectively reduce both the operative time and length of hospitalization, the lateral orbital approach cannot achieve complete resection of intracanalicular tumors and usually results in a substantial cutaneous surgical scar (7), while nasal endoscopy alone is not well-suited to the removal of tumors growing laterally to the temporal side ( 9) and also increases the medical expenditure on the reconstruction of the orbital wall (25).…”

“…The first strength of the approach used in this study lies in the removal of the tumor via a transconjunctival approach rather than the dissection of the tumor within the enlarged intermuscular space (25,26), thus avoiding the ablation of the lamina papyracea and its associated complications. The application of the 360-degree "round-the-clock" approach to accessing the orbit (9,27) has led to the proposal of the endoscopic endonasal approach for lesions in the mid, posterior, or apical orbital regions from 1 to 7 o'clock.…”

Interdisziplinäre Therapie der Erkrankungen der Orbita

“…Beim endonasalen, transethmoidalen Zugangsweg handelt es sich um den klassischen rhinochirurgischen Zugang zur Orbita. Er ist in- diziert zur operativen Entfernung von peribulbären, retrobulbären und intrakonalen Raumforderungen medial des Bulbus bzw, des N. opticus bis in die Orbitaspitze, [480][481][482][483].…”