Endoscopic endonasal orbital cavernous hemangioma resection: global experience in techniques and outcomes

Background:The aim of this work was to present our singlecenter experience on orbital cavernous hemangiomas managed using an endonasal endoscopic approach. Methods:The study design used was one-institutional retrospective review. Twenty-three cases of orbital cavernous hemangioma were analyzed and followed up.Results: There were 10 males and 13 females, with an average age of 46.1 years, included in our study. Seven cases were extraconal, 16 cases were intraconal, and in 10 of the patients the optic nerve was involved and compressed. Total resection of the tumor was achieved in 16 cases; of the remaining 7 cases, partial tumor resection and orbital decompression were conducted, orbital decompression was conducted in 2 cases, and orbital decompression and optic nerve decompression were conducted in 3 cases. Visual acuity in 9 patients improved significantly, as 16 of the 20 patients with a preoperative visual field defect had a smaller defect a er surgery. Conclusion:This study adds to the literature showing that endoscopic transnasal surgery is likely a reasonable option for patients with the orbital cavernous hemangiomas medial of the optic nerve. With greater experience, skilled surgical technique, and careful operation, be er clinical efficacy can be achieved. C 2019 ARS-AAOA, LLC.

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Transnasal endoscopic resection of orbital cavernous hemangiomas: our experience with 23 cases

Zhou

Huang

et al. 2019

“…The majority of data has been acquired by retrospective case reports and case series. The highest LOE has been provided by 2 systematic reviews as well as 2 multicenter retrospective review studies …”

Section: Optic Nerve and Orbitmentioning

confidence: 99%

ICAR: endoscopic skull‐base surgery

Wang

Zanation

Gardner

et al. 2019

Self Cite

151

279

Background Endoscopic skull‐base surgery (ESBS) is employed in the management of diverse skull‐base pathologies. Paralleling the increased utilization of ESBS, the literature in this field has expanded rapidly. However, the rarity of these diseases, the inherent challenges of surgical studies, and the continued learning curve in ESBS have resulted in significant variability in the quality of the literature. To consolidate and critically appraise the available literature, experts in skull‐base surgery have produced the International Consensus Statement on Endoscopic Skull‐Base Surgery (ICAR:ESBS). Methods Using previously described methodology, topics spanning the breadth of ESBS were identified and assigned a literature review, evidence‐based review or evidence‐based review with recommendations format. Subsequently, each topic was written and then reviewed by skull‐base surgeons in both neurosurgery and otolaryngology. Following this iterative review process, the ICAR:ESBS document was synthesized and reviewed by all authors for consensus. Results The ICAR:ESBS document addresses the role of ESBS in primary cerebrospinal fluid (CSF) rhinorrhea, intradural tumors, benign skull‐base and orbital pathology, sinonasal malignancies, and clival lesions. Additionally, specific challenges in ESBS including endoscopic reconstruction and complication management were evaluated. Conclusion A critical review of the literature in ESBS demonstrates at least the equivalency of ESBS with alternative approaches in pathologies such as CSF rhinorrhea and pituitary adenoma as well as improved reconstructive techniques in reducing CSF leaks. Evidence‐based recommendations are limited in other pathologies and these significant knowledge gaps call upon the skull‐base community to embrace these opportunities and collaboratively address these shortcomings.

“…OCH, being the most common adult orbital tumor and having a dense fibrous capsule to facilitate dissection, represents the ideal index lesion for study. Despite a recent global outcomes study specifically focusing on OCH, the literature on endonasal orbital tumor surgery is still quite heterogeneous due to the complexity of the intraorbital anatomy and varying relationship of the tumor to critical neurovascular structures and skull‐base foramina. In an effort to standardize the reporting of outcomes, an international, anatomic‐based staging system was developed for endonasally resectable OCH.…”

mentioning

confidence: 99%

Development of the international orbital Cavernous Hemangioma Exclusively Endonasal Resection (CHEER) staging system

Rassi

Adappa

Battaglia

et al. 2019

Self Cite

Background Orbital cavernous hemangiomas (OCH) are the most common adult orbital tumor and represent an ideal index lesion for endonasal orbital tumor surgery. In order to standardize outcomes reporting, an anatomic‐based staging system was developed. Methods An international, multidisciplinary panel of 23 experts in orbital tumor surgery was formed. A modified Delphi method was used to develop the cavernous hemangioma exclusively endonasal resection (CHEER) staging system with a total of 2 rounds being completed. Results Tumors medial to a plane along the long axis of the optic nerve may be considered amenable for an exclusively endonasal resection. In select cases, tumors may extend inferolaterally if the tumor remains below a plane from the contralateral naris through the long axis of the optic nerve (ie, plane of resectability [POR]). This definition reached consensus with 91.3% of panelists in agreement. Five stages were designed based on increasing technical resection difficulty and potential for morbidity. Stages were based on the relationship of the tumor to the extraocular muscles, the inferomedial muscular trunk of the ophthalmic artery (IMT), and orbital foramina. Staging by anatomic location also reached consensus with 87.0% of panelists in agreement. Size was not included in the staging system due to the lack of agreement on the contribution of size to resection difficulty. Conclusion Endoscopic orbital tumor surgery is a nascent field with a growing, yet heterogeneous, body of literature. The CHEER staging system is designed to facilitate international, high‐quality, standardized studies establishing the safety, efficacy, and outcomes of endonasal resection of OCH.