Endoscopic endonasal surgical resection of tumors of the medial orbital apex and wall

Lee, John Y.K.; Ramakrishnan, Vijay R.; Chiu, Alexander G.; Palmer, James N.; Gausas, Roberta E.

doi:10.1016/j.clineuro.2011.09.005

Cited by 40 publications

(35 citation statements)

References 20 publications

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“…Twelve papers were identified and included which contained patient data for 17 cases [5][6][7][8][9][10][11][12][13][14][15][16]. Six patients were male and eleven were female.…”

Section: Resultsmentioning

confidence: 99%

Purely endoscopic trans-nasal management of orbital intraconal cavernous haemangiomas: a systematic review of the literature

Lenzi

Bleier

Felisati

et al. 2015

Eur Arch Otorhinolaryngol

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The surgical management of medial and inferior orbital lesions is demanding via traditional external approach, since the conic-shaped surgical field is narrow and damage to neural, muscular or vascular structures of the orbit can have serious consequences. In recent years, the evolution of endoscopic endonasal approaches for lesions that goes beyond the nose brought the orbit to the attention of rhinosurgeons. If procedures such as transnasal orbital decompression and lacrimal pathways surgery have been described some decades ago, the last frontier of transnasal orbital surgery, namely intraconal tumor surgery, is a new and rapidly expanding field. Papers describing endoscopic endonasal approaches to the orbit appeared in the international literature, but most of them contain a small number of cases, also because the relatively rarity of intraorbital lesions. We herein report the results of a systematic review of the literature regarding the endoscopic endonasal approach to intraconal cavernous haemangiomas, the most common benign orbital lesion. The endoscopic management of intraconal cavernous haemangiomas results feasible and safe. A critical step of this kind of surgery is the management of the medial rectus muscle, mandatory to expose the intraconal space.

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“…Twelve papers were identified and included which contained patient data for 17 cases [5][6][7][8][9][10][11][12][13][14][15][16]. Six patients were male and eleven were female.…”

Section: Resultsmentioning

confidence: 99%

Purely endoscopic trans-nasal management of orbital intraconal cavernous haemangiomas: a systematic review of the literature

Lenzi

Bleier

Felisati

et al. 2015

Eur Arch Otorhinolaryngol

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“…No systematic reviews or controlled trials were identified in the literature. Thirty‐nine studies contained data for patients who met the inclusion criteria . Of the studies included, 21 were case reports, 8 were case series, and 10 were retrospective chart reviews.…”

Section: Resultsmentioning

confidence: 99%

Short‐term outcomes of purely endoscopic endonasal resection of orbital tumors: a systematic review

Dubal

Svider

Denis

et al. 2014

Int Forum Allergy Rhinol

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“…The corridor between the inferior and medial recti muscles creates the ideal route to access the inferomedial intraconal orbit . Different maneuvers to increase entry into this space and generate stability due to the extreme mobility of the orbital structures have been described (Table ) . External retraction of the medial and inferior rectus muscles was also described by McKinney et al .…”

Section: Discussionmentioning

confidence: 99%

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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Endoscopic endonasal surgical resection of tumors of the medial orbital apex and wall

Cited by 40 publications

References 20 publications

Purely endoscopic trans-nasal management of orbital intraconal cavernous haemangiomas: a systematic review of the literature

Purely endoscopic trans-nasal management of orbital intraconal cavernous haemangiomas: a systematic review of the literature

Short‐term outcomes of purely endoscopic endonasal resection of orbital tumors: a systematic review

Analysis of anterior and posterior maneuvers to enhance intraconal exposure

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