Endoscopic surgery for intraconal orbital tumors

Mueller, Sonja; Bleier, Benjamin S.

doi:10.1007/s00106-022-01156-y

Cited by 10 publications

(8 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Our findings add to the growing literature supporting EEA for lesions of the MIS. 8,13,14,20,21,26,27,[29][30][31] We share our experience and the evolution of the techniques developed, which have allowed us to successfully manage complex lesions in this region as a team. Although there have been several studies on the operative corridor to the MIS through cadaveric analysis, much of the available clinical literature is comprised of small series or pooled experiences of multiple centers with considerable variations in operative techniques and a mixture of intra-and extraconal pathology.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic Endonasal Approach to Intraconal Orbital Tumors: Outcomes and Lessons Learned

2023

View full text Add to dashboard Cite

BackgroundLesions involving the intraconal space of the orbit are rare and challenging to manage. Operative techniques and outcomes for the endoscopic endonasal approach (EEA) to tumors in the medial intraconal space (MIS) remain poorly characterized.ObjectiveWe present our experience with a wide range of isolated intraconal pathology managed via an EEA.MethodsA retrospective review of all cases (2014–2021) performed by a single skull base team in which the EEA was employed for the management of an intraconal orbital lesion.ResultsTwenty patients (13 men, 7 women) with a mean age of 59 years (range, 40–89 years) were included. All lesions were isolated to the MIS, pathology addressed included: cavernous hemangioma (6), schwannoma (4), lymphoma (4), inflammatory pseudotumor (2), chronic invasive fungal sinusitis (2), and metastatic disease (2). Either a biopsy (10/20) or a complete resection (10/20) was performed. In all cases, the MIS was accessed via an endonasal corridor between the medial and inferior rectus muscles. Retraction and safe, intra‐orbital dissection of the lesion was performed using a two‐surgeon, multi‐handed technique. Gross total resection of benign lesions was achieved in 90% (9/10) of cases; a pathologic diagnosis was achieved in 100% (10/10) of biopsy cases. No orbital reconstruction was required. Visual acuity returned to normal in 80% (8/10) of planned resection cases and postoperative diplopia resolved by 3 months in 90%. Mean follow‐up was 15 months.ConclusionThis study demonstrates that the EEA is safe and effective for accessing lesions in the MIS. This technique affords very favorable outcomes with minimal postoperative morbidity.Level of Evidence4 Laryngoscope, 2023

show abstract

Section: Discussionmentioning

confidence: 99%

Endoscopic Endonasal Approach to Intraconal Orbital Tumors: Outcomes and Lessons Learned

2023

View full text Add to dashboard Cite

show abstract

“…The results of our study showed that the mononostril EEA technique has the potential to reduce morbidity and improve outcomes compared to traditional approaches such as craniotomy, orbitotomy, and classic two-nostril EEA. [18,26,30,32] The risks associated with craniotomy and orbitotomy include cerebral edema, stroke, seizures, CSF leak, vision loss, defects in eye movement, pupillary abnormalities, and ptosis. [12,15,24,25,31,33,37] The absence of a skin incision, lack of brain retraction, limited neurovascular manipulation, short hospital stay, decreased recovery time, reduced morbidity, and good cosmetic outcomes make the endoscopic approaches promising and feasible choices.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic Endonasal Approach to the Orbit: A Cadaveric Study and Case Series Emphasizing the Benefits of Ipsilateral Mononostril Technique

Gulsuna,

Truong,

Aksoğan

et al. 2023

Preprint

View full text Add to dashboard Cite

Background Lesions located in the orbit are challenging to manage due to the enclosed space they occupy and their close proximity to critical anatomical structures. The challenge has been to develop a surgical approach that achieves the goal of obtaining complete tumor removal while preserving functional anatomy. Our aim is to understand the surgical anatomy of the orbital apex and inferomedial orbital structures via the ipsilateral endoscopic endonasal approach (EEA) and its feasibility in clinical practice. Methods Five fresh human head specimens were prepared for dissection. Anatomic dissections were performed by using rigid endoscopes, attached to a high-definition camera and a digital recording system. To achieve a meticulous understanding of the anatomy, an EEA to the sellar region was performed by involving a wide bilateral sphenoidotomy, posterior and anterior ethmoidectomy and orbital dissection in a stepwise manner. A retrospective evaluation was carried out with patients who underwent surgery through the ipsilateral mononostril EEA between August 2018 and August 2022. Results The results of endoscopic endonasal cadaveric dissections showed that the medial, inferomedial, and apex portions of the orbit can be accessed through the ipsilateral EEA. Eighteen patients who underwent EEA surgery for various pathologies, 72% of the lesions were intraconal. The patients were between the ages of 17 and 54 (mean 34,1 ± 8,6). The left orbit was affected more commonly (11 left, 7 right) and the most common pathology was intraorbital cavernous hemangioma (13). The average postoperative follow up duration was 22.2 months (range 6 months – 50 months). Conclusion Our study highlights the potential benefits of using a purely ipsilateral mononostril EEA for orbital surgery, particularly for accessing medial and inferomedial orbital lesions, and utilizing the knowledge gained from cadaveric dissection experience. This technique has the potential to reduce morbidity and improve outcomes, especially when used in conjunction with careful patient selection, preoperative planning, and advanced endoscopic skills. Given the limited literature on the subject, we believe that our study, which presents a large case series of orbital pathology operated with the ipsilateral mononostril EEA method, will provide valuable contributions to the literature and guide surgeons considering this approach.

show abstract

“…The endoscopic endonasal route has been widely adopted for lesions involving the medial and inferior orbit with excellent results [61]. More recently, transorbital neuroendoscopic surgery (TONES) has become a possible option for the safe treatment of several lesions in the upper-lateral orbital compartment [62].…”

Section: Benign Lesionsmentioning

confidence: 99%

Differential diagnosis of thyroid orbitopathy — diseases mimicking the presentation or activity of thyroid orbitopathy

Nowak,

Marek

et al. 2024

Endokrynol Pol

View full text Add to dashboard Cite

with no previous or concomitant symptoms of thyroid disorders, lack of symptoms of eyelid retraction, divergent strabismus, diplopia as the only symptom of the disease, and a history of increasing diplopia at the end of the day.The inflammatory activity and severity of TO should be diagnosed based on personal experience and according to standard diagnostic criteria. Assessment of TO inflammatory activity can be performed using the clinical activity score (CAS). Magnetic resonance imaging (MRI) is not necessary to diagnose typical cases of TO but may be necessary to assess the inflammatory activity of TO, especially in those with a so-called "posterior" course. Orbital MRI is indicated in patients with unilateral or highly asymmetric exophthalmos, suspected optic nerve neuropathy, and TO with euthyroidism, while computed tomography (CT) of the orbit is par-

show abstract

Endoscopic surgery for intraconal orbital tumors

Cited by 10 publications

References 31 publications

Endoscopic Endonasal Approach to Intraconal Orbital Tumors: Outcomes and Lessons Learned

Endoscopic Endonasal Approach to Intraconal Orbital Tumors: Outcomes and Lessons Learned

Endoscopic Endonasal Approach to the Orbit: A Cadaveric Study and Case Series Emphasizing the Benefits of Ipsilateral Mononostril Technique

Differential diagnosis of thyroid orbitopathy — diseases mimicking the presentation or activity of thyroid orbitopathy

Contact Info

Product

Resources

About