Endoscopic surgery of the orbital apex: Outcomes and emerging techniques

Stokken, Janalee K.; Gumber, Divya; Antisdel, Jastin L.; Sindwani, Raj

doi:10.1002/lary.25539

Cited by 36 publications

(49 citation statements)

References 24 publications

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“…6,9 Binarial transseptal approaches have been described to augment endoscopic dissection and retraction using a 4-handed technique. 5,[10][11][12] In 3 of our reported cavernous hemangioma resections, we utilized a cryoprobe device to securely grasp the lesion and facilitate the dissection. We have found that the texture of vasculogenic lesions can be difficult to grasp and dissect from surrounding fat using standard sinus instruments, even with assistance from ophthalmology delivering the lesion medially.…”

Section: Discussionmentioning

confidence: 99%

Management of Orbital Masses: Outcomes of Endoscopic and Combined Approaches With No Orbital Reconstruction

Rimmer

Graf

Fastenberg

et al. 2020

Allergy�Rhinol (Providence)

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Introduction: The endoscopic endonasal approach to management of orbital pathology has expanded. Due to the rarity of these conditions, most reports in the literature consist of small case reports. We report a series from a single institution with a focus on outcomes. Methods: A retrospective chart review was carried out between 2010 and 2018. Results: Twenty-four patients were identified (average age 58 years, 15 males, 9 females). Average follow-up was 14.9 months. Most common etiologies included cavernous hemangioma (7), metastases (6), idiopathic orbital inflammatory syndrome (6), orbital hematoma/clot (2), and schwannoma (1). Most common presenting symptoms were decreased visual acuity (8), proptosis (8), diplopia (7), and incidental findings (2). All patients underwent endoscopic medial wall orbital decompressions. Sixteen involved a combined open approach by an ophthalmologist. Pathology was either biopsied (15), resected (6), or could not be identified (3). No intraoperative complications were noted. No patients underwent orbital reconstruction of the medial wall. Six patients developed postoperative sinusitis successfully managed with antibiotics. One patient developed epistaxis managed conservatively. In 5 patients, Sino-Nasal Outcome Test-22 scores increased immediately postop and then decreased, whereas scores only decreased in 6 patients. Six patients noted reduced proptosis. There were no new cases of diplopia or worsening visual acuity. Conclusions: A combined endoscopic endonasal and external approach can be useful for managing orbital lesions. Patients tolerated the procedure well with improvement in ocular symptoms and minimal sinonasal complications. Reconstruction of the medial wall may not be warranted to prevent postoperative diplopia.

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Section: Discussionmentioning

confidence: 99%

Management of Orbital Masses: Outcomes of Endoscopic and Combined Approaches With No Orbital Reconstruction

Rimmer

Graf

Fastenberg

et al. 2020

Allergy�Rhinol (Providence)

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“…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, ). The ocular motor nerves are under risk of injury during orbital approaches to any kind of surgery directed to this region thus; a precise knowledge of their relationships with the muscles and the surrounding structures through microdissection and determination of landmarks may help surgeons avoiding nerve injuries during transcranial and endoscopic orbital approaches.…”

Section: Discussionmentioning

confidence: 99%

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

Apaydın

Kendir

Karahan

2018

The Anatomical Record

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The surgical procedures directed to the orbit are invariably reported to be one of the most challenging procedures of the neurosurgery and it is very important to take measures to protect the ocular nerves. Many researchers have tried to identify safe approaches or safe regions in the orbit but the suggestions and results vary among published studies. The ocular motor nerves are under risk of injury during various approaches to the orbit. Simple but careful attention to potential variations in the origin and anatomical course of the ocular nerves and their relationships to the orbit may help to define "safe zones" during various approaches, thus, help to enhance clinical outcomes. The objective of this review, therefore, is to discuss the surgical anatomy of the orbit with special emphasis on oculomotor, trochlear, and abducens nerves and further emphasize their relationships with a surgical point of view during various approaches directed to the orbit. Anat Rec, 2018. © 2018 Wiley Periodicals, Inc.

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“…2). The most commonly used endonasal endoscopic approaches for lesions that affect vision or cause diplopia are the following: 1) the trans-sellar route for sellar lesions, most commonly for pituitary adenomas and Rathke cleft cysts, 2) trans-sellar, trans-tubercular and trans-planum route for lesions that extend into the suprasellar, prechiasmatic and retrochiasmatic cisterns, most commonly for large or giant pituitary adenomas, tuberculum meningiomas, and craniopharyngiomas, 3) trans-sellar and extended approach to cavernous sinus and Meckel cave most commonly used for invasive pituitary adenomas, invasive parasellar meningiomas, schwannomas, and clival chordomas, 4) trans-clival approach most commonly used for invasive parasellar meningiomas and clival chordomas, and 5) endonasal approach to medial optic canal, orbital apex and orbit, most commonly used for meningiomas, hemangiomas, fibrous dysplasia, malignancies, and inflammatory processes (32)(33)(34)(35)(36)(37)(38)(39)(40)(41).…”

Section: Common Parasellar Endoscopic Approachesmentioning

confidence: 99%

Role of Endoscopic Skull Base and Keyhole Surgery for Pituitary and Parasellar Tumors Impacting Vision

Kelly

Griffiths

Takasumi

et al. 2015

Journal of Neuro-Ophthalmology

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Significant advances over the last 2 decades in imaging technology, instrumentation, anatomical knowledge, and reconstructive techniques have resulted in the endonasal endoscopic approach becoming an integral part of modern skull base surgery. With growing use and greater experience, surgical outcomes continue to incrementally improve across many skull base pathologies, including those tumors that impact vision and ocular motility. The importance of the learning curve and use of a multi-disciplinary approach is critical to maximizing success, minimizing complications, and enhancing quality of life in these patients. Realizing the limits of the endonasal route and reasonable use of transcranial approaches such as the supraorbital eyebrow craniotomy, it may br appropriate to consider nonsurgical therapy including various forms of radiotherapy [corrected] and medical treatment options.

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Endoscopic surgery of the orbital apex: Outcomes and emerging techniques

Abstract: The endoscopic approach to the orbit apex offers significant advantages over traditional external approaches, and should be the preferred approach for all medial and inferior lesions. A two-surgeon multihanded technique can help facilitate difficult cases.

Cited by 36 publications

References 24 publications

Management of Orbital Masses: Outcomes of Endoscopic and Combined Approaches With No Orbital Reconstruction

Management of Orbital Masses: Outcomes of Endoscopic and Combined Approaches With No Orbital Reconstruction

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

Role of Endoscopic Skull Base and Keyhole Surgery for Pituitary and Parasellar Tumors Impacting Vision

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