Endoscopic Transnasal Septotomy for Contralateral Orbital Apex Venous Angioma Resection and Decompression

Abstract

Tumors of the orbital apex region are traditionally difficult to approach surgically due to key anatomic structures found in this highly crowded region. We present a case of progressively enlarging orbital apex venous angioma treated with a novel endoscopic transnasal septotomy technique. We highlight the key steps to this approach, as well as specific landmarks necessary to achieve a safe and successful outcome.

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

“…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.…”

“…The utility of endoscopic techniques in orbital surgery was first described 3 decades ago, and since then, technological advances have led to an increase in these approaches, most significantly in the past 10 years . Transnasal endoscopic procedures allow direct access to the medial orbital wall and are potentially valuable alternatives in lesions of the inferomedial orbit.…”

Expanded exposure and detailed anatomic analysis of the superior orbital fissure: Implications for endonasal and transorbital approaches

“…Advances in endoscopic equipment and experience with expanded endonasal approaches (EEA) have expanded their use for lesions at the orbital apex and superior orbital fissure (SOF) 1‐5 . While the optic nerve and the ophthalmic artery travel through the optic canal, other cranial nerves (CN) related to ocular function, including the oculomotor nerve (CN III), trochlear nerve (CN IV), ophthalmic nerve (CN V 1 ), abducens nerve (CN VI), and the superior ophthalmic vein travel through the SOF 6 .…”

“…their use for lesions at the orbital apex and superior orbital fissure (SOF). [1][2][3][4][5] While the optic nerve and the ophthalmic artery travel through the optic canal, other cranial nerves (CN) related to ocular function, including the oculomotor nerve (CN III), trochlear nerve (CN IV), ophthalmic nerve (CN V 1 ), abducens nerve (CN VI), and the superior ophthalmic vein travel through the SOF. 6 Tumors or trauma may affect the orbital apex and SOF leading to SOF syndrome or orbital apex syndrome (with vision loss).…”

Endoscopic transconjunctival surgical approach to intraconal space of the orbit: First clinical experience

“…Transnasal endoscopic approach, through the lamina papyracea exposed with ethmoidectomy and sphenoidectomy, offers a convenient access to the medial and inferior part of the orbit. However, the procedure is technically demanding and, thus, not widespread: the hitherto published clinical material is restricted to case reports only, and very short clinical series focused on tumor biopsies, and decompression in orbital trauma or in endocrine orbitopathy [5][6][7].…”