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

Dubal, Pariket M.; Svider, Peter F.; Denis, Dan; Folbe, Adam J.; Eloy, Jean Anderson

doi:10.1002/alr.21402

Cited by 25 publications

(32 citation statements)

References 53 publications

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“…A systematic review examined 39 studies covering short-term postoperative complications across 71 cases of exclusively endoscopic resection of orbital masses. 16 In the review, most postoperative complications were transient in nature and did not vary between intraconal and extraconal tumors. The most common complication was diplopia (15%); however, the specific cases involved and if the symptom was present preoperatively are not clear.…”

Section: Discussionmentioning

confidence: 92%

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: 92%

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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“…Tumors requiring more complex dissection (often reflected by a higher CHEER stage) or resulting in greater disruption of orbital septa and attendant intranasal fat herniation may benefit from post‐resection reconstruction 10,11 . Ultimately, management decisions, including the decision to complete orbital reconstruction, must be made by the individual surgeon and ought to be tailored to the specific patient and orbital tumor being addressed 5,11 …”

Section: Discussionmentioning

confidence: 99%

“…Given the rarity of orbital tumors and the relative nascency of the EER approach, high‐quality outcomes data are generally limited and are especially lacking in regard to the decision of when and how to reconstruct following EER 4,11 . Due to the predominance of case reports and case series in the relevant literature, a systematic review offers a robust approach to assess how orbital reconstruction affects clinical outcomes following EER for BOTs 4,5 . In the present analysis, we sought to systematically review and analyze the current literature to characterize the perioperative factors and clinical outcomes following exclusively endoscopic endonasal resections of benign primary orbital tumors in light of reported orbital reconstruction practices from individually extracted and aggregated data.…”

Section: Introductionmentioning

confidence: 99%

Does reconstruction affect outcomes following exclusively endoscopic endonasal resection of benign orbital tumors: A systematic review with meta‐analysis

Lehmann

Sneidern

Shen

et al. 2022

World j. otorhinolaryngol.-head neck surg.

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Objective As exclusively endoscopic endonasal resection of benign orbital tumors has become more widespread, high‐quality outcomes data are lacking regarding the decision of when and how to reconstruct the medial orbital wall following resection. The goal of this study was to systematically review pertinent literature to assess clinical outcomes relative to orbital reconstruction practices. Methods Data Sources: PubMed, EMBASE, Web of Science. A systematic review of studies reporting exclusively endoscopic endonasal resections of benign orbital tumors was conducted. Articles not reporting orbital reconstruction details were excluded. Patient and tumor characteristics, operative details, and outcomes were recorded. Variables were compared using χ 2 , Fisher's exact, and independent t tests. Results Of 60 patients included from 24 studies, 34 (56.7%) underwent orbital reconstruction following resection. The most common types of reconstruction were pedicled flaps ( n = 15, 44.1%) and free mucosal grafts ( n = 11, 32.4%). Rigid reconstruction was uncommon ( n = 3, 8.8%). Performance of orbital reconstruction was associated with preoperative vision compromise ( p < 0.01). The tendency to forego orbital reconstruction was associated with preoperative proptosis ( p < 0.001), larger tumor size ( p = 0.001), and operative exposure of orbital fat ( p < 0.001) and extraocular muscle ( p = 0.035). There were no statistically significant differences between the reconstruction and nonreconstruction groups in terms of short‐ or long‐term outcomes when considering all patients. In patients with intraconal tumors, however, there was a higher rate of short‐term postoperative diplopia when reconstruction was foregone ( p = 0.041). This potential benefit of reconstruction did not persist: At an average of two years postoperatively, all patients for whom reconstruction was foregone either had improved or unchanged diplopia. Conclusion Most outcomes assessed did not appear affected by orbital reconstruction status. This general equivalence may suggest that orbital reconstruction is not a necessity in these cases or that the decision to reconstruct was well‐selected by surgeons in the reported cases included in this systematic review.

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“…7,8 In 1999, Herman et al 9 successfully performed an excision of an orbital hemangioma employing a purely endonasal approach for the first time. In the following years, several series have been published being the multiinstitutional study of Castelnuovo et al 10 and the review published by Dubal et al, 11 the largest case series to date. In these publications, the hemangioma, the osteoma, and the schwannoma represent the most frequent tumors treated with this surgical approach.…”

Section: Discussionmentioning

confidence: 99%

Surgical Anatomy of the Medial Wall of the Orbit in 14 Human Cadavers

et al. 2016

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Objective?The aim of our study is to present the anatomical landmarks to perform an endoscopic endonasal approach to the medial wall of the orbit (EEAMO). Material and Methods?We performed 14 complete nasal and orbital endoscopic dissections in 7 adult cadaveric heads. Results?The EEAMO provides a surgical corridor between the medial rectus muscle superiorly and the inferior rectus muscle inferiorly .The mean distance between the ethmoidal crest and medial rectus muscle was 1.5 cm (range, 1.3?1.9 cm). The width of the medial rectus muscle was 1.2 cm (range, 1?1.5 cm). The main vascular structure in this retrobulbar space was the ophthalmic artery that crosses over the optic nerve in 86% of the cases. In its intraorbital route, the anterior ethmoidal artery and the ethmoidal nerves were situated inferior to the superior oblique muscle in all cases. The posterior ethmoidal artery was found superior to it. We could identify the inferior division of the oculomotor nerve in this surgical approach. Conclusions?The EEAMO allows adequate exposure of the space between the medial rectus muscle and the inferior rectus muscle. The location of the ethmoidal crest of the palatine bone, and its relationship with the medial rectus muscle, is a useful anatomical landmark for this surgical approach.

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

Cited by 25 publications

References 53 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

Does reconstruction affect outcomes following exclusively endoscopic endonasal resection of benign orbital tumors: A systematic review with meta‐analysis

Surgical Anatomy of the Medial Wall of the Orbit in 14 Human Cadavers

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