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An insight into endoscopic transethmoidal resection of intraorbital tumors

This study aims to evaluate indications, complications and surgical technique in the endonasal endoscopic approach to orbital tumor resection. In this retrospective review, 11 patients who admitted and underwent endoscopic orbital surgery were reviewed. Demographics, preoperative and postoperative eye examination, and size and imaging characteristics of the tumours were tabulated. The endonasal approach was selected for tumors located nasal to optic nerve and in medial-inferior orbit to orbital apex. Under general anaesthesia, ethmoidotomy was performed with the aid of endonasal endoscope. The lamina papyracea was then fenestrated and through that opening, the intraorbital tumor was isolated and removed. If necessary, an auxiliary transcaruncular incision was made to facilitate the exposure. An en bloc removal of tumors was achieved in all cases. Pathological examination has confirmed that 9 patients had cavernous haemangioma, 1 patient had schwannoma and 1 had dermoid cyst. The dimension of tumors ranged from 15 × 12 × 10 mm3 to 24 × 23 × 16 mm3. Four tumours were located nasal to the muscular cone and 5 tumors were in the muscle cone, 1 tumor in the medial rectus. After operation, the best-corrected visual acuity improved in 3 patients, with a full recovery of visual field defects. Two patients had impaired visual acuity. Three patients had transient limitation of ocular movements. Abduction and adduction remain restricted in 1 case, respectively. Combination of endonasal endoscopy and orbital surgery technique can improve safety and efficacy in the transethmoidal resection of medial or inferior orbital tumours or orbital apex tumours.

Author(s): Yi Wang, Lihua Xiao, Robert A. Goldberg