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Endoscopic approach for orbital apex lesions: case series and review of the literature

Published online by Cambridge University Press:  09 June 2022

R Shemesh Open the ORCID record for R Shemesh [Opens in a new window] ,
A Yakirevitch ,
A Abergel ,
I Leibovitch ,
G J Ben Simon  and
R Ben Cnaan
R Shemesh
Affiliation:
Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel Goldschleger Eye Institute, Ramat Gan, Israel
A Yakirevitch*
Affiliation:
Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel Department of Otolaryngology – Head and Neck Surgery, Sheba Medical Center, Ramat Gan, Israel
A Abergel
Affiliation:
Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel Department of Otolaryngology – Head and Neck Surgery, Tel Aviv, Israel
I Leibovitch
Affiliation:
Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel Department of Ophthalmology, Tel Aviv Medical Center, Tel Aviv, Israel
G J Ben Simon
Affiliation:
Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel Goldschleger Eye Institute, Ramat Gan, Israel
R Ben Cnaan
Affiliation:
Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
*
Author for correspondence: Dr A Yakirevitch, Department of Otolaryngology – Head and Neck Surgery, The Chaim Sheba Medical Center, Tel Hashomer 52621, Israel E-mail: arkadiyak@gmail.com Fax: +97 23 635 5324
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Abstract

Objective

The transnasal endoscopic approach may provide better visualisation and a safer approach to the orbital apex. This study presents a case series of orbital apex lesions managed by this approach.

Method

This study was an eight-year retrospective analysis of seven patients who were operated on for orbital apex lesions in two tertiary medical centres.

Results

Complete tumour removal was performed in three patients and partial removal was performed in four patients. Visual acuity improved in three patients, remained stable in one patient and decreased in the other two patients. The visual field improved in four patients and did not change in two patients. Complications included worse vision and visual fields in 28.6 per cent of patients and late enophthalmos (of −1.25 ± 4.6 mm) in 2 patients.

Conclusion

The transnasal approach to orbital apex lesions in selected cases may provide a rational alternative to transorbital surgery. Complete tumour removal should be weighed against the risk of damage to the optic nerve.

Keywords

Orbital NeoplasmsVascular MalformationsHemangiomaOptic NerveNeurilemmoma
Type
Main Article
Information
The Journal of Laryngology & Otology , Volume 137 , Issue 4 , April 2023 , pp. 419 - 425
Copyright
Copyright © The Author(s), 2022. Published by Cambridge University Press on behalf of J.L.O. (1984) LIMITED

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Footnotes

*

Equal contribution

Dr A Yakirevitch takes responsibility for the integrity of the content of the paper

References

Vohra, ST, Escott, EJ, Stevens, D, Branstetter, BF. Categorization and characterization of lesions of the orbital apex. Neuroradiol 2011;53:89–107CrossRefGoogle ScholarPubMed
Schick, U, Dott, U, Hassler, W. Surgical treatment of orbital cavernomas. Surg Neurol 2003;60:234–44CrossRefGoogle ScholarPubMed
Tsirbas, A, Kazim, M, Close, L. Endoscopic approach to orbital apex lesions. Ophthalmic Plastic & Reconstr Surg 2005;21:271–5CrossRefGoogle ScholarPubMed
Lee, JY, Ramakrishnan, VR, Chiu, AG, Palmer, J, Gausas, RE. Endoscopic endonasal surgical resection of tumors of the medial orbital apex and wall. Clinical Neurol Neurosurg 2012;114:93CrossRefGoogle ScholarPubMed
Khan, AM, Varvares, MA. Traditional approaches to the orbit. Otolaryngologic Clin North Am 2006;39:895–909CrossRefGoogle ScholarPubMed
Cavallo, LM, Messina, A, Cappabianca, P, Esposito, F, de Divitiis, E, Gardner, P, Tschabitscher, M. Endoscopic endonasal surgery of the midline skull base: anatomical study and clinical considerations. Neurosurg Focus 2005;19:E2Google ScholarPubMed
Stokken, J, Gumber, D, Antisdel, J, Sindwani, R. Endoscopic surgery of the orbital apex: outcomes and emerging techniques. Laryngoscope 2016;126:20–4CrossRefGoogle ScholarPubMed
Ferdousi, A, Sheibani, K, Baghini, AS. Concomitant orbital cavernous hemangioma and solitary fibrous tumor in a 50–years-old man. J Ophthalmic Optometric Sci 2016;1:32–6Google Scholar
Ducatman, BS, Scheithauer, BW, Piepgras, DG, Reiman, HM, Ilstrup, DM. Malignant peripheral nerve sheath tumors. Cancer 1986;57:2006–213.0.CO;2-6>CrossRefGoogle ScholarPubMed
Gupta, P, Sharma, A, Singh, J. Solid cystic trigeminal schwannoma with intraorbital extension causing proptosis and vision loss. Asian J Neurosurg 2016;11:456Google ScholarPubMed
Curragh, DS, Halliday, L, Selva, D. Endonasal approach to orbital pathology. Ophthalmic Plastic Reconstr Surg 2018;34:422–7CrossRefGoogle ScholarPubMed
Yoshimura, K, Kubo, S, Yoneda, H, Hasegawa, H, Tominaga, S, Yoshimine, T. Removal of a cavernous hemangioma in the orbital apex via the endoscopic transnasal approach: a case report. Minim Invasive Neurosurg 2010;53:77–9CrossRefGoogle ScholarPubMed
Ruiz, D, Rebeiz, EE. Endoscopic approach for excision of venous malformation of the orbital apex. J Craniofac Surg 2018;29:733–4CrossRefGoogle ScholarPubMed
Murchison, AP, Rosen, MR, Evans, JJ, Bilyk, JR. Posterior nasal septectomy in endoscopic orbital apex surgery. Ophthalmic Plast Reconstruct Surg 2009;25:458–63Google ScholarPubMed
Karaki, M, Kobayashi, R, Mori, N. Removal of an orbital apex hemangioma using an endoscopic transethmoidal approach: technical note. Neurosurgery 2006;59(suppl 1):159–60Google ScholarPubMed
Locatelli, M, Carrabba, G, Guastella, C, Gaini, SM, Spagnoli, D. Endoscopic endonasal removal of a cavernous hemangioma of the orbital apex. Surg Neurol Int 2011;2:58Google ScholarPubMed
Arai, Y, Kawahara, N, Yokoyama, T, Oridate, N. Endoscopic transnasal approach for orbital tumors: a report of four cases. Auris Nasus Larynx 2016;43:353–8CrossRefGoogle ScholarPubMed
Haruna, S, Tukidate, T, Konno, W, Fukami, S, Nakajima, I. Transnasal endoscopic surgery for benign orbital tumors. Auris Nasus Larynx 2013;40:227–3010.1016/j.anl.2012.03.003CrossRefGoogle ScholarPubMed
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