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Transnasal approach to the orbital apex and cavernous sinus
Alexandre Felippu1, Renzo Mora, Luca Guastini
1Felippu Institute, São Paolo, Brazil.
The Annals of Otology, Rhinology, and Laryngology
|May 24, 2013
Summary
The endoscopic transnasal approach offers an effective method for accessing the orbital apex and cavernous sinus, with a low complication rate. This technique enhances surgical precision and patient safety.
Area of Science:
- Neurosurgery
- Otolaryngology
- Ophthalmology
Background:
- The orbital apex and cavernous sinus are critical neurovascular structures.
- Lesions in these areas present significant surgical challenges.
- Minimally invasive techniques are increasingly sought for complex skull base surgery.
Purpose of the Study:
- To establish the anatomical basis for a transnasal endoscopic approach to the orbital apex and cavernous sinus.
- To assess the feasibility and effectiveness of this surgical technique.
- To analyze the complication profile associated with the procedure.
Main Methods:
- A retrospective review of 100 patients undergoing endoscopic transnasal surgery for lesions in the orbital apex, cavernous sinus, and surrounding structures.
- Utilized standard endoscopic sinus surgery instrumentation.
- Complications were meticulously recorded and categorized as intraoperative or postoperative.
Main Results:
- A total of 8 complications occurred: 4 intraoperative and 4 postoperative.
- Intraoperative complications included internal carotid artery rupture (1) and cerebrospinal fluid leak (3), all managed surgically.
- Postoperative complications involved transient ptosis (2) and diplopia (2), with full recovery.
Conclusions:
- The endoscopic transnasal approach allows for precise instrument navigation in the orbital apex and cavernous sinus.
- This technique significantly reduces the incidence of surgical complications.
- It represents a safe and efficient surgical option for selected pathologies.
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