How I do it: endoscopic endonasal approach to the orbital apex

Area of Science:

• Neurosurgery
• Ophthalmology
• Endoscopic Surgery

Background:

• The endoscopic endonasal approach (EEA) is a viable surgical option for accessing the medial and inferior orbital apex.
• This technique minimizes manipulation of intraorbital structures compared to traditional open approaches.

Purpose of the Study:

• To outline the advantages, complications, indications, and caveats of the EEA for orbital apex lesions.
• To illustrate the utility of EEA with a case example of an intraorbital extraconal cavernous malformation.

Main Methods:

• Retrospective review of cases undergoing EEA for orbital apex pathology.
• Detailed description of the surgical technique, anatomical considerations, and outcomes.
• Presentation of a representative case of intraorbital extraconal cavernous malformation.

Main Results:

• The EEA provides a direct and effective corridor to the medial and inferior orbital apex.
• The approach allows for good exposure of the orbital apex with minimal disruption to surrounding tissues.
• Successful management of an intraorbital extraconal cavernous malformation was demonstrated.

Conclusions:

• The endoscopic endonasal approach is a valuable corridor for reaching the medial and inferior orbital apex.
• It offers significant advantages in terms of exposure and reduced manipulation of intraorbital contents.
• EEA is a safe and effective technique for select orbital apex pathologies.