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Endoscopic Endonasal Intraconal Approach for Orbital Tumor Resection: Case Series and Systematic Review
Xin Zhang1,2,3,4,5, Wei Hua1,2,3,4,5,6, Kai Quan1,2,3,4,5
1Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.
Abstract:
Intraorbital tumor could be approached by numerous surgical methods. The neuroendoscopic endonasal approach could provide a feasible corridor for indicated tumors. Herein we present a series of 6 consecutive intraorbital tumors from April 2018 to October 2020, which received endonasal endoscopic resection. Cadaveric dissection was performed for the intraconal approach, and the literature was also reviewed. Five tumors were located intraconally, while one extraconally. The pathology revealed 1 angioleiomyoma, 1 cavernous hemangioma, 1 pilocytic astrocytoma, 1 meningioma, and 2 schwannomas. Five of the six achieved gross total resection, including 3 tumors with lateral extension beyond the optic nerve. Preoperative visual deterioration was observed in 4 of the 6 patients, and all got improvement postoperatively. Transient oculomotor nerve palsy was presented in one patient postoperatively. No cerebrospinal fluid leakage, enophthalmos, or strabismus was observed. The median follow-up time is 27 months (11~41 months). At the 6-month follow-up, the visual acuity remained unchanged compared with that at discharge. Proptosis was resolved in 2 of the 3 patients; diplopia was improved in one patient. In conclusion, endoscopic endonasal intraconal approach could be suitable for selected pathological conditions, and for both medial or beyond medial extraconal and intraconal orbital tumors.
Insights
The endoscopic endonasal approach is a viable surgical option for selected intraorbital tumors, offering improved vision and tumor removal. This minimally invasive technique shows promise for both intraconal and extraconal orbital lesions.
Area of Science:
- Neurosurgery
- Ophthalmology
- Endoscopic Surgery
Background:
- Intraorbital tumors present surgical challenges.
- Traditional surgical methods have limitations.
- Endoscopic endonasal approaches offer a novel corridor.
Purpose of the Study:
- To evaluate the feasibility and outcomes of the endoscopic endonasal approach for intraorbital tumors.
- To assess the safety and efficacy of this minimally invasive technique.
Main Methods:
- Retrospective review of 6 consecutive intraorbital tumors treated between April 2018 and October 2020.
- Endoscopic endonasal resection was performed.
- Cadaveric dissection and literature review informed the intraconal approach.
Main Results:
- Five tumors were intraconal, one extraconcal; pathologies included schwannomas, meningioma, and others.
- Gross total resection was achieved in 5 out of 6 patients.
- Postoperative visual improvement occurred in all 4 patients with preoperative deterioration; transient oculomotor nerve palsy in one.
Conclusions:
- The endoscopic endonasal intraconal approach is suitable for selected intraorbital tumors.
- This technique is effective for medial and beyond medial extraconal and intraconal tumors.
- The approach offers good oncological and functional outcomes with minimal complications.
