Multiport combined endoscopic endonasal and transorbital approach to orbital schwannoma

We present a case report describing the use of combined endoscopic endonasal and transorbital approach (EETOA) for intraorbital schwannoma that grew rapidly during pregnancy.

A 27-year-old woman who presented with headache was incidentally diagnosed with a tumor mass 1 cm in diameter near the right superior orbital fissure. Treatment of the tumor was deferred to follow-up. One month later, the patient became pregnant, and in the last trimester, she developed right abducens palsy and mildly dilated pupil. Magnetic resonance imaging (MRI) showed that the tumor mass had grown rapidly with a maximal diameter of 5 cm and had extended into the orbit through the superior orbital fissure. After spontaneous vaginal delivery, EETOA was planned to remove both the intraorbital region and cavernous sinus compartment to avoid craniotomy. Surgical resection began with an endoscopic endonasal approach. Orbital decompression was performed by removing the lamina papyracea, and the tumor was resected in the lateral cavernous sinus compartment. An eyebrow incision was made, and endoscopic transorbital surgery was performed to remove the intraorbital region. Multi-perspective views during EETOA enabled gross total resection of the tumor and confirmed by intraoperative MRI. The pathological diagnosis was schwannoma. The patient's abducens nerve palsy improved after surgery.

EETOA can offer maximal exposure and resection for tumors extending from the cavernous sinus to the orbit without craniotomy in selected cases.