Excision of the Frontal Nerve to the Superior Orbital Fissure: A Clinical Case Series

This retrospective case series describes a transorbital endoscopic approach to perform an excision of the frontal nerve branch of the ophthalmic nerve. This was performed for suspected zone 1 perineural spread (PNS) secondary to squamous cell carcinoma. Four patients were identified for inclusion. All were male with a mean age of 76 years (range: 65-81 years). Three patients had histological confirmation of neoplastic nerve infiltration from squamous cell carcinoma. One patient with corneal paraesthesia and radiological frontal nerve enlargement had no histological evidence of PNS. Postoperative complications were encountered in one patient, which included ptosis and upgaze limitation. All patients with histological confirmation of PNS underwent adjuvant radiotherapy and were disease-free at last follow-up (range: 8 months-9 years). The transorbital endoscopic approach to an en bloc stripping of the frontal nerve enables access for biopsy along any segment of the frontal nerve, or for definitive treatment of malignant PNS.