Endoscopic Uninostril Transnasal Transethmoidal Excision of an Orbital Apex Lesion

Orbital apex lesions present significant surgical challenges due to their deep location and proximity to critical neurovascular structures. The endoscopic uninostril transnasal transethmoidal approach offers a minimally invasive alternative to traditional open techniques. We demonstrate the technical nuances, feasibility, and outcome of endoscopic uninostril transnasal transethmoidal excision of an orbital apex lesion using a case example, emphasizing key anatomical landmarks, dissection techniques, and strategies to avoid complications. The approach provides direct access to the orbital apex with minimal morbidity. The lesion was excised completely with preservation of critical structures. The patient had an uneventful postoperative recovery. The endoscopic uninostril transnasal transethmoidal approach is a valuable addition to the armamentarium of skull base surgeons, providing a safe, precise, and effective method for excising orbital apex lesions while preserving key neurovascular structures.