Prelacrimal Transmaxillary-Orbital Approach for Resection of Lateral Extraconal Orbital Cavernous Hemangioma

Endoscopic orbital surgery is likely a reasonable option for patients with orbital cavernous hemangiomas (OCH) medial to the optic nerve (ON). The endoscopic resection of OCH lateral to the ON is extremely challenging. Zhou et al. first described the endoscopic prelacrimal recess approach (PLRA) for the management of the maxillary sinus and skull base. However, the application of PLRA for endoscopic resection of OCH has not been reported. Here, we report a novel modification of the PLRA termed the prelacrimal transmaxillary-orbital approach (PLTMOA) for endoscopic resection of extraconal OCH lateral to the ON. A 58-year-old female presented with a 4-year history of left extraconal OCH causing left proptosis and diplopia. The imaging revealed the tumor to be localized inferolateral to the ON within the extraconal space. The tumor was resected entirely without complications via PLTMOA, and no recurrence was observed during 26 months of follow-up. The PLTMOA technique comprises four key steps: (1) creation of a prelacrimal recess window, (2) entry into the maxillary sinus, (3) exposure of the orbital floor and osteotomy of the orbital floor (orbital window), and (4) dissection to achieve complete tumor excision. This approach represents the first reported application of a PLTMOA for extraconal OCHs inferolateral to the ON, providing direct access to the orbit while preserving the integrity of the nasolacrimal duct.