Endoscopic approaches to orbital lesions: case series and systematic literature review

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OBJECTIVE

Surgical treatment of orbital lesions is challenging because complex approaches with a high risk of postoperative sequelae are required. Recently, minimally invasive endoscopic approaches through endonasal (EEA) and transpalpebral (ETP) routes have been proposed. The objective of this study was to assess outcomes of EEA and ETP in the authors’ series of patients with orbital lesions.

METHODS

Data from all patients who underwent operations for an orbital tumor through an endoscopic approach at the authors’ institution from 2002 to 2018 were retrospectively collected. All patients underwent preoperative MRI and ophthalmological evaluation, which was repeated 3 months after surgery and then at regular follow-up intervals. A systematic review of the literature was also performed using Medline, Embase, and Web of Science databases.

RESULTS

The series includes 23 patients (14 males); the mean patient age was 48 ± 23.9 years. Most of the lesions were intraconal (n = 19, 83%). The more frequent histotype was cavernous hemangioma (n = 5, 22%). Exophthalmos was the most common symptom (21 of 23 patients). EEA was performed in 16 cases (70%) and ETP in 7 (30%). The aim of the surgery was achieved in 94% of the cases after an EEA (successful biopsy in 5 of 6 cases and radical resection in all 10 remaining patients), and in 86% after an ETP (successful biopsy in 2 cases and radical tumor resection in 4 of 5 cases). Complications consisted of 3 cases (13%) of transitory diplopia. One recurrence (4%) was observed at follow-up (mean 59 ± 55 months).

CONCLUSIONS

The EEA and ETP have demonstrated to be safe and effective for tumors located respectively in medial and lateral quadrants, permitting one to approach orbital lesions endoscopically at 360°. Innovative surgical tools, including intraoperative ultrasonography, may be useful to potentially reduce surgical morbidity. Larger series are needed to validate these preliminary suggestions.

ABBREVIATIONS EEA = endoscopic endonasal approach; ETP = endoscopic transpalpebral approach; GTR = gross-total resection; LOE = level of evidence; WOS = Web of Science.
Article Information

Contributor Notes

Correspondence Matteo Zoli: Center for the Diagnosis and Treatment of Hypothalamic-Pituitary Diseases, IRCCS Institute of Neurological Sciences of Bologna, Italy. matteo.zoli4@unibo.it.INCLUDE WHEN CITING Published online January 3, 2020; DOI: 10.3171/2019.10.JNS192138.Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.
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References
  • 1

    Alexandre AMVisconti ELozupone ED’Argento FPedicelli A: Embolization of dural arteriovenous fistula of the cavernous sinus through percutaneous ultrasound-guided puncture of the facial vein. World Neurosurg 99:812.e13812.e202017

    • Search Google Scholar
    • Export Citation
  • 2

    Alqahtani APadoan GSegnini GLepera DFortunato SDallan I: Transorbital transnasal endoscopic combined approach to the anterior and middle skull base: a laboratory investigation. Acta Otorhinolaryngol Ital 35:1731792015

    • Search Google Scholar
    • Export Citation
  • 3

    Arai YKawahara NYokoyama TOridate N: Endoscopic transnasal approach for orbital tumors: A report of four cases. Auris Nasus Larynx 43:3533582016

    • Search Google Scholar
    • Export Citation
  • 4

    Bleier BSCastelnuovo PBattaglia PTurri-Zanoni MDallan IMetson R: Endoscopic endonasal orbital cavernous hemangioma resection: global experience in techniques and outcomes. Int Forum Allergy Rhinol 6:1561612016

    • Search Google Scholar
    • Export Citation
  • 5

    Bleier BSHealy DY JrChhabra NFreitag S: Compartmental endoscopic surgical anatomy of the medial intraconal orbital space. Int Forum Allergy Rhinol 4:5875912014

    • Search Google Scholar
    • Export Citation
  • 6

    Bradoo RPotdar NJoshi AShah KModi RShinde C: Transcutaneous endoscopic orbital surgery: a less morbid alternative to lateral orbitotomy. Orbit 34:152015

    • Search Google Scholar
    • Export Citation
  • 7

    Brusati RGoisis MBiglioli FGuareschi MNucci PGianni AB: Surgical approaches to cavernous haemangiomas of the orbit. Br J Oral Maxillofac Surg 45:4574622007

    • Search Google Scholar
    • Export Citation
  • 8

    Castelnuovo PArosio ADLeone FRavasio AAzzolini CDallan I: Endoscopic transnasal cryo-assisted removal of orbital cavernous hemangiomas: case report and technical hints. World Neurosurg 126:66712019

    • Search Google Scholar
    • Export Citation
  • 9

    Castelnuovo PDallan ILocatelli DBattaglia PFarneti PTomazic PV: Endoscopic transnasal intraorbital surgery: our experience with 16 cases. Eur Arch Otorhinolaryngol 269:192919352012 (Erratum in Eur Arch Otorhinolaryngol 269:1937 2012)

    • Search Google Scholar
    • Export Citation
  • 10

    Castelnuovo PTurri-Zanoni MBattaglia PLocatelli DDallan I: Endoscopic endonasal management of orbital pathologies. Neurosurg Clin N Am 26:4634722015

    • Search Google Scholar
    • Export Citation
  • 11

    Chhabra NWu AWFay AMetson R: Endoscopic resection of orbital hemangiomas. Int Forum Allergy Rhinol 4:2512552014

  • 12

    Craig JRLee JYPetrov DMehta SPalmer JNAdappa ND: Two- versus four-handed techniques for endonasal resection of orbital apex tumors. Am J Rhinol Allergy 29:3833882015

    • Search Google Scholar
    • Export Citation
  • 13

    Dallan ICastelnuovo Pde Notaris MSellari-Franceschini SLenzi RTurri-Zanoni M: Endoscopic endonasal anatomy of superior orbital fissure and orbital apex regions: critical considerations for clinical applications. Eur Arch Otorhinolaryngol 270:164316492013

    • Search Google Scholar
    • Export Citation
  • 14

    Dallan ICastelnuovo PTurri-Zanoni MFiacchini GLocatelli DBattaglia P: Transorbital endoscopic assisted management of intraorbital lesions: lessons learned from our first 9 cases. Rhinology 54:2472532016

    • Search Google Scholar
    • Export Citation
  • 15

    Dallan ISeccia VLenzi RCastelnuovo PBignami MBattaglia P: Transnasal approach to the medial intraconal space: anatomic study and clinical considerations. Minim Invasive Neurosurg 53:1641682010

    • Search Google Scholar
    • Export Citation
  • 16

    Herman PLot GSilhouette BMarianowski RPortier FWassef M: Transnasal endoscopic removal of an orbital cavernoma. Ann Otol Rhinol Laryngol 108:1471501999

    • Search Google Scholar
    • Export Citation
  • 17

    Jaiswal AK: Endonasal endoscopic approach to orbit. Neurol India 65:110211042017

  • 18

    Jian TSun FTang DWang SWu TZhao L: Clinical analysis of transcranial orbitotomy approach on cranio-orbital tumors. J Craniofac Surg 26:4414462015

    • Search Google Scholar
    • Export Citation
  • 19

    Karaki MAkiyama KKagawa MTamiya TMori N: Indications and limitations of endoscopic endonasal orbitotomy for orbital lesion. J Craniofac Surg 23:109310962012

    • Search Google Scholar
    • Export Citation
  • 20

    Khan AMVarvares MA: Traditional approaches to the orbit. Otolaryngol Clin North Am 39:895909 vi2006

  • 21

    Lee JYRamakrishnan VRChiu AGPalmer JGausas RE: Endoscopic endonasal surgical resection of tumors of the medial orbital apex and wall. Clin Neurol Neurosurg 114:93982012

    • Search Google Scholar
    • Export Citation
  • 22

    Lenzi RBleier BSFelisati GMuscatello L: Purely endoscopic trans-nasal management of orbital intraconal cavernous haemangiomas: a systematic review of the literature. Eur Arch Otorhinolaryngol 273:231923222016

    • Search Google Scholar
    • Export Citation
  • 23

    Lim JHSardesai MGFerreira M JrMoe KS: Transorbital neuroendoscopic management of sinogenic complications involving the frontal sinus, orbit, and anterior cranial fossa. J Neurol Surg B Skull Base 73:3944002012

    • Search Google Scholar
    • Export Citation
  • 24

    Lin GCFreitag SKKocharyan AYoon MKLefebvre DRBleier BS: Comparative techniques of medial rectus muscle retraction for endoscopic exposure of the medial intraconal space. Am J Rhinol Allergy 30:2262292016

    • Search Google Scholar
    • Export Citation
  • 25

    Liu YMa JRXu XL: Transcranial surgery through pterional approach for removal of cranio-orbital tumors by an interdisciplinary team of nurosurgeons and ophthalmologists. Int J Ophthalmol 5:2122162012

    • Search Google Scholar
    • Export Citation
  • 26

    Locatelli DPozzi FTurri-Zanoni MBattaglia PSanti LDallan I: Transorbital endoscopic approaches to the skull base: current concepts and future perspectives. J Neurosurg Sci 60:5145252016

    • Search Google Scholar
    • Export Citation
  • 27

    Lyson TSieskiewicz ARutkowski RKochanowicz JRozanska MRogowski M: Endoscopic drainage of orbital abscesses aided with intraoperative sonography. Neurol Neurochir Pol 48:3153212014

    • Search Google Scholar
    • Export Citation
  • 28

    Margalit NEzer HFliss DMNaftaliev ENossek EKesler A: Orbital tumors treated using transcranial approaches: surgical technique and neuroophthalmogical results in 41 patients. Neurosurg Focus 23(5):E112007 (Erratum in Neurosurg Focus 29(2):Erratum 2010)

    • Search Google Scholar
    • Export Citation
  • 29

    Martins CCosta E Silva IECampero AYasuda AAguiar LRTatagiba M: Microsurgical anatomy of the orbit: the rule of seven. Anat Res Int 2011:4687272011

    • Search Google Scholar
    • Export Citation
  • 30

    McKinney KASnyderman CHCarrau RLGermanwala AVPrevedello DMStefko ST: Seeing the light: endoscopic endonasal intraconal orbital tumor surgery. Otolaryngol Head Neck Surg 143:6997012010

    • Search Google Scholar
    • Export Citation
  • 31

    Moe KSBergeron CMEllenbogen RG: Transorbital neuroendoscopic surgery. Neurosurgery 67 (3 Suppl Operative):ons16ons28 2010

  • 32

    Moher DLiberati ATetzlaff JAltman DG: Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med 151:264269W64 2009

    • Search Google Scholar
    • Export Citation
  • 33

    Montano NLauretti LD’Alessandris QGRigante MPignotti FOlivi A: Orbital tumors: report of 70 surgically treated cases. World Neurosurg 119:e449e4582018

    • Search Google Scholar
    • Export Citation
  • 34

    Murchison APRosen MREvans JJBilyk JR: Endoscopic approach to the orbital apex and periorbital skull base. Laryngoscope 121:4634672011

    • Search Google Scholar
    • Export Citation
  • 35

    Netuka DMasopust VBelšán TProfantová NBeneš V: Endoscopic endonasal resection of medial orbital lesions with intraoperative MRI. Acta Neurochir (Wien) 155:4554612013

    • Search Google Scholar
    • Export Citation
  • 36

    Paluzzi AGardner PAFernandez-Miranda JCTormenti MJStefko STSnyderman CH: “Round-the-clock” surgical access to the orbit. J Neurol Surg B Skull Base 76:12242015

    • Search Google Scholar
    • Export Citation
  • 37

    Ramakrishna RKim LJBly RAMoe KFerreira M Jr: Transorbital neuroendoscopic surgery for the treatment of skull base lesions. J Clin Neurosci 24:991042016

    • Search Google Scholar
    • Export Citation
  • 38

    Sieskiewicz ALyson TMariak ZRogowski M: Endoscopic trans-nasal approach for biopsy of orbital tumours using image-guided neuro-navigation system. Acta Neurochir (Wien) 150:4414452008

    • Search Google Scholar
    • Export Citation
  • 39

    Stokken JGumber DAntisdel JSindwani R: Endoscopic surgery of the orbital apex: Outcomes and emerging techniques. Laryngoscope 126:20242016

    • Search Google Scholar
    • Export Citation
  • 40

    Tomazic PVStammberger HHabermann WGerstenberger CBraun HGellner V: Intraoperative medialization of medial rectus muscle as a new endoscopic technique for approaching intraconal lesions. Am J Rhinol Allergy 25:3633672011

    • Search Google Scholar
    • Export Citation
  • 41

    Tan SHPrepageran N: Endoscopic transnasal approach to medial orbital lesions. J Laryngol Otol 129:9289312015

  • 42

    Wu WSelva DJiang FJing WTu YChen B: Endoscopic transethmoidal approach with or without medial rectus detachment for orbital apical cavernous hemangiomas. Am J Ophthalmol 156:5935992013

    • Search Google Scholar
    • Export Citation
  • 43

    Yao WCBleier BS: Endoscopic management of orbital tumors. Curr Opin Otolaryngol Head Neck Surg 24:57622016

  • 44

    Zoli MSollini GAsioli SGelmi CAECorradini AGPasquini E: Endoscopic transpalpebral approach for resection of an intraorbital intraconal cavernous angioma. Neurosurg Focus Video 1(1):V22019

    • Search Google Scholar
    • Export Citation
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