Compartmental Endoscopic Surgical Anatomy of the Inferior Intraconal Orbital Space

Maxfield, Alice Z.; Brook, Christopher; Miyake, Marcel M.; Bleier, Benjamin S.

doi:10.1055/s-0037-1604405

Cited by 12 publications

(12 citation statements)

References 14 publications

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“…Some institutions use IMT as a way to separate the orbit into anterior and posterior zones to facilitate risk assessment during dissection. 15,17 Anterior to the IMT lies the AEA, PEA, neurovascular supply to the extraocular muscle (EOM), as well as the muscles themselves. Posterior to the IMT, within the orbital apex, is the most technically challenging zone to access.…”

Section: Anatomic Locationmentioning

confidence: 99%

Endoscopic Endonasal Approach for Intra- and Extraconal Orbital Pathologies

Melder

Zwagerman

Gardner

et al. 2020

J Neurol Surg B Skull Base

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Endoscopic endonasal approaches offer an important alternative in the management of posterior inferomedial orbital pathology. Beginning with endoscopic orbital decompressions for Graves' disease, the endonasal corridor for the management of intra- and extraconal pathologies has continued to evolve. Endonasal removal of orbital cavernous hemangiomas is well described in the literature; however, many other benign and malignant pathologies of the medial orbit can be accessed through this approach. Advantages of the endonasal approach include improved visualization and decreased manipulation of orbital contents in the medial and posterior orbit. Additionally, for tumors that extend from the paranasal sinuses into the orbit, this corridor may be ideal for concurrent management. The current literature for this approach will be reviewed including the oncologic results, complications, limitations, and reconstructive needs along with pertinent anatomy. In addition, data from our own institution will be reviewed.

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Section: Anatomic Locationmentioning

confidence: 99%

Endoscopic Endonasal Approach for Intra- and Extraconal Orbital Pathologies

Melder

Zwagerman

Gardner

et al. 2020

J Neurol Surg B Skull Base

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“…Several more reports have followed describing successful endonasal removal of both extraconal and intraconal orbital tumors of various pathologic types . In more recent years, technical reports on endonasal orbital tumor surgery have been detailed including methods of medial rectus muscle retraction, endonasal anatomy of the medial and inferior intraconal space, endonasal anatomy of the superior orbital fissure and orbital apex, and considerations for reconstruction after tumor resection . Still, given the relatively nascent field of endonasal orbital tumor surgery, reporting of techniques and outcomes remains extremely variable.…”

mentioning

confidence: 99%

Development of the international orbital Cavernous Hemangioma Exclusively Endonasal Resection (CHEER) staging system

Rassi

Adappa

Battaglia

et al. 2019

Int Forum Allergy Rhinol

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Background Orbital cavernous hemangiomas (OCH) are the most common adult orbital tumor and represent an ideal index lesion for endonasal orbital tumor surgery. In order to standardize outcomes reporting, an anatomic‐based staging system was developed. Methods An international, multidisciplinary panel of 23 experts in orbital tumor surgery was formed. A modified Delphi method was used to develop the cavernous hemangioma exclusively endonasal resection (CHEER) staging system with a total of 2 rounds being completed. Results Tumors medial to a plane along the long axis of the optic nerve may be considered amenable for an exclusively endonasal resection. In select cases, tumors may extend inferolaterally if the tumor remains below a plane from the contralateral naris through the long axis of the optic nerve (ie, plane of resectability [POR]). This definition reached consensus with 91.3% of panelists in agreement. Five stages were designed based on increasing technical resection difficulty and potential for morbidity. Stages were based on the relationship of the tumor to the extraocular muscles, the inferomedial muscular trunk of the ophthalmic artery (IMT), and orbital foramina. Staging by anatomic location also reached consensus with 87.0% of panelists in agreement. Size was not included in the staging system due to the lack of agreement on the contribution of size to resection difficulty. Conclusion Endoscopic orbital tumor surgery is a nascent field with a growing, yet heterogeneous, body of literature. The CHEER staging system is designed to facilitate international, high‐quality, standardized studies establishing the safety, efficacy, and outcomes of endonasal resection of OCH.

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“…The superolateral orbit has been traditionally accessed through a lateral open corridor. 27,28 This study used a small lateral canthus incision (1.5 cm) to facilitate the exposure of both the superolateral intraconal space and the superolateral 2/3's SOF, and its content including the superior ophthalmic vein, CNs III, IV, V 1 , and VI. The endoscopic visualization in combination with the use of appropriate instruments can facilitate maximal exposure of the superolateral 2/3's SOF.…”

Section: Discussionmentioning

confidence: 99%

Expanded exposure and detailed anatomic analysis of the superior orbital fissure: Implications for endonasal and transorbital approaches

London

Chen

et al. 2020

Head & Neck

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This study aimed to ascertain the maximal exposure of the superior orbital fissure (SOF) afforded by combining endonasal and transorbital endoscopic approaches. Six cadaveric specimens (12 sides) were dissected using endonasal and transorbital endoscopic approaches to access the SOF. The order of the approaches was alternated in each specimen (eg, starting with an endonasal approach in one side followed by a transorbital exposure and reversing the order on the contralateral side). Maximal exposure of the SOF and its contents for individual and combined approaches were explored. The endonasal corridor provided adequate access to the inferomedial 1/3 of the SOF and including the proximal segments of cranial nerves (CN) III, V1 and VI. A transorbital approach was superior accessing the superolateral 2/3's of the SOF, including the superior ophthalmic vein, lacrimal nerve, and distal segment of the CN VI at the lateral aspect; the nasociliary nerve and divisions of CN III centrally; and the frontal nerve and CN IV at the dorsal aspect of levator palpebrae superioris. This study suggests that a combined endonasal and transorbital exposure of the SOF may be advantageous to address lesions in this challenging region.

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Compartmental Endoscopic Surgical Anatomy of the Inferior Intraconal Orbital Space

Cited by 12 publications

References 14 publications

Endoscopic Endonasal Approach for Intra- and Extraconal Orbital Pathologies

Endoscopic Endonasal Approach for Intra- and Extraconal Orbital Pathologies

Development of the international orbital Cavernous Hemangioma Exclusively Endonasal Resection (CHEER) staging system

Expanded exposure and detailed anatomic analysis of the superior orbital fissure: Implications for endonasal and transorbital approaches

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