Endonasal endoscopic approach for removal of intraorbital cavernous hemangioma in childhood

BackgroundThe Cavernous Hemangioma Exclusively Endonasal Resection CHEER classification system was developed to standardize prospective outcome analysis following orbital cavernous hemangioma OCH resection The goal of this study was to retroactively apply the CHEER system to all prior existing reports of endoscopic resection of primary benign orbital tumors BOTs to compare patient presentations perioperative characteristics and outcomes between OCH and other BOTs and determine whether the CHEER categorization regime could be expanded to other BOTs Methods A systematic review of studies reporting exclusively endoscopic resections of OCH and other BOTs eg solitary fibrous tumor schwannoma and meningioma was performed Patient tumor characteristics and operative outcomes were recorded All tumors with adequate reporting were retrospectively assigned a CHEER stage Outcomes were compared using chi-square or Fisher's exact tests Results Ninety-three studies met inclusion criteria and sufficient data were available in studies comprising tumors n =OCHs n = other BOTs Baseline patient and tumor characteristics as well as intraoperative and short-term postoperative outcomes were not signifi-cantly different between OCHs and other BOTs Long-term outcomes eg visual deficits diplopia eye position and recurrence also did not differ when controlling for CHEER stage Conclusion This review represents the largest collection of outcomes data following exclusively endoscopic endonasal resection of BOTs Short-term and long-term outcomes appear similar between OCHs and other BOTs These results suggest that exclusively endoscopic resection of orbital tumors may be effective in a range of benign pathologies Furthermore these results support a broader application of the CHEER system to other benign primary orbital tumors

show abstract

“…and A.E.L. ), a final list of articles was generated for data collection (see Supplementary Table 2) 1,3,7,8,17,20–50 …”

Section: Methodsmentioning

confidence: 99%

Exclusively endoscopic endonasal resection of benign orbital tumors: a systematic review and meta‐analysis

Jafari

Sneidern

Lehmann

et al. 2020

Int Forum Allergy Rhinol

View full text Add to dashboard Cite

show abstract

“…Over the past 2 decades, numerous case reports and series have described a purely endoscopic endonasal approach for the resection of medial orbital tumors. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] Early cases involved the removal of orbital CVM due to the well-circumscribed encapsulated nature of these lesions. [1][2][3][4][5][6][7][8][9][10][11] Over time, however, this technique has been used for a variety of pathologies including schwannoma, solitary fibrous tumor, inflammatory lesions, and malignant tumors.…”

Section: Discussionmentioning

confidence: 99%

“…This has been well-described in both the ophthalmic and rhinology literature. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] However, this approach has limits, particularly in terms of retraction, access for multiple instruments through a narrow corridor, and poor angulation for lateral orbital dissection. Combined transorbital-transnasal approaches allow for prolapse of the lesion from the orbit into the nasal cavity, allowing for orbital dissection on the lateral and posterior aspects of the lesion, areas that are otherwise difficult to visualize from an orbital or endoscopic approach alone.…”

mentioning

confidence: 99%

Combined Endonasal and Orbital Approach for Resection of Orbital Apical Tumors

Cohen

Grob²,

Krantz

et al. 2022

Ophthalmic Plastic &Amp; Reconstructive Surgery

View full text Add to dashboard Cite

Purpose: Tumors of the medial orbital apex can be challenging to resect. Primary endonasal resection can be limited by requirements for fat retraction and poor angulation for lateral orbital dissection. Orbital resection alone can have space limitations and a limited view for dissection of the posterior aspect of the tumor. The combined transorbital transnasal approach integrates the retraction and instrumentation advantages of the transorbital approach with the optical and space advantages of the transnasal approach.Methods: In this cross-sectional cohort study, patients who underwent surgical resection of an apical orbital tumor via a combined endoscopic and orbital approach from 2014 to 2019 were identified. Clinical history, examination findings, imaging, surgical technique, histopathology, and complications were reviewed.Results: Six patients were included. Patients presented with proptosis (5), optic neuropathy (3), and motility restriction (2). Surgery involved a medial orbitotomy and endoscopic ethmoidectomy ± sphenoidotomy, medial wall removal, and periosteum opening. The lesion was prolapsed into the sinus, dissected at the apex via the orbital approach, and removed through the nasal cavity. Pathologic diagnoses were cavernous venous malformation (4), venolymphatic malformation (1), and metastatic carcinoid (1). Improvement in pain (2/2), optic neuropathy (2/3), and proptosis (5/5) were noted. Complications included ethmoid mucocele and nasal polyps.Conclusions: The combined endonasal and orbital approach involves prolapsing the lesion into the nasal cavity to aid in dissection on the lateral and posterior aspects, maximizing visibility of the tight intraconal space. This technique can be performed by a team of orbital surgeons experienced in both orbital and endonasal surgery.

show abstract

“…1,2 The external orbitotomy and orbitozygomatic craniotomy approaches offer wide access to the orbit; however, medial lesions remain difficult to access and open techniques require a transcutaneous or transconjunctival approach. 3,4 Even with these open methods, lesions of the orbital apex remain difficult to access and visualize. The endoscopic endonasal approach to medially, and particularly inferomedially, located intraorbital lesions has been described to be a safe alternative.…”

Section: Introductionmentioning

confidence: 99%

Compartmental Endoscopic Surgical Anatomy of the Inferior Intraconal Orbital Space

et al. 2017

View full text Add to dashboard Cite

This study aims to define the endoscopic anatomy of inferior intraconal space, in terms of its neurovascular structures and relationship to fixed anatomic landmarks. A cadaveric anatomical study was conducted. This study was conducted at an academic cranial base center. Cadaveric subjects have been investigated. After dissection of the inferior intraconal space, the number and position of ophthalmic artery (OA) and oculomotor nerve (OMN) branches to the inferior rectus muscle (IRM) were quantified relative to the fixed landmark of the posterior maxillary wall. The point where the OMN branch to the inferior oblique muscle (IOM) crossed the lateral IRM margin was quantified. A total of 18 OA branches were identified with a mean ± standard deviation of 2.6 ± 0.53 branches. The mean distance of the OA branch insertion from the posterior maxillary wall was 7.11 ± 5.65 mm. The average number of OMN branches to the IRM was 1.63 ± 0.74 with a mean insertion distance of 1.88 ± 1.89 mm. The OMN branch to the IOM crossed the lateral IRM margin 5.38 ± 5.42 mm from the posterior maxillary wall. This cadaveric study quantifies the variability of two critical neurovascular structures salient to endoscopic approaches to the inferior intraconal space, the OMN, and OA contributions to the IRM. Knowledge of the interrelationship between these structures is essential in safe technique for dissection.

show abstract

Endonasal endoscopic approach for removal of intraorbital cavernous hemangioma in childhood

Abstract: Endoscopic transnasal approaches can now be considered as an alternative option to traditional external approaches in the management of medial and inferior orbital lesions in childhood.

Cited by 8 publications

References 29 publications

Exclusively endoscopic endonasal resection of benign orbital tumors: a systematic review and meta‐analysis

Exclusively endoscopic endonasal resection of benign orbital tumors: a systematic review and meta‐analysis

Combined Endonasal and Orbital Approach for Resection of Orbital Apical Tumors

Compartmental Endoscopic Surgical Anatomy of the Inferior Intraconal Orbital Space

Contact Info

Product

Resources

About