Endoscopic Endonasal Approach to the Orbital Apex and Medial Orbital Wall

Abuzayed, Bashar; Tanrıöver, Necmettin; Gazioğlu, Nurperi; Eraslan, Berna Şenel; Akar, Zıya

doi:10.1097/scs.0b013e3181b0dc23

Cited by 66 publications

(56 citation statements)

References 28 publications

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“…1,7,10,14,26,36,43,58 This technique definitely provides excellent exposure of the optic canal and orbital apex in a minimally invasive fashion. While decompression in traumatic optic neuropathy has been widely investigated, 11,13,[18][19][20]24,28,29,36,37,40,47,48,[52][53][54][55][56][57][58][59]61 indeed with debatable results, decompression for nontraumatic optic neuropathies (NONs) is still insufficiently studied.…”

mentioning

confidence: 99%

Endoscopic endonasal optic nerve and orbital apex decompression for nontraumatic optic neuropathy: surgical nuances and review of the literature

Berhouma

Jacquesson

Abouaf³

et al. 2014

FOC

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Object While several approaches have been described for optic nerve decompression, the endoscopic endonasal route is gaining favor because it provides excellent exposure of the optic canal and the orbital apex in a minimally invasive manner. Very few studies have detailed the experience with nontraumatic optic nerve decompressions, whereas traumatic cases have been widely documented. Herein, the authors describe their preliminary experience with endoscopic endonasal decompression for nontraumatic optic neuropathies (NONs) to determine the procedure’s efficacy and delineate its potential indications and limits. Methods The medical reports of patients who had undergone endoscopic endonasal optic nerve and orbital apex decompression for NONs at the Lyon University Neurosurgical Hospital in the period from January 2012 to March 2014 were reviewed. For all cases, clinical and imaging data on the underlying pathology and the patient, including demographics, preoperative and 6-month postoperative ophthalmological assessment results, symptom duration, operative details with video debriefing, as well as the immediate and delayed postoperative course, were collected from the medical records. Results Eleven patients underwent endoscopic endonasal decompression for NON in the multidisciplinary skull base surgery unit of the Lyon University Neurosurgical Hospital during the 27-month study period. The mean patient age was 53.4 years, and there was a clear female predominance (8 females and 3 males). Among the underlying pathologies were 4 sphenoorbital meningiomas (36%), 3 optic nerve meningiomas (27%), and 1 each of trigeminal neuroma (9%), orbital apex meningioma (9%), ossifying fibroma (9%), and inflammatory pseudotumor of the orbit (9%). Fifty-four percent of the patients had improved visual acuity at the 6-month follow-up. Only 1 patient whose sphenoorbital meningioma had been treated at the optic nerve atrophy stage continued to worsen despite surgical decompression. The 2 patients presenting with preoperative papilledema totally recovered. One case of postoperative epistaxis was successfully treated using balloon inflation, and 1 case of air swelling of the orbit spontaneously resolved. Conclusions Endoscopic endonasal optic nerve decompression is a safe, effective, and minimally invasive technique affording the restoration of visual function in patients with nontraumatic compressive processes of the orbital apex and optic nerve. The timing of decompression remains crucial, and patients should undergo such a procedure early in the disease course before optic atrophy.

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confidence: 99%

Endoscopic endonasal optic nerve and orbital apex decompression for nontraumatic optic neuropathy: surgical nuances and review of the literature

Berhouma

Jacquesson

Abouaf³

et al. 2014

FOC

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“…Cabe señalar, que si bien desde la década pasada se cuenta con una gran serie de estudios en cadáveres sobre la anatomía endoscópica del ápex orbitario, fosa infratemporal (FIT) y fosa pterigopalatina (FPtP), con descripciones detalladas de puntos o reparos anatómicos, ninguno tuvo en cuenta ni se señaló la unidad estructural FOI-MM.] (1,29,30,31) . Según nuestra indagación, estos estudios pasaron por alto su descripción, relaciones y la utilidad de este binomio o unidad estructural como un importante reparo anatómico para la FOS, ápex orbitario, FIT y la FPtP.…”

Section: Discussionunclassified

“…De esta forma los reparos anatómicos nos brindan la posibilidad de generar un plan peri-operatorio (pre e intraoperatorio) y por lo tanto mayor seguridad durante el acto quirúrgico. A su vez, como sabemos, la elección óptima del abordaje quirúrgico también dependerá del proceso patológico en cuestión (1,2,3) . Los abordajes quirúrgicos tradicionales al ápex orbitario incluyen, entre otros, orbitotomías laterales y craneotomías con componente orbitario, ambos procedimientos muy invasivos y con significativa morbilidad si los comparamos a los empleados en los abordajes quirúrgicos endoscópicos (4,5,6,7,1,8) .…”

Section: Introductionunclassified

Anatomía endoscópica de la unidad estructural Fisura orbitaria inferior - Músculo de Müller en la Junción órbito selar medial y su importancia quirúrgica

Battista

Torres²,

Keller

et al. 2017

Rev Fac Cien Med Univ Nac Cordoba

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Resumen:Antecedentes: Las enfermedades que afectan la órbita representan un desafío quirúrgico, en particular las que comprometen el ápex orbitario. Una vía óptima de acceso quirúrgico proporciona la mejor exposición permitiendo identificar ciertas estructuras anatómicas claves llamadas reparos anatómicos. Objetivo: Describir la anatomía endoscópica de la unidad estructural Fisura Orbitaria Inferior / Músculo de Müller a nivel del ápex orbitario generando así un nuevo reparo anatómico endoscópico. Material y método: Análisis descriptivo óseo de la fisura orbitaria inferior (FOI) en cráneos secos, disección y estudio bajo técnica endoscópica de 6 cabezas fijadas en formol y coloreadas; finalmente se tomaron distancias y ángulos a forámenes relacionados con el ápex orbitario a 10 cráneos secos. El análisis estadístico se realizó con el programa estadístico SPSS 17,0 (SPSS, Inc., Chicago, IL). Resultado: En todas las disecciones endoscópicas se pudo identificar la unidad fisura orbitaria inferior-músculo de Müller y también verificar su íntima relación con el ápex orbitario. Morfométricamente el foramen óptico y el foramen redondo mayor están a una distancia promedio de 65.19mm y 60.16mm respectivamente. Los ángulos promedio del FO fue de 13.32 grados y del FRM de19.31 grados. Hallamos correlación significativa entre CO. y el FRM sólo en el hemicráneo izquierdo, (Tau b de Kendall 0.69, P=0.006). No se encontraron diferencias anatómicas (o morfológicas) significativas entre lados. Conclusión: bajo técnica endoscópica la unidad Fisura Orbitaria Inferior-Músculo de Müller (FOI-MM) es un reparo anatómico constante, útil y seguro que permite el reconocimiento del ápex orbitario y sus áreas contiguas. Palabras clave: base de cráneo; anatomía; endoscopía; órbita Abstract:Background: Diseases of the orbit represent a surgical challenge, particularly those compromising the orbital apex. Optimal surgical access should provide the best possible exposure, allowing to identify certain key anatomical structures, called landmarks. Objective: Describe the endoscopic anatomy of the structural unit formed by the Inferior Orbital Fissure (IOF) and the Müller's muscle (MM) at the orbital apex (OA), thus generating a new endoscopic anatomical landmark. Materials and methods: A bone-descriptive analysis of the IOF in dry craniums, was followed by dissection and endoscopic study of six heads (twelve sides), colored and fixed in formaldehyde. In ten dry craniums (twenty sides), distances and angles of OA foramina were measured (optic foramen [OF] and foramen rotundum [FR]). Statistical analysis was performed with SPSS 17.0 statistical software (SPSS, Inc. Chicago, IL). Results: The structural unit IOF-MM was identified in all endoscopic dissections, verifying its intimate relationship with the OA. From the morpho-metric standpoint, OF and FR were found at an average distance of 65.19 mm and 60.16 mm, respectively. The average angle of the OF was 13.32 degrees, whereas the one for FR was 19.31 degrees. We found a significant correlation b...

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“…After confirmation of the lamina papyracea, the lateral walls of the anterior and posterior ethmoidal air cells were uncovered by removal of the basal lamella of the middle turbinate. 11 The natural ostium of the sphenoid sinus was then identified and opened. Anterior sphenoidectomy provided visualization of the optic protuberance in the sphenoid roof.…”

Section: Surgical Techniquementioning

confidence: 99%

“…1,5 However, detailed reports regarding the endoscopic endonasal approach for optic nerve decompression are extremely limited. 5,[11][12][13][14] An in-depth understanding of endoscopic anatomy around the orbital apex facilitates the surgical procedure and reduces surgical complications.…”

Section: Introductionmentioning

confidence: 99%