Endoscopic Resection of a Venous Hemangioma of the Optic Nerve Sheath

Abstract

We describe a case ofa venous hemangioma that arose in the optic nerve sheath ofthe orbital apex in a 28-year-old man who presented with progressive vision loss. Tothe best of our know ledge, this is the first reported case ofa venous hemangioma occurring at this location. A definitive diagnosis and partial exci sion was achieved via an endoscopic transsphenoethmoid approach with interactive, computerassisted, frame less stereotactic surgical navigation. The interv ention resulted in minimal morbidity, demonstrating yet again that this surgi cal approach is a safe and effective way to treat lesion s of the orbital apex.

Endoscopic transnasal intraorbital surgery: our experience with 16 cases

“…Our dissection work [12] confirms this statement. Until today, clinical experience on this topic is scanty [4][5][6][7][8][9][10] and, at the moment, transnasal endoscopic intraorbital surgery has to be considered under investigation, and proposed and performed in selected cases only by experienced surgeons. From an anatomical view point, the orbit is a highly complex region where critical structures are packed into a small space.…”

“…Pioneeristic clinical experiences addressing the medial orbital spaces by means of an endoscopic transnasal route have been published in the English Literature [4][5][6][7][8][9], with only one small series of 6 cases [10]. As a whole, intraorbital space occupying lesions always pose a challenge both in terms of definite surgical removal as well as preoperative sampling for histopathological examination.…”

Surgical Approaches to the Orbital Apex: Comparison of Endoscopic Endonasal and Transcranial Approaches using a Novel 3D Endoscope

“…(D) 3D picture of the area described in (C). transantral, and transnasal transethmoidal approaches (Chang et al, 2003;Delfini et al, 1992;Goldberg et al, 2007;Graham et al, 2002;Karaki et al, 2006;Kingdom and Delgaudio, 2003;Kiratli et al, 2005;Koerbel et al, 2007;Metson and Pletcher, 2006;Monin et al, 2005;Numa and Kawamoto, 2007;Perry, 2006;Schick et al, 2003;Hassler, 2004, 2005;Tsirbas et al, 2005). Karaki et al (2006) presented the advantages and disadvantages of various approaches, and underlined the importance of the endoscopic endonasal approaches to lesions situated in the inferomedial aspect of the orbital apex.…”

“…Karaki et al (2006) presented the advantages and disadvantages of various approaches, and underlined the importance of the endoscopic endonasal approaches to lesions situated in the inferomedial aspect of the orbital apex. However, only a few case reports have documented the use of endonasal endoscopic approaches for treating orbital pathologies, such as Graves' ophthalmopathy, resection of orbital tumors, and ON decompression for treating both traumatic and nontraumatic optic neuropathies (Brown et al 2007;Chiarelli et al, 2008;Kingdom and Delgaudio, 2003;Metson and Pletcher, 2006;Monin et al, 2005;Muhammad Khyani et al, 2008;Tsirbas et al, 2005). In most of these cases, access was limited to the ON sheath, the ON itself, or the intraconal space.…”

“…This approach was originally developed by otolaryngologists to perform orbital Orbit decompressions for Graves' disease, orbital trauma, and removal of orbital tumors (Chiarelli et al, 2008;Har-El, 2005;Karaki et al, 2006;Kingdom and Delgaudio, 2003;Metson and Pletcher, 2006;Monin et al, 2005;Muhammad Khyani, 2008). However, the anatomical details of this approach have not been well-presented in cadaveric dissection, which may limit the proliferation and utilization of this approach in neurosurgical practice.…”