Endoscopic Transnasal Removal of Cavernous Hemangiomas of the Optic Canal

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

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“…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

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“…Regarding the outcome, preservation of the cranial nerve is the top priority for the surgery of intraorbital tumor. Cranial nerves should be monitored during the surgery ( 14 ). Optic damages are often caused by direct damage, inappropriate traction, or vascular supply impairment during the dissection.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic Endonasal Intraconal Approach for Orbital Tumor Resection: Case Series and Systematic Review

et al. 2022

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Intraorbital tumor could be approached by numerous surgical methods. The neuroendoscopic endonasal approach could provide a feasible corridor for indicated tumors. Herein we present a series of 6 consecutive intraorbital tumors from April 2018 to October 2020, which received endonasal endoscopic resection. Cadaveric dissection was performed for the intraconal approach, and the literature was also reviewed. Five tumors were located intraconally, while one extraconally. The pathology revealed 1 angioleiomyoma, 1 cavernous hemangioma, 1 pilocytic astrocytoma, 1 meningioma, and 2 schwannomas. Five of the six achieved gross total resection, including 3 tumors with lateral extension beyond the optic nerve. Preoperative visual deterioration was observed in 4 of the 6 patients, and all got improvement postoperatively. Transient oculomotor nerve palsy was presented in one patient postoperatively. No cerebrospinal fluid leakage, enophthalmos, or strabismus was observed. The median follow-up time is 27 months (11~41 months). At the 6-month follow-up, the visual acuity remained unchanged compared with that at discharge. Proptosis was resolved in 2 of the 3 patients; diplopia was improved in one patient. In conclusion, endoscopic endonasal intraconal approach could be suitable for selected pathological conditions, and for both medial or beyond medial extraconal and intraconal orbital tumors.

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“…Although the transcranial approach provides an impressive surgical exposure, the added operative time, injury, and brain manipulation were inevitable. In recent years, we have commonly applied endoscopic transnasal surgery for small apical tumors [5, 9]. With the help of superiority of the transnasal endoscope, we removed the tumor completely and safely with delicate manipulation.…”

Section: Discussionmentioning

confidence: 99%

“…But the choice of operation methods for removing small tumors located at the orbital apex remains unsure by most ophthalmologists because of the poor symptom improvement and inevitable iatrogenic injury [1–4]. Recently, an endoscopic transnasal approach for the apical tumor has been reported in some literatures [5–9] which has gained great outcome. However, this approach was made for well-defined tumors located medial or inferomedial to the orbital apex, especially close to the medial orbital wall.…”

Section: Introductionmentioning

confidence: 99%

Navigation-Guided Endoscopy Combined with Deep Lateral Orbitotomy for Removal of Small Tumors at the Lateral Orbital Apex

Zhou

et al. 2018

Journal of Ophthalmology

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Purpose To evaluate the efficacy, feasibility, and safety of the navigation-guided endoscopy combined with deep lateral orbitotomy for removal of small tumors at the lateral orbital apex. Design A retrospective, noncomparative case series. Methods Retrospective analysis of ten patients (10 eyes) with small tumors at the lateral orbital apex comprised navigation-guided endoscopy combined with deep lateral orbitotomy at the Eye Hospital of Wenzhou Medical University from November 2015 to November 2017. In each case, the indication of surgery was existing or imminent visual impairment due to the tumor. The removal was believed to be complete if the mass was removed intactly during the surgery. The tumor character was confirmed by pathological examination after surgery. Patients were followed up to 3 months after surgery. Best corrected visual acuity before and after surgery was compared. Results All tumors were completely removed by the navigation-guided endoscopic approach. The mean preoperative best corrected visual acuity was 6/15 (95% confidence interval (95% CI) 6/40–6/8.5), and the mean postoperative best corrected visual acuity was 6/10 (95% CI 6/15–6/7.5). 5 of 7 (71%) patients with vision loss gained visual improvement in different degrees after surgery, and the rest of the patients had preoperative best corrected visual acuity. Visual field of all patients also improved. 8 cavernous hemangiomas and 2 schwannomas were confirmed postoperatively by pathology. 4 patients accompanied with limitation of eye abduction, which recovered spontaneously in an average of 4 weeks. No other serious complications occurred. Conclusions Navigation-guided endoscopy combined with deep lateral orbitotomy seems to be a feasible, efficient, and safe approach for removing small tumors at the lateral orbital apex. This trial is registered with ChiCTR1800019244.

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Endoscopic Transnasal Removal of Cavernous Hemangiomas of the Optic Canal

Cited by 21 publications

References 20 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

Endoscopic Endonasal Intraconal Approach for Orbital Tumor Resection: Case Series and Systematic Review

Navigation-Guided Endoscopy Combined with Deep Lateral Orbitotomy for Removal of Small Tumors at the Lateral Orbital Apex

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