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Abstract

Orbital disease management, although technically demanding and challenging, benefits nowadays several surgical approaches. According to the location, biological behavior, and size of the lesion, the surgeon should design and choose his/her surgical procedure to offer the best angle of attack the lesion itself, thus minimizing the risks to damage noble neurovascular and muscular intraorbital structures.Laterally located lesions are traditionally managed through lateral orbitotomy or superior eyelid (SE) approach, 1 whereas medially located intraorbital lesions (IOLs) are more easily accessed through the transnasal route or other external transorbital approaches.2-6 However, certain lesions with superomedial location may determine a technical challenge. Keywords► orbital lesion ► orbital surgery ► intraconal venous malformation ► endoscopic transnasal approach ► superior eyelid approach AbstractOrbital lesions are traditionally managed through external approaches when laterally located, and through a transnasal approach or other external approaches when medially located. However, when the lesion is superomedially located, it may determine a technical challenge. In this study, we present the case of a patient with a superomedial intraconal venous malformation of the left eye. We addressed the mass through a combined approach, using the transnasal route as the main approach, and the superior eyelid approach to push down the lesion to facilitate the excision. We have called this approach "push-pull technique." We achieved a complete resection of the lesion and did not observe any intraoperative or postoperative complications. The last follow-up at 6 months postoperatively showed no recurrence, and the patient was satisfied and completely recovered. According to our experience, the "push-pull" technique seems to be a safe procedure and might be considered a valid alternative to address selected superomedial intraconal lesions.