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

Abstract

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.

Surgical Approaches to the Orbit: A Neurosurgical Perspective

“…17 It is also an excellent approach for orbital decompression (e.g., in thyroid eye disease) or for optic nerve decompression at the bony canal. [18][19][20][21][22][23] Surgical Technique…”

“…The lateral orbit can also be accessed through this approach (►Fig. 22). Furthermore, for extended access to the medial or lateral orbit, the PS approach can be used in combination with the PC or LRC.…”

The Lateral Orbitotomy Approach for Intraorbital Lesions

“…However, with improved techniques and greater surgeon comfort, the limits of what can be accomplished through the lateral orbitotomy are expanding. 13,[15][16][17][18][19] At least some of this progress may be related to use of endoscopy over traditional microscopy.…”

“…18,28 Zhou et al presented a 10 patient series of 8 cavernous hemangiomas and 2 schwannomas at the lateral orbital apex who were resected via an endoscopic lateral orbitotomy. 17 These were mostly small tumors (range: 10-18 mm) but all were completely resected. Neuronavigation was used in all cases and there were no major complications.…”

Tumors of the orbit: Case report and review of surgical corridors and current options

“…[20] Zhou et al described Navigation-Guided Endoscopy Combined with Deep Lateral Orbitotomy for Removal of Small Tumors at the Lateral Orbital Apex. [21]…”