Transnasal Endoscopic Removal of an Orbital Cavernoma

Abstract

The approach to posterior and medial orbital tumors is still a challenge, since poor functional results are frequent. We report a case of cavernoma successfully removed by a modified transnasal endoscopic procedure. The patient, a 56-year-old woman, complained of a decrease in vision of the left eye. Magnetic resonance imaging evidenced a lesion in the posterior part of the orbital cavity, inferior to the optic nerve, extending to the sphenoidal cleft. The lesion was isodense on T1-weighted images and showed contrast enhancement. Because of the medial location of the tumor, the patient was referred to the otolaryngology department by the neurosurgeons, and a transnasal endoscopic approach was chosen. A large exposure of the operative field was obtained, and a cavernoma was removed. Rapid relief of the symptoms was obtained. In view of this good result, we advocate the transnasal endoscopic approach in cases of inferomedial and posterior intraconal lesions as an alternative and addition to the standard techniques of orbital surgery.

An Unusual Presentation of Retrobulbar Cavernous Hemangioma in a Young Woman

“…The aim of the surgery is total removal of the lesion, sparing the neurovascular structures as much as possible. The surgical options are direct orbitotomy, transnasal endoscopic removal, transcranial approach or orbital exenteration according to the location of the tumour [ 2 , 4 , 14 - 15 ]. En bloc excision is preferable to avoid intraoperative bleeding and the risk of residue and recurrence [ 2 , 4 , 15 - 16 ].…”

Surgical approaches to the orbit - The past and the present

“…27 In 1999 Herman described trans-nasal endoscopic approach in a case of inferomedial located orbital cavernous hemangioma in the posterior orbit. 28…”

Endonasal Endoscopic Approach to Orbital Tumors

“…This was followed by a precipitous adaptation of endoscopic endonasal surgery for other clinical indications, including optic nerve decompression, 3 orbital biopsies, 4 removal of foreign bodies, 5 repair of medial wall fractures, 6 among others; and indications for this approach have continued to broaden because of increased surgeon experience and advances in technology. The first reported excisions of orbital tumors, specifically cavernous venous malformations, via an endonasal microsurgical approach and EEA were described in 1999 by A.-Mri-Salim and Berghaus 7 and Herman et al, respectively 8 . Multiple other groups have subsequently demonstrated similar techniques with the successful removal of both extraconal and intraconal tumors 9–11 …”