Response to: “Considerations about endoscopic endonasal optic nerve and orbital apex decompression”

2015 ◽  
Vol 157 (4) ◽  
pp. 631-632 ◽  
Author(s):  
Timothée Jacquesson ◽  
Moncef Berhouma ◽  
Emmanuel Jouanneau
Keyword(s):  
Optic Nerve ◽  
Orbital Apex ◽  
Endoscopic Endonasal

scholarly journals Endoscopic endonasal optic nerve and orbital apex decompression for nontraumatic optic neuropathy: surgical nuances and review of the literature

2014 ◽  
Vol 37 (4) ◽  
pp. E19 ◽  
Author(s):  
Moncef Berhouma ◽  
Timothee Jacquesson ◽  
Lucie Abouaf ◽  
Alain Vighetto ◽  
Emmanuel Jouanneau ◽  
...  
Keyword(s):  
Optic Nerve ◽  
Minimally Invasive ◽  
Invasive Technique ◽  
Ossifying Fibroma ◽  
Symptom Duration ◽  
Imaging Data ◽  
Orbital Apex ◽  
Endoscopic Endonasal ◽  
Nerve Decompression ◽  
Optic Nerve Decompression

Object While several approaches have been described for optic nerve decompression, the endoscopic endonasal route is gaining favor because it provides excellent exposure of the optic canal and the orbital apex in a minimally invasive manner. Very few studies have detailed the experience with nontraumatic optic nerve decompressions, whereas traumatic cases have been widely documented. Herein, the authors describe their preliminary experience with endoscopic endonasal decompression for nontraumatic optic neuropathies (NONs) to determine the procedure’s efficacy and delineate its potential indications and limits. Methods The medical reports of patients who had undergone endoscopic endonasal optic nerve and orbital apex decompression for NONs at the Lyon University Neurosurgical Hospital in the period from January 2012 to March 2014 were reviewed. For all cases, clinical and imaging data on the underlying pathology and the patient, including demographics, preoperative and 6-month postoperative ophthalmological assessment results, symptom duration, operative details with video debriefing, as well as the immediate and delayed postoperative course, were collected from the medical records. Results Eleven patients underwent endoscopic endonasal decompression for NON in the multidisciplinary skull base surgery unit of the Lyon University Neurosurgical Hospital during the 27-month study period. The mean patient age was 53.4 years, and there was a clear female predominance (8 females and 3 males). Among the underlying pathologies were 4 sphenoorbital meningiomas (36%), 3 optic nerve meningiomas (27%), and 1 each of trigeminal neuroma (9%), orbital apex meningioma (9%), ossifying fibroma (9%), and inflammatory pseudotumor of the orbit (9%). Fifty-four percent of the patients had improved visual acuity at the 6-month follow-up. Only 1 patient whose sphenoorbital meningioma had been treated at the optic nerve atrophy stage continued to worsen despite surgical decompression. The 2 patients presenting with preoperative papilledema totally recovered. One case of postoperative epistaxis was successfully treated using balloon inflation, and 1 case of air swelling of the orbit spontaneously resolved. Conclusions Endoscopic endonasal optic nerve decompression is a safe, effective, and minimally invasive technique affording the restoration of visual function in patients with nontraumatic compressive processes of the orbital apex and optic nerve. The timing of decompression remains crucial, and patients should undergo such a procedure early in the disease course before optic atrophy.

How I do it: the endoscopic endonasal optic nerve and orbital apex decompression

2014 ◽  
Vol 156 (10) ◽  
pp. 1891-1896 ◽  
Author(s):  
Timothée Jacquesson ◽  
Lucie Abouaf ◽  
Moncef Berhouma ◽  
Emmanuel Jouanneau
Keyword(s):  
Optic Nerve ◽  
Orbital Apex ◽  
Endoscopic Endonasal

scholarly journals Endoscopic endonasal approach to the lateral orbital apex: case report

2015 ◽  
Vol 16 (3) ◽  
pp. 305-308 ◽  
Author(s):  
Tomasz A. Dziedzic ◽  
Vijay K. Anand ◽  
Theodore H. Schwartz
Keyword(s):  
Optic Nerve ◽  
Rectus Muscle ◽  
Lateral Compartment ◽  
Endoscopic Approach ◽  
Minimal Access ◽  
Endoscopic Endonasal Approach ◽  
Orbital Apex ◽  
Total Resection ◽  
Endoscopic Endonasal ◽  
Lateral Rectus Muscle

Although the medial and inferior orbital apex are considered safely accessible using the endonasal endoscopic approach, the lateral apex has been considered unsafe to access since the optic nerve lies between the surgeon and the pathology. The authors present the case of a 4-year-old girl with recurrent rhabdomyosarcoma attached to the lateral rectus muscle located lateral and inferior to the optic nerve in the orbital apex. The tumor was totally resected through an endoscopic endonasal transmaxillary transpterygoidal approach using a 45° endoscope. A gross-total resection was achieved, and the patient’s vision was unchanged. This procedure is a safe, minimal-access alternative to open procedures in selected cases and provides evidence that increases the applicability of the endonasal endoscopic approach to reach the lateral compartment of the orbital apex.

Relationship of the Optic Nerve to the Medial Rectus Muscle During Endonasal Dissection of the Medial Intraconal Orbital Apex

2016 ◽  
Vol 13 (1) ◽  
pp. 131-137 ◽  
Author(s):  
Dmitriy Petrov ◽  
John Craig ◽  
Jayesh Thawani ◽  
Kalil Abdullah ◽  
James N. Palmer ◽  
...  
Keyword(s):  
Optic Nerve ◽  
Rectus Muscle ◽  
Magnetic Resonance Images ◽  
Medial Rectus ◽  
Orbital Apex ◽  
Endoscopic Endonasal ◽  
Endoscopic Techniques ◽  
Superior Approach ◽  
Relationship Of ◽  
The Relationship

Abstract BACKGROUND: Few studies have established surgical landmarks for endoscopic endonasal dissection of the intraconal orbital apex (OA). OBJECTIVE: We describe the optic nerve (ON) anatomy and its relationships, as seen during a fully endoscopic, endonasal approach to the medial intraconal OA. METHODS: The study question was approached through a cadaver dissection and a radiographic study. Four formalin-fixed, latex-injected cadaver heads were dissected using transnasal endoscopic techniques. Dissection was performed using 0 degree and 30 degree nasal endoscopes and standard endoscopic sinus surgical instrumentation. A bi-nostril 4-handed technique was used. The anatomy of 8 medial OAs was evaluated and recorded. As the radiographic portion, 100 consecutively enrolled patient magnetic resonance images were evaluated, with particular attention given to the relationship of the ON to the medial rectus muscle (MRM) in 200 orbits. RESULTS: Intraconally, the ON consistently coursed along the superior half of the MRM. Interestingly, the nerve was more easily identified from a superior approach after retracting the MRM inferiorly. With the identification of the nerve at the OA, carrying the dissection of the medial OA was easily accomplished with the ON as the guiding landmark. The radiographic portion of this study revealed a consistent relationship between the superior edge of the ON and the MRM. This relationship was maintained in the orbital apex in 98.4%-100% of the orbits examined. CONCLUSION: The superior edge of the optic nerve is consistently found coursing along the superior half of the MRM, facilitating facile identification and further dissection navigation.

scholarly journals Endoscopic Endonasal Orbital Apex Decompression for Carotid Cavernous Fistula

2021 ◽  
pp. 014556132110303
Author(s):  
Noah Shaikh ◽  
Anthony Leonard ◽  
Caitlyn Patton ◽  
SoHyun Boo ◽  
John Nguyen ◽  
...  
Keyword(s):  
Complete Resolution ◽  
Standard Of Care ◽  
Endoscopic Endonasal Approach ◽  
Orbital Apex ◽  
Abducens Palsy ◽  
Carotid Cavernous Fistula ◽  
Endoscopic Endonasal ◽  
Cavernous Fistula ◽  
Novel Approach ◽  
Gaze Palsy

Significance Statement This case report demonstrates a novel approach to treating a rare indirect carotid cavernous fistula (CCF) and associated abducens palsy. Although endovascular treatment is the standard of care in the management of CCFs, it was contraindicated in this patient. Instead, she underwent an endoscopic endonasal approach (EEA) with decompression of the medial orbital apex, including the cavernous sinus and optic nerve, with complete resolution of headache, lateral gaze palsy, and diplopia within 2 months.

scholarly journals SINDROM TOLOSA HUNT DENGAN KETERLIBATAN SARAF OPTIKUS

2019 ◽  
Vol 37 (1) ◽  
Author(s):  
Astra Dea Simanungkalit ◽  
Maria Larasati Susyono ◽  
Vivien Puspitasari
Keyword(s):  
Visual Acuity ◽  
Case Report ◽  
Optic Nerve ◽  
Pain Relief ◽  
Clinical Syndrome ◽  
Orbital Apex ◽  
Corticosteroid Administration ◽  
Hunt Syndrome ◽  
Nerve Dysfunction ◽  
Optic Nerve Involvement

TOLOSA HUNT SYNDROME WITH OPTIC NERVE INVOLVEMENTABSTRACTTolosa Hunt syndrome (THS) is a very rare clinical syndrome, which is characterized by unilateral headaches accompanied by dysfunction and painful ophthalmic nerves. In some cases, optic nerve involvement can be found due to inflammation at the orbital apex. Corticosteroid administration is a management of THS with pain relief generally occurring in the first 72 hours. However, corticosteroid administration is not significantly associated with nerve dysfunction or visual acuity improvement.This article is a case report of women with STH and optic nerve involvement.Keywords: Tolosa Hunt syndrome, painful ophtalmoplegia, orbital apex, superior orbital fissureABSTRAKSindrom Tolosa Hunt (STH) adalah sindrom klinik yang sangat jarang, yang ditandai oleh nyeri kepala unilateral disertai disfungsi dan nyeri saraf penggerak bola mata (painful ophtamloplegia). Pada beberapa kasus, dapat ditemukan keterlibatan saraf optikus akibat inflamasi pada apeks orbita. Pemberian kortikosteroid merupakan tatalaksana STH dengan perbaikan nyeri umumnya terjadi pada 72 jam pertama. Meskipun demikian pemberian kortikosteroid tidak berhubungan secara signifikan dengan perbaikan disfungsi saraf penggerak bola mata maupun tajam penglihatan. Artikel ini merupakan laporan kasus perempuan dengan STH dan keterlibatan saraf optikus.Kata kunci: Sindrom Tolosa Hunt, painful ophtalmoplegia, apeksorbita, fisura orbitalis superior

Endoscopic Endonasal Approaches to the Cavernous Sinus: Surgical Approaches

Neurosurgery ◽  
2001 ◽  
Vol 49 (2) ◽  
pp. 354-362 ◽  
Author(s):  
Alessandra Alfieri ◽  
Hae-Dong Jho
Keyword(s):  
Cavernous Sinus ◽  
Middle Turbinate ◽  
Lateral Wall ◽  
Surgical Instruments ◽  
Surgical Approaches ◽  
Lateral Nasal Wall ◽  
Orbital Apex ◽  
Superior Orbital Fissure ◽  
Endoscopic Endonasal ◽  
Surgical Access

Abstract OBJECTIVE After completion of an earlier endoscopic transsphenoidal anatomic study, we studied various endoscopic transsphenoidal approaches using cadaveric specimens to develop endoscopic endonasal surgical approaches to the cavernous sinus. METHODS Ten cavernous sinuses in five artery-injected adult cadaveric heads were studied with 0-, 30-, and 70-degree angled 4-mm rod-lens endoscopes. The extent of the surgical exposure, the skewed endoscopic anatomic view, and the maneuverability of surgical instruments through their relative operating spaces were studied after various endoscopic endonasal approaches via one nostril. RESULTS The paraseptal approach was used between the nasal septum and the middle turbinate and provided exposure at the anteromedial portion of the cavernous sinus. The contralateral paraseptal approach rendered a slightly more medial view at the cavernous sinus than did the ipsilateral approach. This approach offered limited surgical access to the lateral vertical compartment. The middle turbinectomy approach allowed surgical access to the lateral wall of the cavernous sinus, except for the superior orbital fissure and the orbital apex. The middle meatal approach, which was made between the middle turbinate and the lateral nasal wall, revealed the entire lateral vertical compartment of the cavernous sinus, including the orbital apex and the superior orbital fissure. However, its lateral tangential surgical trajectory and the absence of dedicated surgical tools limited the surgeon's surgical maneuverability. A combination of the middle turbinectomy and middle meatal approaches increased the operating space. CONCLUSION Various endoscopic endonasal surgical approaches to the cavernous sinus were studied using adult cadaveric head specimens.

Residual and Recurrent Disease Following Endoscopic Endonasal Approach as a Reflection of Anatomic Limitation for the Resection of Midline Anterior Skull Base Meningiomas

2021 ◽  
Author(s):  
Pradeep Setty ◽  
Juan C Fernandez-Miranda ◽  
Eric W Wang ◽  
Carl H Snyderman ◽  
Paul A Gardner
Keyword(s):  
Optic Nerve ◽  
Skull Base ◽  
Retrospective Chart Review ◽  
Residual Tumor ◽  
Average Diameter ◽  
Anterior Skull Base ◽  
Endoscopic Endonasal ◽  
Olfactory Groove ◽  
Orbital Roof ◽  
Skull Base Meningiomas

Abstract BACKGROUND Endoscopic endonasal approaches (EEAs) to anterior skull base meningiomas have grown in popularity, though anatomic limitations remain unclear. OBJECTIVE To show the anatomic limits of EEA for meningiomas. METHODS Retrospective chart review for all patients that underwent EEA for anterior skull base meningiomas from 2005 to 2014. RESULTS A total of 100 patients averaged follow-up of 46.9 mo (24-100 mo). A total of 35 patients (35%) had olfactory groove, 33 planum sphenoidale (33%), and 32 tuberculum sella (32%) meningiomas. The average diameter was 2.9 cm (0.5-8.1 cm). Vascular encasement was seen in 11 patients (11%) and calcification in 20 (20%). Simpson Grade 1 (SG1) resection was achieved in 64 patients (64%). Only calcification impacted degree of resection (40% SG1, P = .012). The most common residual was on the anterior clinoid dura (11 patients [11%]). Six (6%) had residual superior/lateral to the optic nerve. Residual tumor was adherent to the optic apparatus or arteries in 5 patients (5%) each, and 3 patients (3%) had residual lateral to the mid-orbit. Rates of residual decreased over time. A total of 11 patients (11%) had tumor recurrence (mean of 40 mo): 4 (4%) on the anterior clinoid, 2 (2%) each on the lateral orbital roof, adherent to optic apparatus and superolateral to the optic nerve, and 1 (1%) was at the anterior falx. CONCLUSION Anterior skull base meningiomas can effectively be approached via EEA in most patients; tumors extending to the anterior clinoid, anterior falx, or superolateral to the optic nerve or orbital roof, especially if calcified, may be difficult to reach via EEA.

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