Retrospective Case Analysis of Transnasal Endoscopic Resection of Benign Orbital Apex Tumors: Some Thoughts on Transnasal Endoscopic Surgery

Purpose. To deeply discuss the patient selection, surgical planning, surgical techniques, and the therapeutic challenge for endoscopic transnasal resection of benign orbital apex tumors (OATs). Methods. We retrospectively analyzed the cases of 18 patients (18 eyes) with orbital apex cavernous hemangioma (OACH) who underwent endoscopic transnasal approach for resection of the tumor in Zhongshan Ophthalmic Center from March 2016 to May 2020. At each follow-up visit, the patients underwent measurement of their best-corrected visual acuity (BCVA), slit-lamp examination, indirect ophthalmoscopy, and visual field testing. Results. There were 18 patients, 7 males and 11 females, with a mean age of 49.9 ± 12.6 years (range: 26 to 70 years). All 18 patients had unilateral tumors. Among the 18 cases, 13 were located in the right orbit and 5 were located in the left orbit. Sixteen patients underwent purely endoscopic transnasal surgery, and the other 2 patients underwent an endoscopic transnasal approach combined with a transcutaneous or transconjunctival surgical approach. Fourteen patients’ OACHs were removed completely, 1 patient’s OACH was partly removed, and 3 patients underwent pure decompression of the optic nerve. Fourteen patients gained improved or stable BCVA after surgery. Three patients showed postoperative vision decline, and 1 patient had no light perception after surgery. Conclusions. Endoscopic surgery is an effective surgical technique for the treatment of benign tumors in the orbital apex. It is necessary to strictly select patients and fully evaluate the benefits and risks of tumor completely or partly removed.

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Combined external and endoscopic transnasal approach with use of a diamond burr in the removal of a fishing harpoon hook traversing bilateral sphenoid sinuses in a 22-year-old man

BMJ Case Reports ◽

10.1136/bcr-2020-239055 ◽

2021 ◽

Vol 14 (5) ◽

pp. e239055

Author(s):

Jan Alexeis Lacuata ◽

Agnes Tirona - Remulla ◽

Arsenio Claro Cabungcal ◽

Romiena Mae Santos

Keyword(s):

Visual Acuity ◽

Sphenoid Sinus ◽

Oral Antibiotics ◽

Orbital Apex ◽

Transnasal Approach ◽

Endoscopic Transnasal Approach ◽

Diamond Burr ◽

The Right ◽

Sphenoid Sinuses

A 22-year old construction worker was shot with a fishing harpoon gun on the left side of his face. He consulted at the emergency room 12 days postinjury, stable but with blurring of vision on the right. The shaft of the harpoon was protruding at the left preauricular area; the tip was neither visible nor palpable. Craniofacial CT scan and skull anteroposterolateral radiographs revealed the tip of the harpoon to be at the right orbital apex. A hook attached 1 cm from the tip was lodged in the sphenoid sinus. The hook was dismantled from the shaft via a combined external and endoscopic transnasal approach, enabling the shaft to be gently pulled. The hook, together with the tip, were removed endoscopically. The patient’s visual acuity improved. He was discharged after 2 days on oral antibiotics with no deficits on follow-up.

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Removal of a Cavernous Hemangioma in the Orbital Apex via the Endoscopic Transnasal Approach: A Case Report

min - Minimally Invasive Neurosurgery ◽

10.1055/s-0030-1251984 ◽

2010 ◽

Vol 53 (02) ◽

pp. 77-79 ◽

Cited By ~ 24

Author(s):

K. Yoshimura ◽

S. Kubo ◽

H. Yoneda ◽

H. Hasegawa ◽

S. Tominaga ◽

...

Keyword(s):

Case Report ◽

Cavernous Hemangioma ◽

Orbital Apex ◽

Transnasal Approach ◽

Endoscopic Transnasal Approach

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Transnasal excerebration surgery in ancient Egypt

Journal of Neurosurgery ◽

10.3171/2011.12.jns11417 ◽

2012 ◽

Vol 116 (4) ◽

pp. 743-748 ◽

Cited By ~ 15

Author(s):

Andrew A. Fanous ◽

William T. Couldwell

Keyword(s):

Skull Base ◽

Surgical Techniques ◽

Ancient Egypt ◽

Transnasal Approach ◽

Old Kingdom ◽

Greco Roman ◽

Ancient Egyptian ◽

Transnasal Surgery ◽

The One

Ancient Egyptians were pioneers in many fields, including medicine and surgery. Our modern knowledge of anatomy, pathology, and surgical techniques stems from discoveries and observations made by Egyptian physicians and embalmers. In the realm of neurosurgery, ancient Egyptians were the first to elucidate cerebral and cranial anatomy, the first to describe evidence for the role of the spinal cord in the transmission of information from the brain to the extremities, and the first to invent surgical techniques such as trepanning and stitching. In addition, the transnasal approach to skull base and intracranial structures was first devised by Egyptian embalmers to excerebrate the cranial vault during mummification. In this historical vignette, the authors examine paleoradiological and other evidence from ancient Egyptian skulls and mummies of all periods, from the Old Kingdom to Greco-Roman Egypt, to shed light on the development of transnasal surgery in this ancient civilization. The authors confirm earlier observations concerning the laterality of this technique, suggesting that ancient Egyptian excerebration techniques penetrated the skull base mostly on the left side. They also suggest that the original technique used to access the skull base in ancient Egypt was a transethmoidal one, which later evolved to follow a transsphenoidal route similar to the one used today to gain access to pituitary lesions.

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Endoscopic transnasal resection of the CP angle schwannoma

Neurosurgical Focus: Video ◽

10.3171/2020.4.focusvid.19891 ◽

2020 ◽

Vol 2 (2) ◽

pp. V13

Author(s):

Satoshi Kiyofuji ◽

Masahiro Shin ◽

Kenji Kondo ◽

Tsukasa Koike ◽

Taichi Kin ◽

...

Keyword(s):

Cranial Nerves ◽

Surgical Instruments ◽

Neurological Deficits ◽

Cystic Tumor ◽

Subtotal Resection ◽

Transnasal Approach ◽

Fusion Images ◽

Endoscopic Transnasal Approach ◽

The Right ◽

Peeling Off

Cerebellopontine (CP) angle tumors are often resected via retrosigmoid craniotomy; however, sometimes cranial nerves (CNs) make their resection more complex. In such cases, the endoscopic transnasal approach can avoid such manipulations as delivering surgical instruments over CNs or peeling off CNs from the tumor, minimizing the risk of postoperative deficits. A 35-year-old man presented with a 37-mm cystic tumor in the right CP angle, and preoperative 3D fusion images revealed that multiple CNs (VII, VIII, and lower CNs) were running on the tumor posteriorly. The endoscopic transnasal approach enabled safe subtotal resection without causing neurological deficits, and the patient underwent stereotactic radiosurgery for the residual schwannoma.The video can be found here: https://youtu.be/xKLwdDsLpWA.

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Endoscopic Two-Port Technique for Orbital Tumors, A Combined Transnasal and Sublabial Approach: A Retrospective Case Study

10.21203/rs.3.rs-407897/v1 ◽

2021 ◽

Author(s):

Petr Matousek ◽

Michaela Masárová ◽

Jakub Lubojacký ◽

Adam Kopecký ◽

Jan Němčanský ◽

...

Keyword(s):

Infraorbital Nerve ◽

Medial Part ◽

Retrospective Case ◽

Transnasal Approach ◽

Suitable Alternative ◽

Transnasal Surgery ◽

Sublabial Approach ◽

Retrospective Case Study ◽

Orbital Lesions

Abstract Background: We investigated the indications for a combined endoscopic transnasal and sublabial transantral approach for the surgical treatment of orbital lesions. Methods: This case study enrolled 10 patients scheduled for endoscopic transnasal surgery for treating orbital lesions from 2009 to 2020. When the tumor was localized to the medial part of the orbit, patients underwent endoscopy with a transnasal mononostril approach. Alternatively, when the tumor was localized to the mediocaudal part of the orbit, and when instrument maneuverability was limited, the transnasal approach was combined with a sublabial transantral approach. This two-port surgery approach was preferred over a trans-septal approach (binostril approach), because the two-port approach could expand the operating field in the medial part of the orbit. Here, we evaluated the indications, complications, and advantages of monoportal and combined two-portal approaches. Results: Among the 10 patients enrolled, 8 (80.0%) underwent surgery with the transnasal mononostril approach, and 2 (20.0%) underwent surgery with the combined transnasal mononostril and sublabial transantral approach. In the two latter cases, visualization of the operation field was excellent, and there was adequate room for manipulating instruments. No dysesthesia in the region of infraorbital nerve was observed postoperatively.Conclusion: The combination mononostril-transantral approach provided the space necessary to maneuver instruments and to visualize the surgical field in treating mediocaudal orbital lesions. This two-portal approach enabled extensive resections of intraconal lesions; thus, it could be considered a suitable alternative to the binostril approach.

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Endoscopic transnasal approach for resection of locally aggressive tumors in the orbit

Journal of Neurosurgery ◽

10.3171/2014.11.jns141921 ◽

2015 ◽

Vol 123 (3) ◽

pp. 748-759 ◽

Cited By ~ 12

Author(s):

Masahiro Shin ◽

Kenji Kondo ◽

Shunya Hanakita ◽

Keigo Suzukawa ◽

Taichi Kin ◽

...

Keyword(s):

Cavernous Sinus ◽

Tumor Resection ◽

Neurological Complications ◽

Transnasal Approach ◽

Transnasal Surgery ◽

Endoscopic Transnasal Approach ◽

Aggressive Tumors ◽

Mass Lesions ◽

Functional Preservation ◽

Surgical Pathway

OBJECT In recent years, application of endoscopic transnasal surgery (ETS) has been expanded to orbital lesions, and preliminary results have started to be published for medially located soft mass lesions. However, reports on experience with endoscopic intraorbital surgery aimed at resection of invasive skull base tumors remains quite limited. This report presents the authors’ experience with ETS for locally aggressive tumors involving the orbit. METHODS ETS was performed for 15 cases of aggressive tumors involving the orbit: 5 meningiomas (meningothelial, n = 3; atypical, n = 1; anaplastic, n = 1), 4 chordomas, 2 chondrosarcomas, and 4 others (metastasis from systemic myxofibrosarcoma, schwannoma, inverted papilloma, and acinic cell carcinoma, n = 1 each). Among these, 9 tumors were located outside the periorbita and 6 inside the periorbita. In 6 intraperiosteal tumors, 5 were intraconal lesions, of which 3 arose in the muscle cone (anaplastic meningioma, optic sheath meningioma, and metastatic myxofibrosarcoma), and 2 meningothelial meningioma had invaded from the sphenoid ridge or the cavernous sinus into the muscle cone through the optic canal and the superior orbital fissure. A case of schwannoma originated around the cavernous sinus and pterygopalatine fossa and extended extraconally into the periorbita. Intraoperatively, ethmoid air cells and the lamina papyracea were removed, and extraperiosteal tumors were safely approached. For intraperiosteal tumors, the periorbita was widely opened, and the tumors were approached through the surgical window between the rectus and oblique muscles. RESULTS Gross-total resection was achieved for 12 of the 15 tumors, including 2 intraconal lesions. After surgery, exophthalmos resolved in all 8 patients with this symptom, and diplopia resolved in 5 of 6 patients. Improvement of visual symptoms was reported by 4 of 5 patients with loss of visual acuity or constriction of the visual field. Postoperatively, 1 patient showed mild, transient worsening of existing facial dysesthesia, and another showed transient ptosis and mild hypesthesia of the forehead on the affected side. All those symptoms resolved within 3 months. No patients showed enophthalmos, worsening of diplopia or visual function, or impairment of olfaction after surgery. CONCLUSIONS ETS appears acceptable as a less-invasive alternative for treating aggressive tumors involving the orbit. For extraperiosteal tumors, gross-total removal can generally be achieved without neurological complications. For intraperiosteal tumors, surgical indications should be carefully discussed, considering the relationship between the tumor and normal anatomy. Wide opening of the periorbital window is advocated to create a sufficient surgical pathway between the extraocular muscles, allowing a balance between functional preservation and successful tumor resection.

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Juvenile variant ossifying fibroma of sinonasal region

Nepal Journal of Neuroscience ◽

10.3126/njn.v17i2.30551 ◽

2020 ◽

Vol 17 (2) ◽

pp. 77-81

Author(s):

Susan Pradhan ◽

Suman Phuyal ◽

Dipendra Kumar Shrestha ◽

Sushil Krishna Shilpakar

Keyword(s):

Multidisciplinary Approach ◽

Surgical Excision ◽

Ossifying Fibroma ◽

Brown Tumor ◽

Resonance Imaging ◽

Transnasal Approach ◽

Endoscopic Transnasal Approach ◽

Cranial Fossa ◽

The Right ◽

Stony Hard

Juvenile variant ossifying fibroma of sinonasal region is an extremely rare benign fibro-osseous lesion which is locally aggressive. A 21-year-old male presented with significant proptosis of right eye with stony-hard lump in the middle upper aspect of the right orbit and base of the nose. CT scan of head revealed a non-enhancing expansile lesion in right ethmoidal cells consistent with chronic ethmoidal mucocele. However Magnetic Resonance Imaging of brain revealed enhancing lesion in right ethmoid and frontal sinus extending up to anterior cranial fossa. He underwent right frontal craniotomy with surgical excision of tumor wherein cystic brown tumor of frontal and ethmoidal sinus was found. The procedure was supplemented with endoscopic transnasal approach. Histopathology report suggested an ossifying fibroma. This case highlights the importance of clinical, imaging and histopathological features of ossifying fibroma occurring in the sinonasal tract for better diagnosis and treatment through a multidisciplinary approach.

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