Endoscopic endonasal approach to the lateral orbital apex: case report

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.

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Endocrinological and ophthalmological consequences of an initial endonasal endoscopic approach for resection of craniopharyngiomas

Neurosurgical FOCUS ◽

10.3171/2010.1.focus09292 ◽

2010 ◽

Vol 28 (4) ◽

pp. E8 ◽

Cited By ~ 58

Author(s):

Peter G. Campbell ◽

Brian McGettigan ◽

Adam Luginbuhl ◽

Sanjay Yadla ◽

Marc Rosen ◽

...

Keyword(s):

Visual Field ◽

English Literature ◽

Endoscopic Approach ◽

Pituitary Stalk ◽

Gross Total Resection ◽

Endoscopic Endonasal Approach ◽

Endonasal Approach ◽

Total Resection ◽

Endoscopic Endonasal ◽

Csf Leaks

Object The expanded endoscopic approach to craniopharyngiomas has recently been described in several small case series. The authors present their experience with this technique and review the available literature. Methods Between September 2006 and September 2009, 14 patients underwent a purely endoscopic, endonasal approach for resection of newly diagnosed craniopharyngiomas. These procedures represent index surgeries; no patient had undergone previous tumor resection. A retrospective review of endocrinological and ophthalmological outcomes, extent of resection, and complication prevalence was completed. Additionally, a review of the English literature was performed to evaluate outcomes of similar endoscopic techniques for resection of craniopharyngiomas. Results Four patients (28.6%) underwent gross-total resection; near total resection or better was achieved in 9 patients (64.3%). All patients presented with some form of visual field or acuity deficit. Postoperatively, 12 patients (85.7%) experienced visual improvement, with 6 patients (42.9%) having complete visual recovery. One patient experienced worsening of her visual deficit. Visual acuity improved in 8 patients ((57.1%), while visual field defects improved in 11 (78.6%). The pituitary stalk was preserved in all cases. Eight (57.1%) of 14 patients experienced some form of anterior pituitary dysfunction postoperatively. Although 9 patients (64.3%) were documented to have either transient or permanent new diabetes insipidus immediately after surgery, at 1-month follow-up only 1 patient met clinical criteria. Five patients (35.7%) developed CSF leaks that were successfully treated by subsequent endoscopic revision. All CSF leaks occurred early in the series. Two patients (14.2%) were treated for presumed meningitis postoperatively. Conclusions The endoscopic endonasal approach is a minimally invasive alternative to open transcranial approaches for select craniopharyngiomas. Similar to previous transcranial series, rates of endocrinopathy and gross-total resection were dependent upon the adherence of the tumor capsule to the hypothalamus, pituitary stalk, and associated vasculature. A review of the literature suggests that the results of the current series are similar to other published series on this topic.

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

Operative Neurosurgery ◽

10.1227/neu.0000000000001204 ◽

2016 ◽

Vol 13 (1) ◽

pp. 131-137 ◽

Cited By ~ 2

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.

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Endoscopic Endonasal Orbital Apex Decompression for Carotid Cavernous Fistula

Ear Nose & Throat Journal ◽

10.1177/01455613211030347 ◽

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.

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P.093 Visual outcomes after expanded endoscopic endonasal resection of suprasellar meningiomas and optic nerve decompression

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/cjn.2019.188 ◽

2019 ◽

Vol 46 (s1) ◽

pp. S38

Author(s):

K Yang ◽

Y Ellenbogen ◽

J Kim ◽

A Rodriguez ◽

D Sommer ◽

...

Keyword(s):

Visual Acuity ◽

Optic Nerve ◽

Visual Outcome ◽

Symptom Duration ◽

Endoscopic Endonasal Approach ◽

Endonasal Approach ◽

Endoscopic Endonasal ◽

Visual Symptoms ◽

Nerve Decompression ◽

Optic Nerve Decompression

Background: The Endoscopic endonasal approach (EEA) has become increasingly popular in the treatment of suprasellar meningiomas, which often cause visual symptoms due to compression of the anterior optic apparatus. Methods: We performed a retrospective chart review on patients who underwent EEA optic nerve decompression and resection of suprasellar meningiomas between January 1st 2005 and December 1st 2018 at McMaster University. Results: The mean age of our patients was 59.8 years. We treated 9 male and 23 female patients, with a mean follow up of 6.29 years. 23 patients (71.9%) presented with visual symptoms, with a mean duration of 8.65 months. In our patient cohort, 95.5% had stable or improved visual acuity postoperatively. Less than six months of visual decline was more likely to be associated with postoperative improvement of visual acuity, with an odds ratio (OR) of 0.0222 (95% CI: 0.0017–0.289, p<0.05); as well as visual field (OR:0.0625; 95% CI, 0.0042–0.915, p<0.05). Additionally, the absence of RAPD was associated with improved postoperative visual acuity (OR: 0.0675; 95% CI, 0.0354–0.706, p<0.05). Conclusions: Endoscopic endonasal approach can achieve good visual outcome in patients harboring suprasellar meningiomas. Symptom duration of less than six months and absence of RAPD were positive predictor of postoperative visual outcome.

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

Neurosurgical FOCUS ◽

10.3171/2014.7.focus14303 ◽

2014 ◽

Vol 37 (4) ◽

pp. E19 ◽

Cited By ~ 45

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.

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

Acta Neurochirurgica ◽

10.1007/s00701-014-2199-1 ◽

2014 ◽

Vol 156 (10) ◽

pp. 1891-1896 ◽

Cited By ~ 15

Author(s):

Timothée Jacquesson ◽

Lucie Abouaf ◽

Moncef Berhouma ◽

Emmanuel Jouanneau

Keyword(s):

Optic Nerve ◽

Orbital Apex ◽

Endoscopic Endonasal

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

Acta Neurochirurgica ◽

10.1007/s00701-015-2357-0 ◽

2015 ◽

Vol 157 (4) ◽

pp. 631-632 ◽

Cited By ~ 1

Author(s):

Timothée Jacquesson ◽

Moncef Berhouma ◽

Emmanuel Jouanneau

Keyword(s):

Optic Nerve ◽

Orbital Apex ◽

Endoscopic Endonasal

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The efficacy of an endoscopic endonasal approach in the repair of cerebrospinal fluid fistula: a clinical analysis

International Journal of Scientific Reports ◽

10.18203/issn.2454-2156.intjscirep20191431 ◽

2019 ◽

Vol 5 (4) ◽

pp. 90

Author(s):

Fulya Ozer ◽

Can Alper Cagici ◽

Cem Ozer ◽

Cuneyt Yilmazer

Keyword(s):

Cerebrospinal Fluid ◽

Endoscopic Approach ◽

Graft Material ◽

Endoscopic Endonasal Approach ◽

Endonasal Approach ◽

Cerebrospinal Fluid Fistula ◽

Endoscopic Repair ◽

Endoscopic Endonasal ◽

Csf Leakage ◽

Fluid Fistula

Background: Cerebrospinal fluid (CSF) fistula is an abnormal CSF leakage due to bone and/or dural defect of the skull base and usually operated with endonasal endoscopic approach. The aim of this study was to determine the efficacy of an endonasal endoscopic approach in the repair of CSF leakage and to find the reasons of the recurrence of endoscopic procedure.Methods: The medical records of 24 patients that presented with the diagnosis of cerebrospinal fluid fistula and who had undergone endonasal endoscopic repair surgery were reviewed retrospectively. Results: 13 patients (54.2%) were found to have spontaneous CSF fistulas without any history of trauma, while 11 patients (45.8%) had posttraumatic CSF fistulas. The mean body mass index (BMI) of patients was 31. 3 kg/m² (20.1-49.6). Nasal septal cartilage was used as a graft material in 19 patients (79%) while only fascia was used in 5 patients (21%). The evaluation of long-term results revealed recurrence in 4 patients (16.6%). Two of these patients required a second surgical repair.Conclusions: An endoscopic endonasal approach is a safe method with less morbidity and a reliable outcome in the repair of CSF fistulas. The most important causative factors in the recurrence of endoscopic repair of CSF leak might be to have high BMI and not to use multilayered graft material for closure of fistula.

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