Techniques in Endoscopic Endonasal Tranorbital Tumor Surgery

Introduction: Endoscopic skull base tumor surgery has progressed from extradural sinonasal benign tumors, to tumor that involved up to the skull base, to intradural tumors, and now to intraorbital and intraconal tumors. We describe our experience with endoscopic transorbital tumor surgery.

Methods: Technical description of endoscopic endonasal transorbital approaches to orbital tumors.

Results: Three options currently exist for endoscopic endonasal intraorbital tumor surgery: (1) a medial and inferior approach for extraconal lesions; (2) a transmaxillary approach for lateral extraconal lesions; (3) a medial intraconal approach with displacement of the medial rectus muscle and intraconal dissection between the inferior and medial rectus muscles. The limitation of the intraconal approach is the location of the tumor in relation to the optic nerve; lesions that are inferior-medial are ideal. No optic nerve injuries occurred in 11 endoscopic transorbital tumor resections. The series of orbital tumor resections includes hemangiomas, meningiomas, schwannomas, osseous tumors, and JNAs.

Conclusions: Endoscopic endonasal transorbital approaches to orbital tumors requires an understanding of complex orbital and skull base anatomy; however, this is a safe and viable option for selected orbital lesions.