Abstract
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.
Highlights
Cheng Li,1 Yang Gao,1 Rongxin Chen,1 Chao Cheng,1 Pan Yin,1 Zhihui Zhang,1 Yinghao Wang,1 Yuekun Bao,1 Huan Ma,1 Jianbo Shi,2 and Rong Lu 1
Take cavernous hemangioma as an example; its characteristics are clear: it is the most common orbital lesion in young and middle-aged adults, comprising 7% of primary orbital masses; it usually occurs in patients who are 30–50 years old; it is seen in females 60–70% of the time. ey are low-flow vascular malformations that are well circumscribed and have a capsule. ey most commonly occur along the lateral aspect of the retrobulbar intraconal space and uncommonly involve the orbital apex [6]
For tumors found within or external to the muscle cone, transnasal endoscopy is usually the favored approach for those located in the nasal side of the optic nerve; otherwise, it could be risky for those located on the temporal side of the optic nerve
Summary
Most OATs are identified in the retrobulbar muscle cone, predominantly in the lateral aspect of the intraconal space They are often benign, even a small tumor in this area can cause significant morbidity, with symptoms including orbital pain, headache, and neuroophthalmologic symptoms such as ptosis, ophthalmoplegia, and loss of vision due to compressive optic and/or cranial neuropathy through compression of nerves and vessels [2, 3]. Traditional orbital apex surgery techniques include extended lateral orbitotomy, medial transconjunctival/transcaruncular orbitotomy, and frontotemporal craniotomy These surgical approaches are difficult and challenging in tumors located inferior to the optic nerve; they can even damage the optic nerve, muscles, and blood vessels in the orbit apex [10]. A global multicenter clinic trial in 2015 revealed that 65.2% patients had visual impairment after endoscopic endonasal resection of an orbital cavernous hemangioma [24]
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