gms | German Medical Science

Objective: Conventional approaches to the orbit often require extensive surgery and may create external surgical scars. In spite of the well-known advances in the endoscopic techniques, only recently have single reports been published indicating that at the orbit is a target for endoscopic intervention and a transitory corridor to the skull base. In this contribution we would like to present the results of image-guided endoscopic surgery in 23 patients with intraorbital pathologies using transnasal, transmaxillary and transconjunctival approaches. The presentation will be illustrated by short video recordings and snapshots of the performed endoscopic procedures.

Methods: Trans-nasal endoscopic biopsy of intraorbital mass lesions was performed in 8 patients, in 6 a tumor was completely resected (including 3 osteomas of the apex, one retrobulbar inflammatory tumor, two intraorbital extensions of the sphenoid sinus lesions), in 2 patients foreign bodies from the medial aspect of the orbit were removed, in 3 cases, a retroorbital abscess was drained and in 2 cases a retro-bulbar hematoma was evacuated. There were also 2 blow-out fractures of the inferior orbital wall. All the procedures were performed by a team including an ENT surgeon and a neurosurgeon using a neuronavigation system and intraoperative ultrasonography for precise anatomical orientation.

Results: In all 8 patients, a biopsy was taken from the representative part of the pathological mass and in 5 of them the non – neoplasmatic nature of the lesion was confirmed. None of these patients developed an aggravation of the ocular symptoms after the procedure. In 3 patients after tumor resection and in one with the abscess drainage, transient deterioration was observed: ptosis and diplopia which receded within weeks. Foreign bodies, including an intraconal fragmentized of a 2.5 cm wooden bar, were removed without impairment of ocular functions. In 2 patients with intraorbital hematomas, both exophthalmus and eye globe immotility gradually subsided within 2 weeks. Blow-out fractures were also successfully repaired with restoration of the eye globe position and motion.

Conclusions: In spite of anatomical limitations, the orbit can be explored with endoscopy but the operative technique is rather demanding and satisfactory results are to be obtained only with high quality equipment supported with image guidance.

This work was supported by the National Center of Investigation and Development (NCBiR). Grant No 13-0037-10.