gms | German Medical Science

Conventional surgical approaches to the orbital apex and to the midline skull base are frequently impaired by considerable peri- and postoperative morbidity. The growing experience with extended endoscopic approaches in combination with the implementation of navigational systems allows the transnasal exposition of tumors in these regions.

Here we report six exemplary cases where such techniques were used for biopsies and for surgical resection. In two cases of a tumor of the dorsal orbit, one malignant lymphoma and one malignant sarcoma, biopsies were taken endoscopically. In another case an infiltration with bony destruction of the orbital apex, of the lateral wall of the sphenoid sinus and with intracranial extension, the diagnosis of invasive mucormycosis was made after a transnasal endoscopic biopsy was taken. The extended surgical resection was also performed endoscopically and the patient was treated with antifungal drugs. In another patient destruction of the midline skull base was caused by a meningeoma (WHO-grade II). Two additional cases of tumors of the midline skull base, located caudally and laterally of the sphenoid sinus with destruction of the clivus and neighboring structures were operated endoscopically for biopsy and treatment. Histopathology revealed a non-malignant fibro-lipomatous lesion and a metastasis of a squamous cell carcinoma. In none of these cases did we observe intra- or postoperative complications such as bleeding or liquorrhea. Endoscopic endonasal approaches to the orbit and the midline skull base – especially when performed in conjnction with the use of navigational systems and four-hand-techniques enable surgical exploration with little traumatization even in cases with complicated anatomical location of the tumor.