Transnasal Endoscopic Image-Guided Orbital Apex Surgery

Image guidance has emboldened surgeons while at the same time has allowed safer surgery. Transnasal endoscopic orbital surgery has been described in the treatment of nasolacrimal duct obstruction and Graves' ophthalmopathy and as an approach to optic canal decompression in cases of traumatic optic neuropathy. To expand the utility of this technology, we have utilized a transnasal endoscopic image-guided approach to biopsy or excise medial orbital apex tumors since 2001.

Collaboration of a surgical neuro-ophthalmologist and head and neck surgeon has brought together unique skills to achieve a less invasive, safer, and more cost-effective treatment for these disease processes which can now be treated on an outpatient basis. Specifically, in the case of orbital apex tumors, this approach obviates the need for a neurosurgical or extended lateral approach affording a greatly decreased morbidity.

Case presentations, including our first transnasal orbital apex tumor excision performed in 2001, will detail our surgical planning with emphasis on radiologic anatomic boundaries of dissection leading to a safe surgical approach. Potential disease states applicable to this approach will be presented to highlight our 7-year experience.