Abstract
Background
The endoscopic endonasal approach provides an option to approach the medial and inferior orbital apex, with less manipulation of intraorbital structures.
Method
We described the advantages, complications, caveats, and indications of the endoscopic endonasal approach to the orbital apex. An intraorbital extraconal cavernous malformation is shown as example.
Conclusion
The endoscopic endonasal approach is a good corridor to the medial and inferior orbital apex, providing good exposure and little manipulation of the intraorbital contents.
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Abbreviations
- CT:
-
Computed tomography
- MRI:
-
Magnetic resonance imaging
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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Informed consent was obtained from the individual participant included in the study.
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The authors declare no competing interests.
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Key points
- The endonasal approach provides excellent exposure to the medial and inferior orbital apex.
- A binostril approach is preferred to the orbital apex due to the angle of attack.
- Evaluation of the particular anatomy of the patient and the use of navigation may decrease complications of the approach.
- Limited orbitotomy and periobital opening avoid fat prolapse into the field and postoperative enophthalmos.
- Careful blunt dissection of the tumor is preferred over sharp dissection.
- Hemostasis is achieved with warm saline irrigation or bipolar cauterization in the lowest setting.
- Extraconal fat may be carefully resected or coagulated.
- Resection or coagulation of intraconal fat is to be avoided.
- For intraconal lesions, the surgeon may work above or below the medial rectus muscle, or retract it.
- Orbital reconstruction is not necessary when only the orbital apex is exposed.
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Constanzo, F., Pinto, J. & Schmidt, T. How I do it: endoscopic endonasal approach to the orbital apex. Acta Neurochir 163, 3433–3437 (2021). https://doi.org/10.1007/s00701-021-04900-5
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DOI: https://doi.org/10.1007/s00701-021-04900-5