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Sollini G, Giorli A, Zoli M, Farneti P, Arena G, Astarita F, Mazzatenta D, Pasquini E. Endoscopic transnasal approach to remove an intraorbital bullet: systematic review and case report. ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2024:1-7. [PMID: 38712521 DOI: 10.14639/0392-100x-n2868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 02/05/2024] [Indexed: 05/08/2024]
Abstract
Introduction Intraorbital foreign bodies (IOFBs) represent a clinical challenge: surgical management can be controversial and different strategies have been proposed. When removal is recommended, depending on the location and nature of the IOFB both external and endoscopic approaches have been proposed, with significantly different surgical corridors to the orbit and different morbidities. Methods We performed a literature review of cases of IOFBs that received exclusive endoscopic transnasal surgical treatment to evaluate the role of this surgery in these occurrences. We also present a case of an intraorbital intraconal bullet that was successfully removed using an endoscopic transnasal approach with good outcomes in terms of ocular motility and visual acuity. Results A limited number of cases of IOFBs have been treated with an exclusive endoscopic transnasal approach. When in the medial compartment, this approach appears to be safe and effective. In our case, two months after surgery the patient showed complete recovery with no significant long-term sequelae. Conclusions When feasible, an endoscopic transnasal approach for intraorbital foreign bodies represents a valid surgical technique with optimal outcomes and satisfactory recovery.
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Affiliation(s)
- Giacomo Sollini
- Department of Otolaryngology and Head and Neck Surgery, Bellaria Hospital, AUSL Bologna, Bologna, Italy
| | - Alessia Giorli
- ENT Department, University of Siena, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Matteo Zoli
- Department of Bio-Medical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Programma Neurochirurgia Ipofisi-Pituitary Unit, Bologna, Italy
| | - Paolo Farneti
- Department of Otolaryngology and Head and Neck Surgery, Bellaria Hospital, AUSL Bologna, Bologna, Italy
| | - Giorgio Arena
- ENT Division, University of Eastern Piedmont, AOU Maggiore della Carità di Novara, Novara, Italy
| | - Fabio Astarita
- UO Rete Chirurgia del Volto e Odontoiatria Ospedaliera e Territoriale, AUSL Bologna, Bologna, Italy
| | - Diego Mazzatenta
- Department of Bio-Medical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Programma Neurochirurgia Ipofisi-Pituitary Unit, Bologna, Italy
| | - Ernesto Pasquini
- Department of Otolaryngology and Head and Neck Surgery, Bellaria Hospital, AUSL Bologna, Bologna, Italy
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Zoia C, Maiorano E, Borromeo S, Mantovani G, Spena G, Pagella F. Endoscopic approaches to the orbit: Transnasal and transorbital, a retrospective case series. BRAIN & SPINE 2024; 4:102770. [PMID: 38510598 PMCID: PMC10951755 DOI: 10.1016/j.bas.2024.102770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 02/18/2024] [Indexed: 03/22/2024]
Abstract
Introduction Orbital pathologies requiring surgery are traditionally treated by open approach with different techniques depending on the lesion location. Recently, minimally invasive endoscopic approaches, such as the Endoscopic Endonasal Approach (EEA) and the Endoscopic Transorbital Approach (ETA) have been introduced in orbital surgery. Research question The purpose of this study is to report the combined experience of the Neurosurgical and Ear-Nose-Throat (ENT) Units in the endoscopic approach of orbital pathologies. Material and methods We retrospectively retrieved data on patients treated at our Institution between 2016 and 2021 with endoscopic approach for orbital pathologies. The Clavien-Dindo classification and the Scar Cosmesis Assessment and Rating (SCAR) Scale have been used to assess complications and cosmetic outcomes. Results 39 patients met the inclusion criteria. EEA (15 patients) or ETA (20 patients) were chosen to approach the lesions. In three cases we used a combination of endoscopic and anterior orbitotomy and in one patient a combination of EEA + ETA. The type of procedure performed was orbital biopsy (9 cases), orbital decompression (6 cases), subtotal resection of the lesion (STR) (8 cases) and total resection of the lesion (GTR) (16 cases). The more frequent postoperative complications were diplopia (5.1%, with 1 case of permanent diplopia), trigeminal paraesthesia and dysesthesia (5.1%), palpebral edema (17.9%), periorbital ecchymosis (7.7%). Mean follow up time was 21 months (range 2-63 months). Discussion and conclusion Endoscopic approaches to orbital compartments provide minimally invasive access to every orbital compartment with low complications rate and good cosmetic outcome.
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Affiliation(s)
- Cesare Zoia
- Neurosurgery Unit, Moriggia Pelascini Hospital, Gravedona e Uniti, Italy
| | - Eugenia Maiorano
- Department of Surgical Science, University of Pavia, Pavia, Italy
- Department of Otorhinolaryngology, Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy
| | - Sara Borromeo
- Department of Otorhinolaryngology, Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy
| | - Giorgio Mantovani
- Neurosurgery Unit, Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - Giannantonio Spena
- Neurosurgery Unit, Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy
| | - Fabio Pagella
- Department of Surgical Science, University of Pavia, Pavia, Italy
- Department of Otorhinolaryngology, Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy
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Locatelli D, Veiceschi P, Arosio AD, Agosti E, Peris-Celda M, Castelnuovo P. 360 Degrees Endoscopic Access to and Through the Orbit. Adv Tech Stand Neurosurg 2024; 50:231-275. [PMID: 38592533 DOI: 10.1007/978-3-031-53578-9_8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Abstract
The treatment of pathologies located within and surrounding the orbit poses considerable surgical challenges, due to the intricate presence of critical neurovascular structures in such deep, confined spaces. Historically, transcranial and craniofacial approaches have been widely employed to deal with orbital pathologies. However, recent decades have witnessed the emergence of minimally invasive techniques aimed at reducing morbidity. Among these techniques are the endoscopic endonasal approach and the subsequently developed endoscopic transorbital approach (ETOA), encompassing both endonasal and transpalpebral approaches. These innovative methods not only facilitate the management of intraorbital lesions but also offer access to deep-seated lesions within the anterior, middle, and posterior cranial fossa via specific transorbital and endonasal corridors. Contemporary research indicates that ETOAs have demonstrated exceptional outcomes in terms of morbidity rates, cosmetic results, and complication rates. This study aims to provide a comprehensive description of endoscopic-assisted techniques that enable a 360° access to the orbit and its surrounding regions. The investigation will delve into indications, advantages, and limitations associated with different approaches, while also drawing comparisons between endoscopic approaches and traditional microsurgical transcranial approaches.
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Affiliation(s)
- Davide Locatelli
- Division of Neurosurgery, Department of Biotechnology and Life Sciences, "Ospedale di Circolo e Fondazione Macchi", University of Insubria, Varese, Italy
- Head and Neck and Forensic Dissection Research Center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
- Research Center for Pituitary Adenoma and Sellar Pathology, University of Insubria, Varese, Italy
| | - Pierlorenzo Veiceschi
- Division of Neurosurgery, Department of Biotechnology and Life Sciences, "Ospedale di Circolo e Fondazione Macchi", University of Insubria, Varese, Italy
| | - Alberto Daniele Arosio
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, "Ospedale di Circolo e Fondazione Macchi", University of Insubria, Varese, Italy
| | - Edoardo Agosti
- Division of Neurosurgery, Department of Biotechnology and Life Sciences, "Ospedale di Circolo e Fondazione Macchi", University of Insubria, Varese, Italy
- Unit of Neurosurgery, Spedali Civili Hospital, Brescia, Italy
| | - Maria Peris-Celda
- Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, MN, USA
- Department of Neurological Surgery, Mayo Clinic, Rochester, MN, USA
| | - Paolo Castelnuovo
- Head and Neck and Forensic Dissection Research Center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
- Research Center for Pituitary Adenoma and Sellar Pathology, University of Insubria, Varese, Italy
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, "Ospedale di Circolo e Fondazione Macchi", University of Insubria, Varese, Italy
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Das S, Vathulya M, Singh A, Chaturvedi J, Pasricha A, Singh T. Site-based customized surgical approaches for orbital lesion and their outcomes - A case series. Int J Surg Case Rep 2023; 110:108782. [PMID: 37678035 PMCID: PMC10510062 DOI: 10.1016/j.ijscr.2023.108782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 08/30/2023] [Accepted: 08/30/2023] [Indexed: 09/09/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE The orbit is a complex region of the body that is susceptible to several diseases. The term "anterior orbitotomy" describes access to the orbit through the conjunctiva or eyelid from the front. This includes transconjunctival, medial, inferior, and superior approaches. The superior and lateral regions of the posterior orbit can be adequately exposed using a frontotemporal orbitozygomatic approach. The main aim of orbital surgery is to preserve vision. We discuss numerous surgical procedures for ocular tumours in this case series, along with the results of those procedures. CASE PRESENTATION In this case series, various surgical procedures for ocular tumours are discussed, along with their results postoperatively. Meningioma, cavernous hemangioma, dermoid, and Erdheim Chester disease were among the diagnoses. The early surgical outcome parameters in this case series were increased ocular motility and decreased proptosis. CLINICAL DISCUSSION A medial orbitotomy was done as the lesion was in the medial orbit in our first case. In the second, third, and fourth cases, lateral orbitotomies were done because the lesion was in the lateral orbit. The frontotemporal orbitozygomatic approach was used in the fifth and sixth cases with the lesion reaching the orbital apex. Patients with symptoms should consider surgical excision, which involves completely removing the tumour while maintaining the functionality of the muscles and optic nerve. Having a good surgical view and exposure is essential to understand the anatomical relationships in a small area. CONCLUSION The surgical strategy should be used in a manner that maintains visual acuity, limits injury to nearby objects, lowers postoperative morbidity, and is cosmetically acceptable.
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Affiliation(s)
- Sucharita Das
- Department of Ophthalmology, All India Institute of Medical Sciences Rishikesh, Uttarakhand 249203, India
| | - Madhubari Vathulya
- Department of Burns and Plastic Surgery, All India Institute of Medical Sciences Rishikesh, Uttarakhand 249203, India.
| | - Anupam Singh
- Department of Ophthalmology, All India Institute of Medical Sciences Rishikesh, Uttarakhand 249203, India
| | - Jitendra Chaturvedi
- Department of Neurosurgery, All India Institute of Medical Sciences Rishikesh, Uttarakhand 249203, India
| | - Arush Pasricha
- Department of Burns and Plastic Surgery, All India Institute of Medical Sciences Rishikesh, Uttarakhand 249203, India
| | - Taruna Singh
- Department of Burns and Plastic Surgery, All India Institute of Medical Sciences Rishikesh, Uttarakhand 249203, India
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Mattogno PP, Zoli M, D’Alessandris QG, Bongetta D, Caccavella VM, Rigante M, Della Pepa GM, Mazzatenta D, Lauretti L, Olivi A, Spena G, Zoia C. Ultra-Early Treatment of Neurosurgical Emergencies with Endoscopic Endonasal Approach: Experience from Three Italian Referral Centers. J Clin Med 2023; 12:5471. [PMID: 37685541 PMCID: PMC10487769 DOI: 10.3390/jcm12175471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 08/21/2023] [Accepted: 08/22/2023] [Indexed: 09/10/2023] Open
Abstract
PURPOSE the aim of this multicenter study is to preliminarily assess the role of the Endoscopic Endonasal Approach (EEA) in ultra-early (i.e., within 12 h) management of selected neurosurgical emergencies in terms of clinical and radiological outcomes. METHODS 26 patients affected by sellar/parasellar pathologies with rapid progression of symptoms were managed with EEA within 12 h from diagnosis in three Italian tertiary referral Centers from January 2016 to December 2019. Both clinical and radiological data have been collected preoperatively as well as post-operatively in order to perform retrospective analysis. RESULTS The average time from admission to the operating room was 5.5 h (±2.3). The extent of resection was gross-total in 20 (76.9%), subtotal in 6 (23.1%) patients. One patient experienced re-bleeding after a subtotal removal of a hemorrhagic lesion. Patients with a longer time from admission (>4 h) to the operatory room (OR) experienced stable impairment of the visual acuity (p = 0.033) and visual field (p = 0.029) in the post-operative setting. CONCLUSIONS The Endoscopic Endonasal Approach represents a safe, effective technique that can be efficiently used with good results in the management of selected neurosurgical emergencies in centers with adequate experience.
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Affiliation(s)
- Pier Paolo Mattogno
- Department of Neurosurgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00100 Rome, Italy
| | - Matteo Zoli
- Programma Neurochirurgia Ipofisi-Pituitary Unit, IRCCS Institute of Neurological Sciences of Bologna, 40121 Bologna, Italy
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, 40121 Bologna, Italy
| | | | - Daniele Bongetta
- Department of Neurosurgery, ASST Fatebenefratelli Sacco, 20100 Milan, Italy
| | - Valerio Maria Caccavella
- Department of Neurosurgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00100 Rome, Italy
| | - Mario Rigante
- Department of Otolaryngology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00100 Rome, Italy
| | - Giuseppe Maria Della Pepa
- Department of Neurosurgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00100 Rome, Italy
| | - Diego Mazzatenta
- Programma Neurochirurgia Ipofisi-Pituitary Unit, IRCCS Institute of Neurological Sciences of Bologna, 40121 Bologna, Italy
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, 40121 Bologna, Italy
| | - Liverana Lauretti
- Department of Neurosurgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00100 Rome, Italy
| | - Alessandro Olivi
- Department of Neurosurgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00100 Rome, Italy
| | - Giannantonio Spena
- Neurosurgery, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Cesare Zoia
- Neurosurgery, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
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Uchimura M, Hayashi K, Sakamoto T, Nagai H. A case of intraorbital malignant lymphoma biopsied using an endoscopic transnasal approach. Surg Neurol Int 2023; 14:259. [PMID: 37560596 PMCID: PMC10408611 DOI: 10.25259/sni_404_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 07/10/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND While most orbital tumors are primary, some are secondary, including extension or invasion from adjacent sites. The diagnosis varies widely, and the treatment strategy depends on the pathological diagnosis. Transcranial and transorbital surgical approaches are typically used. Recently, a transnasal endoscopic approach has emerged as a viable option. We report a case of an intraorbital tumor treated with endoscopic transnasal biopsy and compare the results with those of other surgical approaches. CASE DESCRIPTION A 74-year-old woman visited a nearby hospital due to a right eye protrusion and decreased visual acuity. An intraorbital tumor was detected and the patient was referred to our hospital. Head computed tomography revealed a mass along the posterior wall of the right orbital apex. Contrast-enhanced magnetic resonance imaging showed a 37-mm lesion with a uniform contrast effect and no intracranial extension. Intraorbital lymphoma was considered a differential diagnosis, and a biopsy was performed using an endoscopic transnasal approach. The pathological diagnosis was B-cell lymphoma, and chemotherapy was administered. CONCLUSION The endoscopic transnasal approach for intraorbital tumors is less invasive, highly cosmetic, and useful, especially for medial and inferior orbital lesions.
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Affiliation(s)
- Masahiro Uchimura
- Department of Neurosurgery, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
| | - Kentaro Hayashi
- Advanced Stroke Center, Shimane University Hospital, Izumo, Shimane, Japan
| | - Tatsunori Sakamoto
- Department of Otorhinolaryngology-Head and Neck Surgery, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
| | - Hidemasa Nagai
- Department of Neurosurgery, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
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7
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Chiou CA, Vickery TW, Reshef ER, Bleier BS, Freitag SK. Endonasal Endoscopic Approach to Orbital Tumors. Int Ophthalmol Clin 2023; 63:249-262. [PMID: 37439622 DOI: 10.1097/iio.0000000000000461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/14/2023]
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8
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Cheok SK, Zada G. Commentary: Intraoperative Ultrasonography in Endoscopic Approaches for Orbital Lesions: A Single-Center Case Series. Oper Neurosurg (Hagerstown) 2023; 24:e137-e138. [PMID: 36637326 DOI: 10.1227/ons.0000000000000529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 09/20/2022] [Indexed: 01/14/2023] Open
Affiliation(s)
- Stephanie Kim Cheok
- Department of Neurological Surgery, Keck School of Medicine at University of Southern California, Los Angeles, California, USA
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9
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Zoli M, Sollini G, Martinoni M, Rustici A, Guaraldi F, Asioli S, Fabbri VP, Cirillo L, Pasquini E, Mazzatenta D. Intraoperative Ultrasonography in Endoscopic Approaches for Orbital Lesions: A Single-Center Case Series. Oper Neurosurg (Hagerstown) 2023; 24:23-32. [PMID: 36519876 DOI: 10.1227/ons.0000000000000437] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 07/29/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Recently, endoscopic approaches for orbital lesions have been proposed. Their results seem promising; however, orbital surgery remains challenging with possible significant morbidity, mostly because of orbital structures manipulation. Ultrasonography is an innovative intraoperative imaging technique that can assist the surgeon in these approaches. OBJECTIVE To assess the role of intraoperative ultrasound (IOUS) in endoscopic orbital surgery. METHODS All consecutive patients with orbital tumors operated in our institution through an endoscopic approach with IOUS have been prospectively collected from 2019 to May 2021. RESULTS Fifteen patients were included. Based on tumor location, evaluated on preoperative MRI, the endoscopic endonasal approach was preferred in 7 tumors in medial quadrants while the endoscopic transpalpebral in 8 lateral ones. During surgery, IOUS allowed us to identify the tumors and the most relevant anatomic structures in all cases. Time spent for IOUS preparation before the first scan was 8 ± 6 minutes on average, and each intraoperative scan took approximately 30 to 120 seconds. Gross tumor removal was achieved in 8 patients, subtotal in 3, while in 4 patients, surgery was limited to a biopsy. No surgical complications were observed. CONCLUSION IOUS has allowed us to localize the lesion and to identify the straighter surgical corridor and assess the tumor resection, effectively helping the surgeon and potentially reducing operative complications. This tool provides a real-time image, not affected by the orbital structures shift, which can be dynamically assessed multiple times during surgery. However, it is hampered by the need of specific training and possible artifacts.
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Affiliation(s)
- Matteo Zoli
- Programma Neurochirurgia Ipofisi-Pituitary Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.,Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Giacomo Sollini
- ENT Unit, Bellaria Hospital, Azienda Unità Sanitaria Locale, Bologna, Italy
| | - Matteo Martinoni
- Programma Neurochirurgia Ipofisi-Pituitary Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Arianna Rustici
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Federica Guaraldi
- Programma Neurochirurgia Ipofisi-Pituitary Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Sofia Asioli
- Programma Neurochirurgia Ipofisi-Pituitary Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.,Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Viscardo Paolo Fabbri
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Luigi Cirillo
- Programma Neurochirurgia Ipofisi-Pituitary Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.,Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Ernesto Pasquini
- ENT Unit, Bellaria Hospital, Azienda Unità Sanitaria Locale, Bologna, Italy
| | - Diego Mazzatenta
- Programma Neurochirurgia Ipofisi-Pituitary Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.,Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
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10
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Combined Endonasal and Orbital Approach for Resection of Orbital Apical Tumors. Ophthalmic Plast Reconstr Surg 2022; 38:393-400. [PMID: 35170569 DOI: 10.1097/iop.0000000000002139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE Tumors of the medial orbital apex can be challenging to resect. Primary endonasal resection can be limited by requirements for fat retraction and poor angulation for lateral orbital dissection. Orbital resection alone can have space limitations and a limited view for dissection of the posterior aspect of the tumor. The combined transorbital transnasal approach integrates the retraction and instrumentation advantages of the transorbital approach with the optical and space advantages of the transnasal approach. METHODS In this cross-sectional cohort study, patients who underwent surgical resection of an apical orbital tumor via a combined endoscopic and orbital approach from 2014 to 2019 were identified. Clinical history, examination findings, imaging, surgical technique, histopathology, and complications were reviewed. RESULTS Six patients were included. Patients presented with proptosis (5), optic neuropathy (3), and motility restriction (2). Surgery involved a medial orbitotomy and endoscopic ethmoidectomy ± sphenoidotomy, medial wall removal, and periosteum opening. The lesion was prolapsed into the sinus, dissected at the apex via the orbital approach, and removed through the nasal cavity. Pathologic diagnoses were cavernous venous malformation (4), venolymphatic malformation (1), and metastatic carcinoid (1). Improvement in pain (2/2), optic neuropathy (2/3), and proptosis (5/5) were noted. Complications included ethmoid mucocele and nasal polyps. CONCLUSIONS The combined endonasal and orbital approach involves prolapsing the lesion into the nasal cavity to aid in dissection on the lateral and posterior aspects, maximizing visibility of the tight intraconal space. This technique can be performed by a team of orbital surgeons experienced in both orbital and endonasal surgery.
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11
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Djuric ML, Krstic VP, Lazic TM, Grozdanic SD. Endoscopic diagnostic and surgical orbital approach in canines. Acta Vet Hung 2022. [PMID: 35895555 DOI: 10.1556/004.2022.00017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 05/31/2022] [Indexed: 02/18/2024]
Abstract
The aim of this study is to describe new diagnostic and surgical orbital approaches using video endoscopy in canines. Four different endoscopic approaches were investigated in this study of video endoscopy in cadavers: dorsal transorbital ligament approach via incision of the orbital ligament (DTOLA), dorsal subpalpebral transconjunctival approach (DSTA), ventral subpalpebral transconjunctival approach (VSTA), and transoral orbital approach (TOA). Two additional approaches, the ventral transpalpebral approach (VTA) and dorsal caudal transmuscular approach (DCTA) along with the DTOLA and DSTA were used in clinical patients. The most technically demanding approach was DTOLA; however, it provided the best visualisation of different anterior and posterior orbital structures. Visualisation of primarily the dorsal orbital wall, dorsal portion of the eye globe, and dorsal extraconal space also was achieved by DSTA. The VSTA enabled good visualisation of the ventral orbital floor and the ventral extraconal and intraconal space. In contrast, the TOA provided relatively poor visualisation of orbital structures, limited to the ventral orbital quadrant. Meanwhile, the VTA provided visualisation similar to the VSTA, while DCTA visualisation was limited to the dorsal and caudal orbital space. Orbital endoscopy is an effective and minimally invasive procedure that can be used for diagnostic and surgical orbital procedures.
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Affiliation(s)
- Milos Lj Djuric
- 1 Department of Equine, Small Animal, Poultry and Wild Animal Diseases, Faculty of Veterinary Medicine, University of Belgrade, Belgrade, Serbia
| | - Vanja P Krstic
- 1 Department of Equine, Small Animal, Poultry and Wild Animal Diseases, Faculty of Veterinary Medicine, University of Belgrade, Belgrade, Serbia
| | - Tatjana M Lazic
- 2 Animal Eye Consultants of Iowa, Hiawatha, IA, USA
- 3 Oculus Specialty Veterinary Clinic, Belgrade, Serbia
| | - Sinisa D Grozdanic
- 2 Animal Eye Consultants of Iowa, Hiawatha, IA, USA
- 3 Oculus Specialty Veterinary Clinic, Belgrade, Serbia
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12
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Wu CH, Ho YY, Liu TL, Wu TY, Cheng HC, Tsai CC. Navigational Transmaxillary Endoscopic Approach for Inferomedial Tumors. Front Oncol 2022; 12:804070. [PMID: 35574337 PMCID: PMC9092654 DOI: 10.3389/fonc.2022.804070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 03/22/2022] [Indexed: 11/13/2022] Open
Abstract
Orbital tumors encompass a heterogeneous range of histopathology and usually variable in location. Traditionally, transconjunctival medial orbitotomy is used to access the medial orbital wall. However, it creates potential risk of soft tissue sequelae such as scarring, lid contracture, or entropion/ectropion. For the lesions close to the orbital apex, increased risk of optical nerve injury should be cautious during orbitotomy procedure. Transnasal endoscopic approach to the orbital walls has been applied since 1999. Although it provides good surgical visualization and prevents the soft tissue and neural complications, the narrow nasal corridor increases the surgical complexity. Extensive sphenoethmoidectomy is usually required to gaining access. Furthermore, the resultant medical orbital defect is difficult to repair. The maxillary sinus is the largest paranasal sinuses which is located beneath the orbital floor. It provides an ample working space for instrumentation. Meanwhile, repair of the orbital floor defect is feasible and with high degree of accuracy under navigation control. In this report, we propose a novel computer-assisted endoscopic protocol to excise the medial orbital tumors with immediate repair of the wall defect.
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Affiliation(s)
- Cheng-Hsien Wu
- Oral and Maxillofacial Surgery, Department of Stomatology, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Dentistry, School of Dentistry, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yi-Yun Ho
- Oral and Maxillofacial Surgery, Department of Stomatology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Tzu-Lun Liu
- Oral and Maxillofacial Surgery, Department of Stomatology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Tzu-Ying Wu
- Department of Dentistry, School of Dentistry, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Orthodontic and Pediatric Dentistry, Department of Dentistry, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Han-Chieh Cheng
- Oral and Maxillofacial Surgery, Department of Stomatology, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Dentistry, School of Dentistry, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chieh-Chih Tsai
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Ophthalmology, School of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan
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13
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Jungbauer F, Gvaramia D, Huber L, Kramer B, Ponto KA, Popovic Z, Riffel P, Rotter N, Scherl C, Zaubitzer L, Lammert A. [Differential diagnosis of intraorbital masses - a narrative review]. Laryngorhinootologie 2021; 101:390-398. [PMID: 34902864 DOI: 10.1055/a-1580-7371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Intraorbital masses represent a condition that is frequently threatening for the visual system. A rigorous differential diagnosis is essential to promptly initiate appropriate therapy and optimize prognosis. MATERIALS/METHODS Narrative review of current literature and expert recommendations. For further illustration we describe the case of a 71-year-old male admitted to our department three months after sinus surgery. Postoperative intraorbital hematoma of the right orbit had been treated conservatively with antibiotics/corticosteroids, leading to a near-complete unilateral visual loss. The immediate surgical intervention aimed at decompression of the orbit and the optical nerve. Due to the delay, the intervention could not prevent formation of a lipogranuloma. Inflammatory phases associated with the lipogranuloma are successfully managed by conservative treatment based on multidisciplinary recommendations. RESULTS In the case reported, delay of surgical therapy acted as a cause of intraorbital lipogranuloma formation. Literature supports our recommendation of immediate surgical intervention in case of acute retrobulbar hematoma. Besides acute conditions, intraorbital masses can be a sign of systemic disease. In every case, a multidisciplinary therapeutic approach is required for adequate management. CONCLUSIONS Intraorbital masses can occur as a complication of trauma or e.g. sinus surgery. On the other hand they can be a sign of systemic disease. Timely diagnosis and treatment prevents from visual loss. That is why rigorous differential diagnosis is essential for every discipline managing intraorbital lesions.
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Affiliation(s)
| | | | - Lena Huber
- HNO, Universitatsklinikum Mannheim, Mannheim, Germany
| | | | - Katharina A Ponto
- Universitäts-Augenklinik, Universitätsklinikum Mainz, Mainz, Germany
| | - Zoran Popovic
- Pathologisches Institut Mannheim, Universitätsklinikum Mannheim, Mannheim, Germany
| | - Philipp Riffel
- Klinik für Radiologie und Nuklearmedizin, Universitätsklinikum Mannheim, Mannheim, Germany
| | - Nicole Rotter
- HNO, Universitatsklinikum Mannheim, Mannheim, Germany
| | | | | | - Anne Lammert
- Fakultät Mannheim, ENT, Heidelberg University, Heidelberg, Germany
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Peron S, Paulli S, Stefini R. Case Report: High-Definition 4K-3D Exoscope for Removal of an Orbital Cavernous Hemangioma Using a Transpalpebral Approach. Front Surg 2021; 8:671423. [PMID: 34422890 PMCID: PMC8377276 DOI: 10.3389/fsurg.2021.671423] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 07/07/2021] [Indexed: 12/28/2022] Open
Abstract
Background: Cavernous hemangioma, also known as cavernous vascular malformation (CVM), is the most common primary lesion of the orbit in adults. The management of these lesions is challenging and is strongly dependent on their location, as well as the patient's symptoms and expectations. The trans-palpebral approach is currently used in surgery for orbital tumors, anterior skull base tumors, and even more, orbital reconstruction, because of its well-demonstrated esthetic advantages. Similarly, the use of magnification can be provided by surgical loupes, microscope, or more recently, endoscope, which is well-documented for its advantages in terms of minimal invasiveness and safety. In the last years, the use of exoscopes in microsurgery has been proposed due to their greater and sharper intraoperative magnification, but never for the removal of orbital tumors. Clinical Presentation: We describe a case of a 38-year-old woman with a right orbital intraconic CVM removed using an inferior transpalpebral approach performed under 4K-3-dimensional (4K-3D) exoscopic vision. Navigation and ultrasound were also used, with the former allowing better identification of the lesion within the orbit and the second overcoming the limitations of navigation, in terms of the retraction on the ocular globe before or just after periorbital incision. Conclusion: The use of a 4K-3D exoscope allowed us to perform the surgery safely, thanks to the high magnification and definition of anatomical details, with the surgeon operating in an upright, comfortable position. The CVM was completely removed with excellent results from both functional and esthetic points of view.
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Affiliation(s)
- Stefano Peron
- Department of Neurosurgery, Azienda Socio Sanitaria Territoriale (ASST) Ovest Milanese - Legnano Hospital, Milan, Italy
| | - Stefano Paulli
- Department of Maxillofacial Surgery, Azienda Socio Sanitaria Territoriale (ASST) Ovest Milanese - Legnano Hospital, Milan, Italy
| | - Roberto Stefini
- Department of Neurosurgery, Azienda Socio Sanitaria Territoriale (ASST) Ovest Milanese - Legnano Hospital, Milan, Italy
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