Awadhesh Kumar Jaiswal

Professor, Department of Neurosurgery,

Sanjay Gandhi Postgraduate Institute of Medical Sciences,

Lucknow, INDIA-226014

Endonasal endoscopic approach

for orbital lesions

• Orbital tumors: not very common

• Treatment: Surgical excision

• Approaches:

Endonasal endoscopic

Lateral

orbitotomy

Trans-cranial

Trans-

conjunctival

Introduction

ORBIT ORBIT

NASAL CAVITY

ETHMOID

ETHMOID

Endonasal endoscopic approach

• Minimally invasive

• Direct access

NASAL CAVITY

ORBIT

Endonasal endoscopic approach4 gates

• Uncinate process

• Bulla ethmoidale

• Ground lamella

• Ant. Sphenoid wall

Nasal cavity

Lesions located in

• Medial part of orbit

• Orbital apex

Indications

Endonasal endoscopic approach

• 35/M

• Rt. proptosis

• Diplopia

O/E:

• Rt axial proptosis

• Vn – R 6/9, L 6/6

• EOM– Rt restricted

• No other deficit

4 mon.

Pre-op. imaging

Operative video

Specimen

Post-op. imaging

Pre-op

Post-op

• 74/F

• Lt. proptosis - 9 mon.

O/E:

• Lt axial proptosis

• Lt APD

• EOM– Lt restricted

• No other deficit

Pre op. imaging

Operative video

Post op Imaging

Cavernoma

Pre-op

Post-op

•23/M•Rt propotosis•Rt Vn-HM close to face

Operative video

Post op imaging

• 39/F

• Rt. proptosis - 6 months

O/E:

• Rt axial proptosis

• Vn – B/L 6/6

• EOM– Rt restricted

• No other deficit

Pre-op. imaging

Post-op. imaging

Pre-op.

FU-12 months

Post-op.

• 61/M

• Trauma Lt eye-3 yr

• Lt. proptosis-10 mon.

O/E:

• Lt proptosis

• Vn – Lt PL -ve

• EOM– Lt ophthalmoplegia

• No other deficit

Pre-op. imaging

Post op imaging

Pre-op

Post-op

• 23/M

• Lt visual

deterioration

• Lt ophthalmoparesis

Operative video

• 36/M

• Rt Proptosis

Operative video

Specimen

Schwannoma

Post op imaging

Pre-op

Post-op

• 56/M

• Rt propotosis

• Rt adduction weak

Post op imaging

• 55/F• Rt propotosis• Rt Vn PL -ve

Operative video

Pre op

Post op

Follow up

• 48/M• Lt Proptosis• Lt Vision reduced

Post op image

• 58/M

• Rt propotosis

• Rt Vn 6/6

Operative video

Pre op

Post op

Pre op

Post op

• 5/F

• Lt propotosis

• Lt Vn PL-ve

Post op imaging

• 15/F

• Rt propotosis

• Optd. elsewhere

• Rt Vn PL-ve

• Rt Ophthalmoplegia

Pre op Post op

• 7/M

• Lt propotosis

• Lt Vn PL-ve

• 29/F• Transient visual blurring• Minimal proptosis (R)

• 56/F• (L) Proptosis• (L) low Vn

• (L) Mild proptosis• (L) PL -ve

• (L) proptosis• (L) PL -ve

• 19/F• Proptosis (L)• Impaired EOM

N= 20

Extent of excision

• Total -19; Subtotal-1

Complications-

• Mild lid edema-6

• Transient ophthalmoparesis-7

• Visual deterioration-3

• Anophthalmos - 1

Our experience

• Cavernous angioma - 5

• Schwannoma - 5

• Pilocytic astrocytoma – 3

• Epidermoid - 1

• Solitary fibrous tumor – 1

• Poorly diff. metastatic CA - 1

• Lymphoid hyperplasia- 1

• Meningioma - 1

• Mesenchymal tumor- 1

• Neurocysticercosis- 1

Histopathology (n=20)

• 2 Dimensional image

• Steep learning curve

• Limited working space

• Not all tumors can be dealt with

Limitations:

Endonasal endoscopic approach for orbit

• Direct access and minimally invasive

• Well suited for lesions located in the

medial part of orbit and orbital apex.

• Scarless

• Less tissue trauma

• Less operative time

• Excellent result with minimal complications

Conclusions

THANK YOU