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Endoscopic surgery for intraconal orbital tumors

Endoskopische Chirurgie bei intrakonalen Orbitatumoren

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Abstract

Traditionally, external craniofacial approaches have been used for orbital tumor resection. Over the last 30 years, endoscopic sinonasal and skull base techniques have become widely used throughout the world. These experiences paved the way for the extension of transnasal endoscopic techniques to the intraconal orbit. Transnasal endoscopic intraconal surgery has several advantages regarding morbidity and outcome as compared with purely external approaches. However, the anatomical knowledge and experience of the surgeon is crucial for the success of the surgery. Endoscopic approaches for intraconal tumor removal are feasible for medial and inferior lesions as well as for lesions lateral to the optic nerve provided they remain inferior to the “plane of resectability” and no optic nerve retraction is required. As intraorbital tumors are rare, new international staging systems including CHEER (Cavernous Hemangioma Exclusively Endonasal Resection) and ORBIT (Orbital Resection by Intranasal Technique) help to standardize safety, efficacy, and outcome.

Zusammenfassung

Orbitale Tumoren sind traditionell durch externe kraniofaziale Zugangswege operiert worden. Seit nunmehr 30 Jahren sind endoskopische Techniken für Operationen der Nasennebenhöhlen und der Schädelbasis weltweit etabliert. Diese Erfahrungen haben die Tür für transnasale endoskopische Zugangswege zu intrakonalen Tumoren der Orbita geöffnet. Die endoskopischen Techniken zeigen hierbei mehrere Vorteile im Vergleich zu rein externen Zugangswegen, v. a. in Bezug auf die Patientenmorbidität und das Operationsergebnis. Allerdings sind für den Operationserfolg die Kenntnis der komplexen Anatomie und die Erfahrung des Operierenden entscheidend. Intrakonale Tumoren, die durch endoskopische Techniken entfernt werden können, liegen medial und inferior des N. opticus. Lateral gelegene Tumoren können ebenfalls entfernt werden, wenn diese inferior der „Resektabilitätsebene“ liegen und keine Verlagerung des N. opticus notwendig ist. Da intraorbitale Tumoren eine seltene Entität darstellen, sind die neuen, internationalen Klassifikationssysteme wie CHEER (Cavernous Hemangioma Exclusively Endonasal Resection) oder ORBIT (Orbital Resection by Intranasal Technique) wichtig, um Sicherheit, Effektivität und Erfolg der Operation standardisiert zu erfassen.

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Funding

This study did not receive any funding.

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Authors and Affiliations

  1. Department of Otolaryngology, Head and Neck Surgery, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Waldstr. 1, 91054, Erlangen, Germany

    Sarina K. Mueller MD

  2. Department of Otolaryngology, Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Charles Street 243, 02114, Boston, MA, USA

    Benjamin S. Bleier MD, FACS, FARS

Authors
  1. Sarina K. Mueller MD
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  2. Benjamin S. Bleier MD, FACS, FARS
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Corresponding authors

Correspondence to Sarina K. Mueller MD or Benjamin S. Bleier MD, FACS, FARS.

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Conflict of interest

B.S. Bleier has received grants from MEEI Curing Kids Fund, Cook Medical, Medtronics, and the NIH/NINDS (1R01NS108968-01); Dr. Bleier has consultant arrangements with Olympus, Medtronics, 3D Matrix, Third Wave Therapeutics, Bear-ENT, and Karl Storz; he has provided expert testimony on ENT-related cases; he has a patent for P‑gp and Cystatin inhibition for chronic rhinosinusitis and receives royalties from this patent. S.K. Mueller declares that she has no competing interests.

For this article no studies with human participants or animals were performed by any of the authors. All studies performed were in accordance with the ethical standards indicated in each case.

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Mueller, S.K., Bleier, B.S. Endoscopic surgery for intraconal orbital tumors. HNO 70, 345–351 (2022). https://doi.org/10.1007/s00106-022-01156-y

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