Endoscopic endonasal surgical resection of tumors of the medial orbital apex and wall

摘要

Tumors of the orbital apex can present in a variety of ways based on the complexity of the neurovascular anatomy in this region. The differential diagnosis of lesions in this region range from benign, slow-growing lesions such as cavernous hemangioma, schwan-noma, pseudotumor, and fibrous dysplasia to more aggressive, and fast-growing lesions such as lymphoma, sarcoma, and metastasis. Symptoms from optic nerve compression and a lack of clinical diagnosis prompt surgical management.The surgical approach to lesions in the orbital apex includes orbital approaches and intracranial approaches [9,11]. These approaches, however, involve traversing normal ocular tissue or normal brain tissue to reach the orbital apex. In 1990 David Kennedy first described an endoscopic approach to decompression of the orbit for dysthyroid opthalmopathy [8], and this was expanded upon by Sethi and Lau in 1997 who described the natural benefits of endoscopic approaches to biopsying and decompressing tumors of the orbital apex [21 ]. Since that time there has been increasing interest in the use of the endoscope to target tumors located in orbital apex [1,5,7,17,18,22,23].