Herman P, Lot G, Silhouette B, Marianowski R, Portier F, Wassef M, Huy P T
Department of Otolaryngology, Hôpital Lariboisière, Paris, France.
Ann Otol Rhinol Laryngol. 1999 Feb;108(2):147-50. doi: 10.1177/000348949910800208.
The approach to posterior and medial orbital tumors is still a challenge, since poor functional results are frequent. We report a case of cavernoma successfully removed by a modified transnasal endoscopic procedure. The patient, a 56-year-old woman, complained of a decrease in vision of the left eye. Magnetic resonance imaging evidenced a lesion in the posterior part of the orbital cavity, inferior to the optic nerve, extending to the sphenoidal cleft. The lesion was isodense on T1-weighted images and showed contrast enhancement. Because of the medial location of the tumor, the patient was referred to the otolaryngology department by the neurosurgeons, and a transnasal endoscopic approach was chosen. A large exposure of the operative field was obtained, and a cavernoma was removed. Rapid relief of the symptoms was obtained. In view of this good result, we advocate the transnasal endoscopic approach in cases of inferomedial and posterior intraconal lesions as an alternative and addition to the standard techniques of orbital surgery.
由于术后功能恢复不佳的情况较为常见，处理眼眶后部及内侧肿瘤仍是一项挑战。我们报告一例经改良鼻内镜手术成功切除海绵状血管瘤的病例。患者为一名56岁女性，主诉左眼视力下降。磁共振成像显示眼眶腔后部、视神经下方有一病变，延伸至蝶骨裂。该病变在T1加权图像上呈等密度，并有强化表现。由于肿瘤位于内侧，神经外科医生将患者转诊至耳鼻喉科，遂选择鼻内镜入路。术中获得了较大的术野暴露，并切除了海绵状血管瘤。患者症状迅速缓解。鉴于这一良好结果，我们主张对于眶内下及后部病变，鼻内镜入路可作为眼眶手术标准技术的一种替代和补充方法。
