Batra Pete S, Lanza Donald C
Section of Nasal and Sinus Disorders, Head and Neck Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, A71, Cleveland, OH 44195, USA.
Am J Rhinol. 2005 May-Jun;19(3):297-301.
Orbital exenteration can be accomplished by either an external eyelid-sparing or eyelid-sacrificing approach. The purpose of this study was to describe an alternative technique for orbital exenteration and its specific advantages over traditional methods.
A retrospective analysis at a tertiary care referral center was performed. Three patients with sinonasal malignancy (two cases) and fulminant invasive fungal sinusitis (one case) are reported. Intraconal involvement was evident in all patients by imaging and surgical pathology. Advanced endoscopic techniques in conjunction with image guidance and soft-tissue shaver technology were used for resection in all cases.
The orbit was successfully exenterated via an eyelid-sparing endoscopic approach with minimal blood loss in all three patients. Exenteration was completed within 30-45 minutes. Uninvolved superior and lateral orbital periosteum was preserved in all patients, which permitted cavity "mucosalization" within 8 weeks. Two patients are alive without disease at 15-month follow-up. One patient with persistent cavernous sinus malignant peripheral nerve sheath tumor died 4 months after resection despite proton beam therapy.
This preliminary experience showed endoscopic power-assisted orbital exenteration to be an effective technique for exenteration of the orbit. Endoscopic power-assisted orbital exenteration offers two critical advantages: (1) direct transnasal control of the ophthalmic artery as it emerges from the optic foramen and (2) the ability to preserve the uninvolved superior and lateral periorbita. This can facilitate mucosal coverage of the exenterated space and obviate the need for tissue grafts and/or packing. Additionally, intraorbital pathology can be better visualized and blood loss and operative time are minimized. This technique may serve as an important adjunct for management of the orbit in patients with sinonasal malignancy or invasive fungal rhinosinusitis.
眼眶内容剜除术可通过保留眼睑的外部入路或牺牲眼睑的入路来完成。本研究的目的是描述一种眼眶内容剜除术的替代技术及其相对于传统方法的特定优势。
在一家三级医疗转诊中心进行了回顾性分析。报告了3例鼻窦恶性肿瘤患者（2例）和暴发性侵袭性真菌性鼻窦炎患者（1例）。通过影像学和手术病理检查，所有患者均可见眶内受累。所有病例均采用先进的内镜技术结合图像引导和软组织刨削技术进行切除。
所有3例患者均通过保留眼睑的内镜入路成功完成眼眶内容剜除术，术中出血极少。剜除术在30 - 45分钟内完成。所有患者均保留了未受累的眶上和眶外侧骨膜，这使得腔隙在8周内实现了“黏膜化”。2例患者在15个月的随访中无疾病存活。1例持续性海绵窦恶性外周神经鞘瘤患者尽管接受了质子束治疗，但在切除后4个月死亡。
这一初步经验表明，内镜动力辅助眼眶内容剜除术是一种有效的眼眶内容剜除技术。内镜动力辅助眼眶内容剜除术具有两个关键优势：（1）在眼动脉从视神经管穿出时可经鼻直接控制；（2）能够保留未受累的眶上和眶外侧眶周组织。这有助于对剜除空间进行黏膜覆盖，避免了组织移植和/或填塞的需要。此外，眶内病变可以更好地可视化，同时减少了出血和手术时间。该技术可能是鼻窦恶性肿瘤或侵袭性真菌性鼻窦炎患者眼眶管理的重要辅助手段。
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