Department of General Otorhinolaryngology-Head and Neck Surgery, Medical University Graz, Austria.
Am J Rhinol Allergy. 2011 Sep-Oct;25(5):363-7. doi: 10.2500/ajra.2011.25.3663.
Intraconal tumors of the orbit are rare entities and surgical treatment is challenging. Endoscopic transnasal approaches to the orbit offer a new perspective for surgery, although only few reports exist in literature. This study displays the Graz experience with endoscopic approaches to intraorbital tumors between 2006 and 2010 introducing a novel endoscopic technique for temporary medialization of the medial rectus muscle facilitating access to the orbital cone.
A retrospective analysis of patients' charts was performed.
For approaches to intraconal lesions a special endoscopic temporary medialization technique of the medial rectus muscle through applying transseptal sutures was developed. Six patients (four male and two female patients) have been included in this study presenting with intraconal/intraorbital tumors. Three patients underwent endoscopic surgery for two hemangiomas and one Schwannoma, respectively, and three patients were successfully biopsied endoscopically revealing one malignant melanoma, one malignant lymphoma, and one optic glioma each. Both hemangiomas were completely resected without any deterioration of vision. The Schwannoma was partially resected with postoperative imaging showing no tumor progression within 3 months. No intraoperative complications occurred. Five cases were performed with computer assisted surgery using CT/MR fusion navigation.
Although technically challenging, the endoscopic approach to the orbit, even for intraconal lesions with medialization of the medial rectus muscle, can be safe and promising for well-selected cases. Good postoperative results and sufficient material acquisition for proper histological examination can be obtained. Advantages are good visualization of the surgical field and avoidance of external scars. Limitations to endoscopic techniques are tumors in the lateral superior and lateral inferior quadrant of the orbit.
眼眶内肿瘤是一种罕见的实体瘤，手术治疗具有挑战性。尽管文献中仅有少数报道，但经鼻内镜入路为手术提供了一个新的视角。本研究展示了格拉茨在 2006 年至 2010 年间经鼻内镜治疗眼眶内肿瘤的经验，介绍了一种新的内镜技术，可暂时将内直肌内侧化，便于进入眶锥。
对患者病历进行回顾性分析。
对于眶内病变的入路，我们开发了一种特殊的内镜下暂时性内直肌内侧化技术，通过应用鼻中隔缝线。本研究纳入了 6 名（4 名男性和 2 名女性）患者，他们患有眶内/眶内肿瘤。3 名患者接受了内镜手术，分别为 2 例海绵状血管瘤和 1 例神经鞘瘤，3 名患者经内镜成功活检，分别为 1 例恶性黑色素瘤、1 例恶性淋巴瘤和 1 例视神经胶质瘤。2 例海绵状血管瘤完全切除，视力无恶化。神经鞘瘤部分切除，术后影像学检查显示 3 个月内无肿瘤进展。无术中并发症发生。5 例病例采用 CT/MR 融合导航辅助手术。
尽管技术上具有挑战性，但即使是对于内直肌内侧化的眶内病变，经鼻内镜入路也可以安全地应用于选择合适的病例，并获得良好的术后效果和足够的组织学检查材料。优点是手术视野可视化良好，避免了外部疤痕。内镜技术的局限性在于眼眶外侧上象限和外侧下象限的肿瘤。
