Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA.
Department of Biotechnology and Life Sciences, Division of Otorhinolaryngology, University of Insubria, Varese, Italy.
Int Forum Allergy Rhinol. 2016 Feb;6(2):156-61. doi: 10.1002/alr.21645. Epub 2015 Dec 1.
Endoscopic orbital surgery represents the next frontier in endonasal surgery. The current literature is largely composed of small, heterogeneous, case series with little consensus regarding optimal techniques. The purpose of this study was to combine the experience of multiple international centers to create a composite of the global experience on the endoscopic management of a single type of tumor, the orbital cavernous hemangioma (OCH).
This was a retrospective study of techniques for endoscopic OCH resection from 6 centers on 3 continents. Only primary data from strictly endoscopic resection of OCHs were included. Responses were analyzed to qualitatively identify points of both consensus and variability among the different groups.
Data for a total of 23 patients, 10 (43.5%) male and 13 (56.5%) female were collected. The majority of lesions were intraconal (60.9%). The mean ± standard deviation (SD) surgical time was 150.7 ± 75.0 minutes with a mean blood loss of 82.7 ± 49.6 mL. Binarial approaches (26.1%) were used exclusively in the setting of intraconal lesions, which were associated with a higher rate of incomplete resection (31.3%), postoperative diplopia (25.0%), and the need for reconstruction (37.5%) than extraconal lesions. Orthotropia and symmetric orbital appearance were achieved in 60.9% and 78.3% of cases, respectively.
Extraconal lesions were managed similarly; however, greater variability was evident for intraconal lesions. These included the laterality and number of hands in the approach, methods of medial rectus retraction, and the need for reconstruction. The increased technical complexity and disparity of techniques in addressing intraconal OCHs suggests that continued research into the optimal management of this subclass of lesions is of significant priority.
内镜眶内手术代表了经鼻内镜手术的下一个前沿领域。目前的文献主要由小型、异质的病例系列组成，对于最佳技术几乎没有共识。本研究的目的是结合多个国际中心的经验，对单一类型肿瘤（眶海绵状血管瘤[OCH]）的内镜管理全球经验进行综合分析。
这是一项回顾性研究，研究了来自六大洲的 6 个中心对 OCH 内镜切除术的技术。仅包括严格行 OCH 内镜切除术的原始数据。对回复进行了分析，以定性确定不同组之间的共识和变异性点。
共收集了 23 例患者的数据，其中 10 例（43.5%）为男性，13 例（56.5%）为女性。大多数病变位于眶内（60.9%）。平均手术时间±标准差（SD）为 150.7±75.0 分钟，平均出血量为 82.7±49.6mL。双入路（26.1%）仅用于眶内病变，其不完全切除率（31.3%）、术后复视（25.0%）和重建需求（37.5%）较高，而眶外型病变则无。60.9%的患者眼位正，78.3%的患者眶形对称。
眶外型病变的处理方式相似；然而，眶内病变的处理方式存在更大的差异。这些差异包括手术入路的侧别和手的数量、内直肌牵拉的方法以及重建的需求。处理眶内 OCH 时，技术复杂性和技术方法的差异较大，表明对这一类病变的最佳管理方法进行持续研究具有重要的优先级。
