Eye Department, Eye and Skull Base Research Center, The Five Senses Institute, Iran University of Medical Science, Tehran, Iran.
Ophthalmic Plast Reconstr Surg. 2020 Sep/Oct;36(5):508-511. doi: 10.1097/IOP.0000000000001661.
To demonstrate the technique and report the results of endoscopic-assisted lateral orbitotomy for 6 patients with huge intraorbital dermoid cyst causing orbital roof bone erosion and dural invasion.
Patients had unilateral cystic tumor with proptosis and hypoglobus for more than 6 months. There was no compressive optic neuropathy. Lateral orbitotomy procedure was performed from 2004 to 2016 by 1 surgeon. Cysts were dissected, and fluid content was aspirated to reduce the size. Solid contents were then suctioned, its cavity was repeatedly irrigated, and orbital part of epithelial lining was removed. The remained epithelial lining and keratinized content at the orbital roof (abutting the dura) were removed using the rigid endoscope lenses (4 mm, 0° and 30°) and curettage. Orbital tissue was pulled away from the roof (inferior) by an assistant surgeon to make a space for introducing the lens and curette. The surgical field was frequently irrigated. No orbital drain was used, and all the patients were discharged on the same day after 8-10 hours of observation. Skin sutures were removed 1 week later.
They were 4 men and 2 women with age range of 19-48 years. A large superolateral orbital tumor with roof erosion and dural invasion was observed on imaging. Procedures were performed uneventfully. Dermoid was the pathological diagnosis. While one patient lost to follow up after 1 week, others had 6-18 months follow-up time with no recurrence.
Endoscopic-assisted lateral orbitotomy approach provided a good field of view, illumination, and magnification to totally remove all the content and epithelial lining of very large orbital roof dermoid cysts with dural invasion.
展示内镜辅助外侧眶切开术治疗 6 例巨大眶内皮样囊肿的技术，并报告结果，这些囊肿导致眶顶骨侵蚀和硬脑膜侵犯。
患者均为单侧囊性肿瘤伴眼球突出和眼球下移位超过 6 个月，无压迫性视神经病变。外侧眶切开术由 1 名外科医生于 2004 年至 2016 年进行。切开囊肿，吸出囊内容物以缩小体积。然后抽吸实性内容物，反复冲洗囊腔，去除眼内部分上皮衬里。使用硬性内镜镜头（4mm、0°和 30°）和刮匙去除剩余的上皮衬里和位于眶顶（毗邻硬脑膜）的角化内容物。助手将眶组织从顶（下）部拉开，为引入镜头和刮匙留出空间。手术视野频繁冲洗。未使用眶内引流管，所有患者观察 8-10 小时后于当天出院。1 周后拆除皮肤缝线。
患者为 4 男 2 女，年龄 19-48 岁。影像学检查显示，眶外侧有一个大的肿瘤，伴有顶骨侵蚀和硬脑膜侵犯。手术过程顺利。病理诊断为皮样囊肿。1 例患者在 1 周后失访，其余患者随访 6-18 个月无复发。
内镜辅助外侧眶切开术提供了良好的视野、照明和放大效果，可彻底清除所有内容物和有硬脑膜侵犯的巨大眶顶皮样囊肿的上皮衬里。
