Department of Ophthalmology, Rhode Island Hospital, the Warren Alpert School of Medicine, Brown University, Providence, USA.
Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, Boston, USA.
Orbit. 2021 Dec;40(6):536-542. doi: 10.1080/01676830.2020.1832123. Epub 2020 Oct 12.
To describe a surgical approach for the resection of schwannomas occurring in the medial aspect of the orbit and to review a series of patients who underwent this novel technique.
This retrospective, non-comparative case series presents the surgical technique and outcomes of patients who underwent removal of a medial orbital schwannoma via an endoscopic endonasal approach combined with a small-incision medial orbitotomy by a team of two surgeons (BSB and SKF). Patient demographics, pre- and post-operative clinical examination findings, visual field testing, and radiographic studies were reviewed. Operative reports were reviewed for technical details and complications.
The patients included a 12 year-old male, 73 year-old female and 8 year-old male. Indications for surgery included: decreased visual acuity, diplopia, proptosis and Humphrey visual field (HVF) deficit, in the presence of a medial orbital biopsy-proven schwannoma. The surgical approach in all three patients was primarily endoscopic endonasal. Additionally, two had transcaruncular orbitotomies and one had a small-incision medial lid crease orbitotomy to assist with lateral tumor dissection. Tumor resection was complete in one case and near-total in two cases. There were no intra-operative surgical complications. Average resected specimen volume was 3.41 cm ± 2.20. All patients had post-operative improvement in visual acuity (VA) and proptosis. Post-operative follow-up intervals were 27.5 months, 12.3 months and 3.5 months, respectively.
Resection of orbital schwannomas using an endoscopic endonasal approach with small-incision medial transorbital assistance is a safe and effective option for a multidisciplinary surgical team.
描述一种用于切除发生在眼眶内侧的神经鞘瘤的手术入路，并回顾一组接受这种新手术技术的患者。
本回顾性、非对照病例系列研究介绍了由两位外科医生（BSB 和 SKF）团队通过内镜经鼻入路联合小切口内侧眶切开术切除内侧眶神经鞘瘤的手术技术和患者结果。回顾了患者的人口统计学资料、术前和术后临床检查结果、视野测试和影像学研究。回顾手术报告以了解技术细节和并发症。
患者包括 1 名 12 岁男性、1 名 73 岁女性和 1 名 8 岁男性。手术指征包括：存在内侧眶活检证实的神经鞘瘤，伴有视力下降、复视、眼球突出和 Humphrey 视野（HVF）缺损。所有三名患者的手术入路均主要为内镜经鼻入路。此外，两名患者行经泪阜眶切开术，一名患者行小切口内侧睑缘皱襞眶切开术，以协助外侧肿瘤分离。1 例肿瘤完全切除，2 例近全切除。术中无手术并发症。平均切除标本体积为 3.41 cm ± 2.20。所有患者术后视力（VA）和眼球突出均有改善。术后随访时间分别为 27.5 个月、12.3 个月和 3.5 个月。
对于多学科手术团队，使用内镜经鼻入路联合小切口内侧经眶辅助切除眼眶神经鞘瘤是一种安全有效的选择。
