Resection of an Orbital Apex Cavernous Hemangioma Adhering to the Oculomotor Nerve via Five-Hand Endonasal and Transcaruncular Approaches.

A 43-year-old male presented with marked loss of visual acuity in the left eye during a two-year follow-up for a cavernous hemangioma located in the inferomedial orbital apex. A four-handed endonasal and transcaruncular orbital tumor resection was planned and carried out under general anesthesia. During the surgery, the oculomotor nerve branch was found to be firmly adherent to the tumor. To facilitate safe dissection, an additional surgeon provided a fifth hand by inserting a cotton swab and seeker through the nose, enabling precise separation of the oculomotor nerve branch from the tumor. A complete excision of the tumor was achieved, leading to full recovery of visual acuity and no paralysis of the medial rectus muscle at the six-month follow-up. This case highlights the effectiveness of a five-handed endonasal and transcaruncular approach for resection of orbital apex tumors.