Endoscopic approaches to the orbit: Transnasal and transorbital, a retrospective case series

Cesare Zoia; Eugenia Maiorano; Sara Borromeo; Giorgio Mantovani; Giannantonio Spena; Fabio Pagella

doi:10.1016/j.bas.2024.102770

Endoscopic approaches to the orbit: Transnasal and transorbital, a retrospective case series

Brain Spine. 2024 Feb 19:4:102770. doi: 10.1016/j.bas.2024.102770. eCollection 2024.

Authors

Cesare Zoia¹, Eugenia Maiorano^{2

3}, Sara Borromeo³, Giorgio Mantovani⁴, Giannantonio Spena⁵, Fabio Pagella^{2

3}

Affiliations

¹ Neurosurgery Unit, Moriggia Pelascini Hospital, Gravedona e Uniti, Italy.
² Department of Surgical Science, University of Pavia, Pavia, Italy.
³ Department of Otorhinolaryngology, Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy.
⁴ Neurosurgery Unit, Department of Translational Medicine, University of Ferrara, Ferrara, Italy.
⁵ Neurosurgery Unit, Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy.

Abstract

Introduction: Orbital pathologies requiring surgery are traditionally treated by open approach with different techniques depending on the lesion location. Recently, minimally invasive endoscopic approaches, such as the Endoscopic Endonasal Approach (EEA) and the Endoscopic Transorbital Approach (ETA) have been introduced in orbital surgery.

Research question: The purpose of this study is to report the combined experience of the Neurosurgical and Ear-Nose-Throat (ENT) Units in the endoscopic approach of orbital pathologies.

Material and methods: We retrospectively retrieved data on patients treated at our Institution between 2016 and 2021 with endoscopic approach for orbital pathologies. The Clavien-Dindo classification and the Scar Cosmesis Assessment and Rating (SCAR) Scale have been used to assess complications and cosmetic outcomes.

Results: 39 patients met the inclusion criteria. EEA (15 patients) or ETA (20 patients) were chosen to approach the lesions. In three cases we used a combination of endoscopic and anterior orbitotomy and in one patient a combination of EEA + ETA. The type of procedure performed was orbital biopsy (9 cases), orbital decompression (6 cases), subtotal resection of the lesion (STR) (8 cases) and total resection of the lesion (GTR) (16 cases). The more frequent postoperative complications were diplopia (5.1%, with 1 case of permanent diplopia), trigeminal paraesthesia and dysesthesia (5.1%), palpebral edema (17.9%), periorbital ecchymosis (7.7%). Mean follow up time was 21 months (range 2-63 months).

Discussion and conclusion: Endoscopic approaches to orbital compartments provide minimally invasive access to every orbital compartment with low complications rate and good cosmetic outcome.

Keywords: Endoscopy; Orbital surgery; Skull base; Transnasal; Transorbital.